|
BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 15823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,075.40
|
| Rate for Payer: BCN Commercial |
$2,075.40
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT
|
Facility
|
OP
|
$24,778.95
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
173348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$22,301.06 |
| Rate for Payer: Aetna American Axle |
$16,106.32
|
| Rate for Payer: Aetna Commercial |
$21,062.11
|
| Rate for Payer: Aetna Medicare |
$170.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,106.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.95
|
| Rate for Payer: BCBS Complete |
$90.05
|
| Rate for Payer: BCBS MAPPO |
$163.96
|
| Rate for Payer: BCBS Trust/PPO |
$530.76
|
| Rate for Payer: BCN Commercial |
$530.76
|
| Rate for Payer: BCN Medicare Advantage |
$163.96
|
| Rate for Payer: Cash Price |
$19,823.16
|
| Rate for Payer: Cash Price |
$19,823.16
|
| Rate for Payer: Cofinity Advantage |
$17,345.26
|
| Rate for Payer: Cofinity Commercial |
$21,309.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,823.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.96
|
| Rate for Payer: Healthscope Commercial |
$22,301.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,345.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,584.21
|
| Rate for Payer: Mclaren Medicaid |
$163.96
|
| Rate for Payer: Mclaren Medicare |
$163.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.16
|
| Rate for Payer: Meridian Medicaid |
$172.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$180.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,062.11
|
| Rate for Payer: Nomi Health Commercial |
$491.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,584.21
|
| Rate for Payer: PACE Medicare |
$155.76
|
| Rate for Payer: PACE SWMI |
$163.96
|
| Rate for Payer: PHP Commercial |
$21,062.11
|
| Rate for Payer: PHP Medicare Advantage |
$163.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$518.05
|
| Rate for Payer: Priority Health Medicare |
$163.96
|
| Rate for Payer: Priority Health SBD |
$15,610.74
|
| Rate for Payer: Priority Health Tiered Network |
$414.44
|
| Rate for Payer: Railroad Medicare Medicare |
$163.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.07
|
| Rate for Payer: UHC Core |
$270.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.96
|
| Rate for Payer: UHC Exchange |
$270.07
|
| Rate for Payer: UHC Medicaid |
$85.75
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: UMR Bronson Commercial |
$9,168.21
|
| Rate for Payer: VA VA |
$163.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,584.21
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS KIT
|
Facility
|
IP
|
$24,778.95
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
173348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,902.74 |
| Max. Negotiated Rate |
$22,301.06 |
| Rate for Payer: Aetna American Axle |
$16,106.32
|
| Rate for Payer: Aetna Commercial |
$21,062.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,106.32
|
| Rate for Payer: Cash Price |
$19,823.16
|
| Rate for Payer: Cofinity Advantage |
$17,345.26
|
| Rate for Payer: Cofinity Commercial |
$21,309.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,823.16
|
| Rate for Payer: Healthscope Commercial |
$22,301.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,345.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,584.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,062.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,584.21
|
| Rate for Payer: PHP Commercial |
$21,062.11
|
| Rate for Payer: Priority Health SBD |
$15,610.74
|
| Rate for Payer: UMR Bronson Commercial |
$10,902.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,584.21
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,778.96
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
183575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,902.74 |
| Max. Negotiated Rate |
$22,301.06 |
| Rate for Payer: Aetna American Axle |
$16,106.32
|
| Rate for Payer: Aetna Commercial |
$21,062.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,106.32
|
| Rate for Payer: Cash Price |
$19,823.17
|
| Rate for Payer: Cofinity Advantage |
$17,345.27
|
| Rate for Payer: Cofinity Commercial |
$21,309.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,823.17
|
| Rate for Payer: Healthscope Commercial |
$22,301.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,345.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,584.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,062.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,584.22
|
| Rate for Payer: PHP Commercial |
$21,062.12
|
| Rate for Payer: Priority Health SBD |
$15,610.74
|
| Rate for Payer: UMR Bronson Commercial |
$10,902.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,584.22
|
|
|
BLINATUMOMAB 35 MCG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,778.96
|
|
|
Service Code
|
HCPCS J9039
|
| Hospital Charge Code |
183575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$22,301.06 |
| Rate for Payer: Aetna American Axle |
$16,106.32
|
| Rate for Payer: Aetna Commercial |
$21,062.12
|
| Rate for Payer: Aetna Medicare |
$170.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,106.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.95
|
| Rate for Payer: BCBS Complete |
$90.05
|
| Rate for Payer: BCBS MAPPO |
$163.96
|
| Rate for Payer: BCBS Trust/PPO |
$530.76
|
| Rate for Payer: BCN Commercial |
$530.76
|
| Rate for Payer: BCN Medicare Advantage |
$163.96
|
| Rate for Payer: Cash Price |
$19,823.17
|
| Rate for Payer: Cash Price |
$19,823.17
|
| Rate for Payer: Cofinity Advantage |
$17,345.27
|
| Rate for Payer: Cofinity Commercial |
$21,309.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,823.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.96
|
| Rate for Payer: Healthscope Commercial |
$22,301.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,345.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,584.22
|
| Rate for Payer: Mclaren Medicaid |
$163.96
|
| Rate for Payer: Mclaren Medicare |
$163.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.16
|
| Rate for Payer: Meridian Medicaid |
$172.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$180.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,062.12
|
| Rate for Payer: Nomi Health Commercial |
$491.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,584.22
|
| Rate for Payer: PACE Medicare |
$155.76
|
| Rate for Payer: PACE SWMI |
$163.96
|
| Rate for Payer: PHP Commercial |
$21,062.12
|
| Rate for Payer: PHP Medicare Advantage |
$163.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$518.05
|
| Rate for Payer: Priority Health Medicare |
$163.96
|
| Rate for Payer: Priority Health SBD |
$15,610.74
|
| Rate for Payer: Priority Health Tiered Network |
$414.44
|
| Rate for Payer: Railroad Medicare Medicare |
$163.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.07
|
| Rate for Payer: UHC Core |
$270.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.96
|
| Rate for Payer: UHC Exchange |
$270.07
|
| Rate for Payer: UHC Medicaid |
$85.75
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: UMR Bronson Commercial |
$9,168.22
|
| Rate for Payer: VA VA |
$163.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,584.22
|
|
|
BLUE FOOD COLOR (BULK) LIQUID
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 51927100600
|
| Hospital Charge Code |
161587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
BLUE FOOD COLOR (BULK) LIQUID
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 51927100600
|
| Hospital Charge Code |
161587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$2.47
|
| Rate for Payer: UHC Exchange |
$1.87
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
BONE DISEASES AND ARTHROPATHIES WITH MCC
|
Facility
|
IP
|
$25,913.74
|
|
|
Service Code
|
MSDRG 553
|
| Min. Negotiated Rate |
$10,861.85 |
| Max. Negotiated Rate |
$25,913.74 |
| Rate for Payer: Aetna Medicare |
$11,890.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,291.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,291.91
|
| Rate for Payer: BCBS MAPPO |
$11,433.53
|
| Rate for Payer: BCBS Trust/PPO |
$25,913.74
|
| Rate for Payer: BCN Commercial |
$25,913.74
|
| Rate for Payer: BCN Medicare Advantage |
$11,433.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,433.53
|
| Rate for Payer: Mclaren Medicare |
$11,433.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,005.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,148.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,576.88
|
| Rate for Payer: Nomi Health Commercial |
$16,722.27
|
| Rate for Payer: PACE Medicare |
$10,861.85
|
| Rate for Payer: PACE SWMI |
$11,433.53
|
| Rate for Payer: PHP Medicare Advantage |
$11,433.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,899.13
|
| Rate for Payer: Priority Health Medicare |
$11,433.53
|
| Rate for Payer: Priority Health Tiered Network |
$16,719.30
|
| Rate for Payer: Railroad Medicare Medicare |
$11,433.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,129.69
|
| Rate for Payer: UHC Core |
$17,677.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,433.53
|
| Rate for Payer: UHC Exchange |
$14,436.89
|
| Rate for Payer: VA VA |
$11,433.53
|
|
|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
|
IP
|
$16,445.89
|
|
|
Service Code
|
MSDRG 554
|
| Min. Negotiated Rate |
$7,158.11 |
| Max. Negotiated Rate |
$16,445.89 |
| Rate for Payer: Aetna Medicare |
$7,836.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,418.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,418.56
|
| Rate for Payer: BCBS MAPPO |
$7,534.85
|
| Rate for Payer: BCBS Trust/PPO |
$16,445.89
|
| Rate for Payer: BCN Commercial |
$16,445.89
|
| Rate for Payer: BCN Medicare Advantage |
$7,534.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,534.85
|
| Rate for Payer: Mclaren Medicare |
$7,534.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,911.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,665.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,288.33
|
| Rate for Payer: Nomi Health Commercial |
$10,708.29
|
| Rate for Payer: PACE Medicare |
$7,158.11
|
| Rate for Payer: PACE SWMI |
$7,534.85
|
| Rate for Payer: PHP Medicare Advantage |
$7,534.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,382.99
|
| Rate for Payer: Priority Health Medicare |
$7,534.85
|
| Rate for Payer: Priority Health Tiered Network |
$10,706.39
|
| Rate for Payer: Railroad Medicare Medicare |
$7,534.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,530.63
|
| Rate for Payer: UHC Core |
$11,320.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,534.85
|
| Rate for Payer: UHC Exchange |
$9,244.82
|
| Rate for Payer: VA VA |
$7,534.85
|
|
|
BONE GRAFT, ANY DONOR AREA; MAJOR OR LARGE
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 20902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$5,816.50
|
| Rate for Payer: BCN Commercial |
$5,816.50
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
BONE GRAFT, ANY DONOR AREA; MINOR OR SMALL (EG, DOWEL OR BUTTON)
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 20900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$5,724.74
|
| Rate for Payer: BCN Commercial |
$5,724.74
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
BONE MARROW ASPIRATION FOR BONE GRAFTING, SPINE SURGERY ONLY, THROUGH SEPARATE SKIN OR FASCIAL INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$296.14
|
|
|
Service Code
|
CPT 20939
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$296.14 |
| Max. Negotiated Rate |
$296.14 |
| Rate for Payer: BCBS Trust/PPO |
$296.14
|
| Rate for Payer: BCN Commercial |
$296.14
|
|
|
BORIC ACID (BULK) POWDER
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
NDC 00395030396
|
| Hospital Charge Code |
1131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.67
|
| Rate for Payer: UHC Core |
$47.83
|
| Rate for Payer: UHC Exchange |
$36.08
|
| Rate for Payer: UMR Bronson Commercial |
$33.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
BORIC ACID (BULK) POWDER
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
NDC 00395030396
|
| Hospital Charge Code |
1131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UMR Bronson Commercial |
$40.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
BORTEZOMIB 2.5 MG/ML SUBCUTANEOUS INJECTION
|
Facility
|
OP
|
$323.60
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
151057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$291.24 |
| Rate for Payer: Aetna American Axle |
$210.34
|
| Rate for Payer: Aetna American Axle |
$101.14
|
| Rate for Payer: Aetna American Axle |
$129.11
|
| Rate for Payer: Aetna American Axle |
$4,678.36
|
| Rate for Payer: Aetna Commercial |
$168.84
|
| Rate for Payer: Aetna Commercial |
$132.26
|
| Rate for Payer: Aetna Commercial |
$275.06
|
| Rate for Payer: Aetna Commercial |
$6,117.85
|
| Rate for Payer: Aetna Medicare |
$3,598.74
|
| Rate for Payer: Aetna Medicare |
$161.80
|
| Rate for Payer: Aetna Medicare |
$77.80
|
| Rate for Payer: Aetna Medicare |
$99.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.11
|
| Rate for Payer: BCBS Complete |
$2,878.99
|
| Rate for Payer: BCBS Complete |
$79.45
|
| Rate for Payer: BCBS Complete |
$62.24
|
| Rate for Payer: BCBS Complete |
$129.44
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cash Price |
$124.48
|
| Rate for Payer: Cash Price |
$258.88
|
| Rate for Payer: Cash Price |
$124.48
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cash Price |
$258.88
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cofinity Advantage |
$5,038.23
|
| Rate for Payer: Cofinity Advantage |
$139.04
|
| Rate for Payer: Cofinity Advantage |
$108.92
|
| Rate for Payer: Cofinity Advantage |
$226.52
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$133.82
|
| Rate for Payer: Cofinity Commercial |
$170.82
|
| Rate for Payer: Cofinity Commercial |
$278.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,757.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.90
|
| Rate for Payer: Healthscope Commercial |
$140.04
|
| Rate for Payer: Healthscope Commercial |
$178.77
|
| Rate for Payer: Healthscope Commercial |
$6,477.72
|
| Rate for Payer: Healthscope Commercial |
$291.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,038.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,398.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,757.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,117.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,398.10
|
| Rate for Payer: PHP Commercial |
$275.06
|
| Rate for Payer: PHP Commercial |
$132.26
|
| Rate for Payer: PHP Commercial |
$168.84
|
| Rate for Payer: PHP Commercial |
$6,117.85
|
| Rate for Payer: Priority Health SBD |
$98.03
|
| Rate for Payer: Priority Health SBD |
$203.87
|
| Rate for Payer: Priority Health SBD |
$125.14
|
| Rate for Payer: Priority Health SBD |
$4,534.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UMR Bronson Commercial |
$73.49
|
| Rate for Payer: UMR Bronson Commercial |
$57.57
|
| Rate for Payer: UMR Bronson Commercial |
$2,663.06
|
| Rate for Payer: UMR Bronson Commercial |
$119.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,398.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.70
|
|
|
BORTEZOMIB 2.5 MG/ML SUBCUTANEOUS INJECTION
|
Facility
|
IP
|
$7,197.47
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
151057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,166.89 |
| Max. Negotiated Rate |
$6,477.72 |
| Rate for Payer: Aetna American Axle |
$4,678.36
|
| Rate for Payer: Aetna Commercial |
$6,117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.36
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cofinity Advantage |
$5,038.23
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,757.98
|
| Rate for Payer: Healthscope Commercial |
$6,477.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,038.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,398.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,398.10
|
| Rate for Payer: PHP Commercial |
$6,117.85
|
| Rate for Payer: Priority Health SBD |
$4,534.41
|
| Rate for Payer: UMR Bronson Commercial |
$3,166.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,398.10
|
|
|
BORTEZOMIB 3.5 MG/3.5ML INJECTION SOL (WET VIAL)
|
Facility
|
OP
|
$419.43
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
4083583902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$377.49 |
| Rate for Payer: Aetna American Axle |
$272.63
|
| Rate for Payer: Aetna American Axle |
$101.14
|
| Rate for Payer: Aetna American Axle |
$210.34
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$129.11
|
| Rate for Payer: Aetna American Axle |
$604.50
|
| Rate for Payer: Aetna American Axle |
$4,678.36
|
| Rate for Payer: Aetna Commercial |
$790.50
|
| Rate for Payer: Aetna Commercial |
$132.26
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$275.06
|
| Rate for Payer: Aetna Commercial |
$356.52
|
| Rate for Payer: Aetna Commercial |
$168.84
|
| Rate for Payer: Aetna Commercial |
$6,117.85
|
| Rate for Payer: Aetna Medicare |
$77.80
|
| Rate for Payer: Aetna Medicare |
$465.00
|
| Rate for Payer: Aetna Medicare |
$209.72
|
| Rate for Payer: Aetna Medicare |
$3,598.74
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna Medicare |
$99.31
|
| Rate for Payer: Aetna Medicare |
$161.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.36
|
| Rate for Payer: BCBS Complete |
$79.45
|
| Rate for Payer: BCBS Complete |
$372.00
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Complete |
$167.77
|
| Rate for Payer: BCBS Complete |
$2,878.99
|
| Rate for Payer: BCBS Complete |
$62.24
|
| Rate for Payer: BCBS Complete |
$129.44
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: Cash Price |
$258.88
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$124.48
|
| Rate for Payer: Cash Price |
$335.54
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cash Price |
$124.48
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cash Price |
$335.54
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cash Price |
$258.88
|
| Rate for Payer: Cofinity Advantage |
$233.55
|
| Rate for Payer: Cofinity Advantage |
$226.52
|
| Rate for Payer: Cofinity Advantage |
$139.04
|
| Rate for Payer: Cofinity Advantage |
$108.92
|
| Rate for Payer: Cofinity Advantage |
$293.60
|
| Rate for Payer: Cofinity Advantage |
$5,038.23
|
| Rate for Payer: Cofinity Advantage |
$651.00
|
| Rate for Payer: Cofinity Commercial |
$360.71
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$799.80
|
| Rate for Payer: Cofinity Commercial |
$133.82
|
| Rate for Payer: Cofinity Commercial |
$170.82
|
| Rate for Payer: Cofinity Commercial |
$278.30
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,757.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$744.00
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$6,477.72
|
| Rate for Payer: Healthscope Commercial |
$837.00
|
| Rate for Payer: Healthscope Commercial |
$377.49
|
| Rate for Payer: Healthscope Commercial |
$178.77
|
| Rate for Payer: Healthscope Commercial |
$140.04
|
| Rate for Payer: Healthscope Commercial |
$291.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$651.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,038.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,398.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$697.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$744.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,757.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$335.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,117.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$697.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,398.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.70
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$275.06
|
| Rate for Payer: PHP Commercial |
$132.26
|
| Rate for Payer: PHP Commercial |
$168.84
|
| Rate for Payer: PHP Commercial |
$356.52
|
| Rate for Payer: PHP Commercial |
$6,117.85
|
| Rate for Payer: PHP Commercial |
$790.50
|
| Rate for Payer: Priority Health SBD |
$4,534.41
|
| Rate for Payer: Priority Health SBD |
$203.87
|
| Rate for Payer: Priority Health SBD |
$264.24
|
| Rate for Payer: Priority Health SBD |
$585.90
|
| Rate for Payer: Priority Health SBD |
$125.14
|
| Rate for Payer: Priority Health SBD |
$98.03
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Core |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UHC Exchange |
$4.42
|
| Rate for Payer: UMR Bronson Commercial |
$119.73
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$73.49
|
| Rate for Payer: UMR Bronson Commercial |
$57.57
|
| Rate for Payer: UMR Bronson Commercial |
$344.10
|
| Rate for Payer: UMR Bronson Commercial |
$2,663.06
|
| Rate for Payer: UMR Bronson Commercial |
$155.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$697.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,398.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
|
|
BORTEZOMIB 3.5 MG/3.5ML INJECTION SOL (WET VIAL)
|
Facility
|
IP
|
$333.64
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
4083583902
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$300.28 |
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$210.34
|
| Rate for Payer: Aetna American Axle |
$4,678.36
|
| Rate for Payer: Aetna American Axle |
$129.11
|
| Rate for Payer: Aetna American Axle |
$101.14
|
| Rate for Payer: Aetna Commercial |
$132.26
|
| Rate for Payer: Aetna Commercial |
$275.06
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$6,117.85
|
| Rate for Payer: Aetna Commercial |
$168.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.36
|
| Rate for Payer: Cash Price |
$258.88
|
| Rate for Payer: Cash Price |
$158.90
|
| Rate for Payer: Cash Price |
$5,757.98
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$124.48
|
| Rate for Payer: Cofinity Advantage |
$108.92
|
| Rate for Payer: Cofinity Advantage |
$5,038.23
|
| Rate for Payer: Cofinity Advantage |
$139.04
|
| Rate for Payer: Cofinity Advantage |
$233.55
|
| Rate for Payer: Cofinity Advantage |
$226.52
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$133.82
|
| Rate for Payer: Cofinity Commercial |
$170.82
|
| Rate for Payer: Cofinity Commercial |
$278.30
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,757.98
|
| Rate for Payer: Healthscope Commercial |
$140.04
|
| Rate for Payer: Healthscope Commercial |
$178.77
|
| Rate for Payer: Healthscope Commercial |
$291.24
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$6,477.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,038.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,398.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,398.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.23
|
| Rate for Payer: PHP Commercial |
$275.06
|
| Rate for Payer: PHP Commercial |
$132.26
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$6,117.85
|
| Rate for Payer: PHP Commercial |
$168.84
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$4,534.41
|
| Rate for Payer: Priority Health SBD |
$125.14
|
| Rate for Payer: Priority Health SBD |
$98.03
|
| Rate for Payer: Priority Health SBD |
$203.87
|
| Rate for Payer: UMR Bronson Commercial |
$87.40
|
| Rate for Payer: UMR Bronson Commercial |
$3,166.89
|
| Rate for Payer: UMR Bronson Commercial |
$142.38
|
| Rate for Payer: UMR Bronson Commercial |
$68.46
|
| Rate for Payer: UMR Bronson Commercial |
$146.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,398.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.97
|
|
|
BORTEZOMIB 3.5 MG/3.5ML INTRAVENOUS SOL (WET VIAL)
|
Facility
|
OP
|
$6,907.69
|
|
|
Service Code
|
HCPCS J9048
|
| Hospital Charge Code |
408185652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$6,216.92 |
| Rate for Payer: Aetna American Axle |
$4,490.00
|
| Rate for Payer: Aetna Commercial |
$5,871.54
|
| Rate for Payer: Aetna Medicare |
$7.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,490.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.71
|
| Rate for Payer: BCBS Complete |
$3.83
|
| Rate for Payer: BCBS MAPPO |
$6.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.66
|
| Rate for Payer: BCN Commercial |
$8.66
|
| Rate for Payer: BCN Medicare Advantage |
$6.97
|
| Rate for Payer: Cash Price |
$5,526.15
|
| Rate for Payer: Cash Price |
$5,526.15
|
| Rate for Payer: Cofinity Advantage |
$4,835.38
|
| Rate for Payer: Cofinity Commercial |
$5,940.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,526.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.97
|
| Rate for Payer: Healthscope Commercial |
$6,216.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,835.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,180.77
|
| Rate for Payer: Mclaren Medicaid |
$6.97
|
| Rate for Payer: Mclaren Medicare |
$6.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.32
|
| Rate for Payer: Meridian Medicaid |
$7.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,871.54
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,180.77
|
| Rate for Payer: PACE Medicare |
$6.62
|
| Rate for Payer: PACE SWMI |
$6.97
|
| Rate for Payer: PHP Commercial |
$5,871.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.97
|
| Rate for Payer: Priority Health Medicare |
$6.97
|
| Rate for Payer: Priority Health SBD |
$4,351.84
|
| Rate for Payer: Priority Health Tiered Network |
$17.58
|
| Rate for Payer: Railroad Medicare Medicare |
$6.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.50
|
| Rate for Payer: UHC Core |
$11.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.97
|
| Rate for Payer: UHC Exchange |
$11.50
|
| Rate for Payer: UHC Medicaid |
$3.65
|
| Rate for Payer: UHCCP Medicaid |
$3.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,555.85
|
| Rate for Payer: VA VA |
$6.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,180.77
|
|
|
BORTEZOMIB 3.5 MG/3.5ML INTRAVENOUS SOL (WET VIAL)
|
Facility
|
OP
|
$7,197.39
|
|
|
Service Code
|
HCPCS J9046
|
| Hospital Charge Code |
408185652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$6,477.65 |
| Rate for Payer: Aetna American Axle |
$4,678.30
|
| Rate for Payer: Aetna Commercial |
$6,117.78
|
| Rate for Payer: Aetna Medicare |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.33
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$3.46
|
| Rate for Payer: BCBS Trust/PPO |
$28.04
|
| Rate for Payer: BCN Commercial |
$28.04
|
| Rate for Payer: BCN Medicare Advantage |
$3.46
|
| Rate for Payer: Cash Price |
$5,757.91
|
| Rate for Payer: Cash Price |
$5,757.91
|
| Rate for Payer: Cofinity Advantage |
$5,038.17
|
| Rate for Payer: Cofinity Commercial |
$6,189.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,757.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$6,477.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,038.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,398.04
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicare |
$3.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.63
|
| Rate for Payer: Meridian Medicaid |
$3.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,117.78
|
| Rate for Payer: Nomi Health Commercial |
$10.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,398.04
|
| Rate for Payer: PACE Medicare |
$3.29
|
| Rate for Payer: PACE SWMI |
$3.46
|
| Rate for Payer: PHP Commercial |
$6,117.78
|
| Rate for Payer: PHP Medicare Advantage |
$3.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.90
|
| Rate for Payer: Priority Health Medicare |
$3.46
|
| Rate for Payer: Priority Health SBD |
$4,534.36
|
| Rate for Payer: Priority Health Tiered Network |
$8.72
|
| Rate for Payer: Railroad Medicare Medicare |
$3.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.71
|
| Rate for Payer: UHC Core |
$5.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.46
|
| Rate for Payer: UHC Exchange |
$5.71
|
| Rate for Payer: UHC Medicaid |
$1.81
|
| Rate for Payer: UHCCP Medicaid |
$1.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,663.03
|
| Rate for Payer: VA VA |
$3.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,398.04
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$10,057.47
|
|
|
Service Code
|
APR-DRG 1324
|
| Min. Negotiated Rate |
$9,578.55 |
| Max. Negotiated Rate |
$10,057.47 |
| Rate for Payer: BCBS Complete |
$10,057.47
|
| Rate for Payer: Mclaren Medicaid |
$9,578.55
|
| Rate for Payer: Meridian Medicaid |
$10,057.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,578.55
|
| Rate for Payer: UHC Medicaid |
$9,578.55
|
| Rate for Payer: UHCCP Medicaid |
$9,578.55
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$3,491.51
|
|
|
Service Code
|
APR-DRG 1321
|
| Min. Negotiated Rate |
$3,325.25 |
| Max. Negotiated Rate |
$3,491.51 |
| Rate for Payer: BCBS Complete |
$3,491.51
|
| Rate for Payer: Mclaren Medicaid |
$3,325.25
|
| Rate for Payer: Meridian Medicaid |
$3,491.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,325.25
|
| Rate for Payer: UHC Medicaid |
$3,325.25
|
| Rate for Payer: UHCCP Medicaid |
$3,325.25
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$4,825.05
|
|
|
Service Code
|
APR-DRG 1322
|
| Min. Negotiated Rate |
$4,595.28 |
| Max. Negotiated Rate |
$4,825.05 |
| Rate for Payer: BCBS Complete |
$4,825.05
|
| Rate for Payer: Mclaren Medicaid |
$4,595.28
|
| Rate for Payer: Meridian Medicaid |
$4,825.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,595.28
|
| Rate for Payer: UHC Medicaid |
$4,595.28
|
| Rate for Payer: UHCCP Medicaid |
$4,595.28
|
|
|
BPD AND OTHER CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD
|
Facility
|
IP
|
$8,076.25
|
|
|
Service Code
|
APR-DRG 1323
|
| Min. Negotiated Rate |
$7,691.66 |
| Max. Negotiated Rate |
$8,076.25 |
| Rate for Payer: BCBS Complete |
$8,076.25
|
| Rate for Payer: Mclaren Medicaid |
$7,691.66
|
| Rate for Payer: Meridian Medicaid |
$8,076.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,691.66
|
| Rate for Payer: UHC Medicaid |
$7,691.66
|
| Rate for Payer: UHCCP Medicaid |
$7,691.66
|
|
|
BREAST AUGMENTATION WITH IMPLANT
|
Facility
|
OP
|
$26,336.97
|
|
|
Service Code
|
CPT 19325
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,259.31 |
| Max. Negotiated Rate |
$26,336.97 |
| Rate for Payer: Aetna Medicare |
$8,469.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,180.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,180.00
|
| Rate for Payer: BCBS Complete |
$4,472.68
|
| Rate for Payer: BCBS MAPPO |
$8,144.00
|
| Rate for Payer: BCBS Trust/PPO |
$6,991.30
|
| Rate for Payer: BCN Commercial |
$6,991.30
|
| Rate for Payer: BCN Medicare Advantage |
$8,144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,144.00
|
| Rate for Payer: Mclaren Medicaid |
$8,144.00
|
| Rate for Payer: Mclaren Medicare |
$8,144.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,551.20
|
| Rate for Payer: Meridian Medicaid |
$8,551.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,365.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,958.40
|
| Rate for Payer: Nomi Health Commercial |
$24,432.00
|
| Rate for Payer: PACE Medicare |
$7,736.80
|
| Rate for Payer: PACE SWMI |
$8,144.00
|
| Rate for Payer: PHP Medicare Advantage |
$8,144.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,259.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,336.97
|
| Rate for Payer: Priority Health Medicare |
$8,144.00
|
| Rate for Payer: Priority Health Tiered Network |
$21,069.58
|
| Rate for Payer: Railroad Medicare Medicare |
$8,144.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,144.00
|
| Rate for Payer: UHC Medicaid |
$4,259.31
|
| Rate for Payer: UHCCP Medicaid |
$4,259.31
|
| Rate for Payer: VA VA |
$8,144.00
|
|
