|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 0338-0357-02
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Aetna American Axle |
$61.70
|
| Rate for Payer: Aetna Commercial |
$80.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.70
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$66.44
|
| Rate for Payer: Cofinity Commercial |
$81.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$85.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.68
|
| Rate for Payer: PHP Commercial |
$80.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.44
|
| Rate for Payer: Priority Health SBD |
$59.80
|
| Rate for Payer: UMR Bronson Commercial |
$41.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.19
|
|
|
MANNITOL 25 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$78.96
|
|
|
Service Code
|
HCPCS J2150
|
| Hospital Charge Code |
4750
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.74 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Aetna American Axle |
$51.32
|
| Rate for Payer: Aetna American Axle |
$39.77
|
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Commercial |
$52.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cash Price |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Cofinity Commercial |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.94
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Healthscope Commercial |
$55.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.12
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: PHP Commercial |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.83
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: Priority Health SBD |
$38.54
|
| Rate for Payer: UMR Bronson Commercial |
$26.92
|
| Rate for Payer: UMR Bronson Commercial |
$34.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.88
|
|
|
MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 56440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.77 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,374.68
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.75
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$179.77
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
MARSUPIALIZATION OF SUBLINGUAL SALIVARY CYST (RANULA)
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 42409
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$231.17 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,396.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.29
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$231.17
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
MASTECTOMY FOR GYNECOMASTIA
|
Facility
|
OP
|
$10,666.11
|
|
|
Service Code
|
CPT 19300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$427.97 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$5,130.25
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,666.11
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,532.89
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.77
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$427.97
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: VA VA |
$3,388.17
|
|
|
MASTECTOMY FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$79,608.67
|
|
|
Service Code
|
MS-DRG 582
|
| Min. Negotiated Rate |
$13,234.32 |
| Max. Negotiated Rate |
$79,608.67 |
| Rate for Payer: Aetna Medicare |
$14,488.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,413.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,413.58
|
| Rate for Payer: BCBS MAPPO |
$13,930.86
|
| Rate for Payer: BCBS Trust/PPO |
$79,608.67
|
| Rate for Payer: BCN Medicare Advantage |
$13,930.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,930.86
|
| Rate for Payer: Mclaren Medicare |
$13,930.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,627.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,020.49
|
| Rate for Payer: PACE Medicare |
$13,234.32
|
| Rate for Payer: PACE SWMI |
$13,930.86
|
| Rate for Payer: PHP Medicare Advantage |
$13,930.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,922.75
|
| Rate for Payer: Priority Health Medicare |
$13,930.86
|
| Rate for Payer: Priority Health Narrow Network |
$19,138.20
|
| Rate for Payer: Railroad Medicare Medicare |
$13,930.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,429.94
|
| Rate for Payer: UHC Core |
$20,852.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,930.86
|
| Rate for Payer: UHC Exchange |
$16,577.64
|
| Rate for Payer: UHC Medicare Advantage |
$14,348.79
|
| Rate for Payer: VA VA |
$13,930.86
|
|
|
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$71,984.53
|
|
|
Service Code
|
MS-DRG 583
|
| Min. Negotiated Rate |
$11,628.14 |
| Max. Negotiated Rate |
$71,984.53 |
| Rate for Payer: Aetna Medicare |
$12,729.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,300.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,300.19
|
| Rate for Payer: BCBS MAPPO |
$12,240.15
|
| Rate for Payer: BCBS Trust/PPO |
$71,984.53
|
| Rate for Payer: BCN Medicare Advantage |
$12,240.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,240.15
|
| Rate for Payer: Mclaren Medicare |
$12,240.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,852.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,076.17
|
| Rate for Payer: PACE Medicare |
$11,628.14
|
| Rate for Payer: PACE SWMI |
$12,240.15
|
| Rate for Payer: PHP Medicare Advantage |
$12,240.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,839.14
|
| Rate for Payer: Priority Health Medicare |
$12,240.15
|
| Rate for Payer: Priority Health Narrow Network |
$17,471.31
|
| Rate for Payer: Railroad Medicare Medicare |
$12,240.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,215.06
|
| Rate for Payer: UHC Core |
$19,035.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,240.15
|
| Rate for Payer: UHC Exchange |
$15,133.77
|
| Rate for Payer: UHC Medicare Advantage |
$12,607.35
|
| Rate for Payer: VA VA |
$12,240.15
|
|
|
MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE
|
Facility
|
OP
|
$18,247.50
|
|
|
Service Code
|
CPT 19307
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,164.06 |
| Max. Negotiated Rate |
$18,247.50 |
| Rate for Payer: Aetna Medicare |
$6,028.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.58
|
| Rate for Payer: BCBS Complete |
$3,329.49
|
| Rate for Payer: BCBS MAPPO |
$5,796.46
|
| Rate for Payer: BCBS Trust/PPO |
$6,728.75
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.46
|
| Rate for Payer: Mclaren Medicaid |
$3,170.66
|
| Rate for Payer: Mclaren Medicare |
$5,796.46
|
| Rate for Payer: Meridian Medicaid |
$3,329.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,086.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.93
|
| Rate for Payer: PACE Medicare |
$5,506.64
|
| Rate for Payer: PACE SWMI |
$5,796.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,170.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,247.50
|
| Rate for Payer: Priority Health Medicare |
$5,796.46
|
| Rate for Payer: Priority Health Narrow Network |
$14,598.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,280.47
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.46
|
| Rate for Payer: UHC Exchange |
$1,164.06
|
| Rate for Payer: UHC Medicare Advantage |
$5,970.35
|
| Rate for Payer: VA VA |
$5,796.46
|
|
|
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);
|
Facility
|
OP
|
$10,666.11
|
|
|
Service Code
|
CPT 19301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$652.59 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,780.86
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,666.11
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,532.89
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$717.85
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$652.59
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: VA VA |
$3,388.17
|
|
|
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); WITH AXILLARY LYMPHADENECTOMY
|
Facility
|
OP
|
$18,247.50
|
|
|
Service Code
|
CPT 19302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$895.88 |
| Max. Negotiated Rate |
$18,247.50 |
| Rate for Payer: Aetna Medicare |
$6,028.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.58
|
| Rate for Payer: BCBS Complete |
$3,329.49
|
| Rate for Payer: BCBS MAPPO |
$5,796.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,353.19
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.46
|
| Rate for Payer: Mclaren Medicaid |
$3,170.66
|
| Rate for Payer: Mclaren Medicare |
$5,796.46
|
| Rate for Payer: Meridian Medicaid |
$3,329.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,086.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.93
|
| Rate for Payer: PACE Medicare |
$5,506.64
|
| Rate for Payer: PACE SWMI |
$5,796.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,170.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,247.50
|
| Rate for Payer: Priority Health Medicare |
$5,796.46
|
| Rate for Payer: Priority Health Narrow Network |
$14,598.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$985.47
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.46
|
| Rate for Payer: UHC Exchange |
$895.88
|
| Rate for Payer: UHC Medicare Advantage |
$5,970.35
|
| Rate for Payer: VA VA |
$5,796.46
|
|
|
MASTECTOMY, SIMPLE, COMPLETE
|
Facility
|
OP
|
$18,247.50
|
|
|
Service Code
|
CPT 19303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$945.65 |
| Max. Negotiated Rate |
$18,247.50 |
| Rate for Payer: Aetna Medicare |
$6,028.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.58
|
| Rate for Payer: BCBS Complete |
$3,329.49
|
| Rate for Payer: BCBS MAPPO |
$5,796.46
|
| Rate for Payer: BCBS Trust/PPO |
$7,332.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.46
|
| Rate for Payer: Mclaren Medicaid |
$3,170.66
|
| Rate for Payer: Mclaren Medicare |
$5,796.46
|
| Rate for Payer: Meridian Medicaid |
$3,329.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,086.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.93
|
| Rate for Payer: PACE Medicare |
$5,506.64
|
| Rate for Payer: PACE SWMI |
$5,796.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,170.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,247.50
|
| Rate for Payer: Priority Health Medicare |
$5,796.46
|
| Rate for Payer: Priority Health Narrow Network |
$14,598.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,040.22
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.46
|
| Rate for Payer: UHC Exchange |
$945.65
|
| Rate for Payer: UHC Medicare Advantage |
$5,970.35
|
| Rate for Payer: VA VA |
$5,796.46
|
|
|
MASTOPEXY
|
Facility
|
OP
|
$18,247.50
|
|
|
Service Code
|
CPT 19316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$781.28 |
| Max. Negotiated Rate |
$18,247.50 |
| Rate for Payer: Aetna Medicare |
$6,028.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.58
|
| Rate for Payer: BCBS Complete |
$3,329.49
|
| Rate for Payer: BCBS MAPPO |
$5,796.46
|
| Rate for Payer: BCBS Trust/PPO |
$6,349.78
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.46
|
| Rate for Payer: Mclaren Medicaid |
$3,170.66
|
| Rate for Payer: Mclaren Medicare |
$5,796.46
|
| Rate for Payer: Meridian Medicaid |
$3,329.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,086.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.93
|
| Rate for Payer: PACE Medicare |
$5,506.64
|
| Rate for Payer: PACE SWMI |
$5,796.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,170.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,247.50
|
| Rate for Payer: Priority Health Medicare |
$5,796.46
|
| Rate for Payer: Priority Health Narrow Network |
$14,598.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$859.41
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.46
|
| Rate for Payer: UHC Exchange |
$781.28
|
| Rate for Payer: UHC Medicare Advantage |
$5,970.35
|
| Rate for Payer: VA VA |
$5,796.46
|
|
|
MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
OP
|
$4,536.73
|
|
|
Service Code
|
CPT 19020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$311.72 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,225.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.89
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$311.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT
|
Facility
|
IP
|
$291.04
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
10512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.06 |
| Max. Negotiated Rate |
$261.94 |
| Rate for Payer: Aetna American Axle |
$189.18
|
| Rate for Payer: Aetna Commercial |
$247.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.18
|
| Rate for Payer: Cash Price |
$232.83
|
| Rate for Payer: Cofinity Commercial |
$203.73
|
| Rate for Payer: Cofinity Commercial |
$250.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.83
|
| Rate for Payer: Healthscope Commercial |
$261.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.38
|
| Rate for Payer: PHP Commercial |
$247.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.73
|
| Rate for Payer: Priority Health SBD |
$183.36
|
| Rate for Payer: UMR Bronson Commercial |
$128.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.28
|
|
|
MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON-IMAGING
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 51798
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$56.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$118.97
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.15
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$136.92
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.24
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.37
|
| Rate for Payer: UHC Exchange |
$11.13
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: VA VA |
$54.37
|
|
|
MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); EXCEPT INFANT
|
Facility
|
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 53020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.98 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,372.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.38
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$93.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); INFANT
|
Facility
|
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 53025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.13 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,000.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.84
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$67.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 51079-423-01
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna American Axle |
$3.04
|
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.98
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health SBD |
$2.95
|
| Rate for Payer: UMR Bronson Commercial |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.51
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$366.70
|
|
|
Service Code
|
NDC 0904-6516-61
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.35 |
| Max. Negotiated Rate |
$330.03 |
| Rate for Payer: Aetna American Axle |
$238.36
|
| Rate for Payer: Aetna Commercial |
$311.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.36
|
| Rate for Payer: Cash Price |
$293.36
|
| Rate for Payer: Cofinity Commercial |
$315.36
|
| Rate for Payer: Cofinity Commercial |
$256.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.36
|
| Rate for Payer: Healthscope Commercial |
$330.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.70
|
| Rate for Payer: PHP Commercial |
$311.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.69
|
| Rate for Payer: Priority Health SBD |
$231.02
|
| Rate for Payer: UMR Bronson Commercial |
$161.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.02
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$467.40
|
|
|
Service Code
|
NDC 51079-423-20
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.66 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Aetna American Axle |
$303.81
|
| Rate for Payer: Aetna Commercial |
$397.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.81
|
| Rate for Payer: Cash Price |
$373.92
|
| Rate for Payer: Cofinity Commercial |
$327.18
|
| Rate for Payer: Cofinity Commercial |
$401.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.92
|
| Rate for Payer: Healthscope Commercial |
$420.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$397.29
|
| Rate for Payer: PHP Commercial |
$397.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.18
|
| Rate for Payer: Priority Health SBD |
$294.46
|
| Rate for Payer: UMR Bronson Commercial |
$205.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.55
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 0904-6517-61
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.62 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna American Axle |
$247.62
|
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.62
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$266.66
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.81
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.66
|
| Rate for Payer: Priority Health SBD |
$240.00
|
| Rate for Payer: UMR Bronson Commercial |
$167.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.71
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$202.10
|
|
|
Service Code
|
NDC 53746-442-01
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna American Axle |
$131.36
|
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.36
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.78
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.47
|
| Rate for Payer: Priority Health SBD |
$127.32
|
| Rate for Payer: UMR Bronson Commercial |
$88.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.58
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$4.14
|
|
|
Service Code
|
NDC 60687-730-11
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna American Axle |
$2.69
|
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.69
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.31
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.52
|
| Rate for Payer: PHP Commercial |
$3.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.10
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$413.25
|
|
|
Service Code
|
NDC 60687-730-01
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$371.92 |
| Rate for Payer: Aetna American Axle |
$268.61
|
| Rate for Payer: Aetna Commercial |
$351.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.61
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cofinity Commercial |
$289.28
|
| Rate for Payer: Cofinity Commercial |
$355.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.60
|
| Rate for Payer: Healthscope Commercial |
$371.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.26
|
| Rate for Payer: PHP Commercial |
$351.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.28
|
| Rate for Payer: Priority Health SBD |
$260.35
|
| Rate for Payer: UMR Bronson Commercial |
$181.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.94
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 59746-121-06
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.05 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna American Axle |
$271.90
|
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.90
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.81
|
| Rate for Payer: Priority Health SBD |
$263.53
|
| Rate for Payer: UMR Bronson Commercial |
$184.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
