|
NEOMYCIN-BACITRACIN-POLYMYXN 3.5 MG-400 UNIT-10,000 UNIT/GRAM EYE OINT
|
Facility
|
IP
|
$143.29
|
|
|
Service Code
|
NDC 0574-4250-35
|
| Hospital Charge Code |
38701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$128.96 |
| Rate for Payer: Aetna American Axle |
$93.14
|
| Rate for Payer: Aetna Commercial |
$121.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.14
|
| Rate for Payer: Cash Price |
$114.63
|
| Rate for Payer: Cofinity Commercial |
$100.30
|
| Rate for Payer: Cofinity Commercial |
$123.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.63
|
| Rate for Payer: Healthscope Commercial |
$128.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.80
|
| Rate for Payer: PHP Commercial |
$121.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.30
|
| Rate for Payer: Priority Health SBD |
$90.27
|
| Rate for Payer: UMR Bronson Commercial |
$63.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.47
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$11.97
|
|
|
Service Code
|
NDC 59390-027-14
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna American Axle |
$7.78
|
| Rate for Payer: Aetna Commercial |
$10.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.78
|
| Rate for Payer: Cash Price |
$9.58
|
| Rate for Payer: Cofinity Commercial |
$10.29
|
| Rate for Payer: Cofinity Commercial |
$8.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.58
|
| Rate for Payer: Healthscope Commercial |
$10.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.17
|
| Rate for Payer: PHP Commercial |
$10.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.38
|
| Rate for Payer: Priority Health SBD |
$7.54
|
| Rate for Payer: UMR Bronson Commercial |
$5.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.98
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$9.41
|
|
|
Service Code
|
NDC 45802-143-01
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna American Axle |
$6.12
|
| Rate for Payer: Aetna Commercial |
$8.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.12
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$6.59
|
| Rate for Payer: Cofinity Commercial |
$8.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.53
|
| Rate for Payer: Healthscope Commercial |
$8.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.00
|
| Rate for Payer: PHP Commercial |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.59
|
| Rate for Payer: Priority Health SBD |
$5.93
|
| Rate for Payer: UMR Bronson Commercial |
$4.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.06
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$7.98
|
|
|
Service Code
|
NDC 61269-179-34
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Aetna American Axle |
$5.19
|
| Rate for Payer: Aetna Commercial |
$6.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.19
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$5.59
|
| Rate for Payer: Cofinity Commercial |
$6.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$7.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.78
|
| Rate for Payer: PHP Commercial |
$6.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.59
|
| Rate for Payer: Priority Health SBD |
$5.03
|
| Rate for Payer: UMR Bronson Commercial |
$3.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.98
|
|
|
NEOMYCIN-BACITRACN ZN-POLYMYX 3.5 MG-400 UNIT-5,000 UNIT/GRAM TOP OINT
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
NDC 81073088
|
| Hospital Charge Code |
854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna American Axle |
$13.79
|
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: UMR Bronson Commercial |
$9.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$62.97
|
|
|
Service Code
|
NDC 61314-630-06
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$56.67 |
| Rate for Payer: Aetna American Axle |
$40.93
|
| Rate for Payer: Aetna Commercial |
$53.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.93
|
| Rate for Payer: Cash Price |
$50.38
|
| Rate for Payer: Cofinity Commercial |
$44.08
|
| Rate for Payer: Cofinity Commercial |
$54.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.38
|
| Rate for Payer: Healthscope Commercial |
$56.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.52
|
| Rate for Payer: PHP Commercial |
$53.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.08
|
| Rate for Payer: Priority Health SBD |
$39.67
|
| Rate for Payer: UMR Bronson Commercial |
$27.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.23
|
|
|
NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS
|
Facility
|
IP
|
$44.28
|
|
|
Service Code
|
NDC 24208-830-60
|
| Hospital Charge Code |
10708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Aetna American Axle |
$28.78
|
| Rate for Payer: Aetna Commercial |
$37.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.78
|
| Rate for Payer: Cash Price |
$35.42
|
| Rate for Payer: Cofinity Commercial |
$31.00
|
| Rate for Payer: Cofinity Commercial |
$38.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.42
|
| Rate for Payer: Healthscope Commercial |
$39.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.64
|
| Rate for Payer: PHP Commercial |
$37.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.00
|
| Rate for Payer: Priority Health SBD |
$27.90
|
| Rate for Payer: UMR Bronson Commercial |
$19.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.21
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
IP
|
$149.49
|
|
|
Service Code
|
NDC 24208-635-62
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.78 |
| Max. Negotiated Rate |
$134.54 |
| Rate for Payer: Aetna American Axle |
$97.17
|
| Rate for Payer: Aetna Commercial |
$127.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.17
|
| Rate for Payer: Cash Price |
$119.59
|
| Rate for Payer: Cofinity Commercial |
$104.64
|
| Rate for Payer: Cofinity Commercial |
$128.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.59
|
| Rate for Payer: Healthscope Commercial |
$134.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.07
|
| Rate for Payer: PHP Commercial |
$127.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.64
|
| Rate for Payer: Priority Health SBD |
$94.18
|
| Rate for Payer: UMR Bronson Commercial |
$65.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.12
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
IP
|
$175.11
|
|
|
Service Code
|
NDC 24208-631-10
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.05 |
| Max. Negotiated Rate |
$157.60 |
| Rate for Payer: Aetna American Axle |
$113.82
|
| Rate for Payer: Aetna Commercial |
$148.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.82
|
| Rate for Payer: Cash Price |
$140.09
|
| Rate for Payer: Cofinity Commercial |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$150.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.09
|
| Rate for Payer: Healthscope Commercial |
$157.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.84
|
| Rate for Payer: PHP Commercial |
$148.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.58
|
| Rate for Payer: Priority Health SBD |
$110.32
|
| Rate for Payer: UMR Bronson Commercial |
$77.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.33
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
IP
|
$278.99
|
|
|
Service Code
|
NDC 61314-646-10
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.76 |
| Max. Negotiated Rate |
$251.09 |
| Rate for Payer: Aetna American Axle |
$181.34
|
| Rate for Payer: Aetna Commercial |
$237.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.34
|
| Rate for Payer: Cash Price |
$223.19
|
| Rate for Payer: Cofinity Commercial |
$195.29
|
| Rate for Payer: Cofinity Commercial |
$239.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.19
|
| Rate for Payer: Healthscope Commercial |
$251.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$237.14
|
| Rate for Payer: PHP Commercial |
$237.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.29
|
| Rate for Payer: Priority Health SBD |
$175.76
|
| Rate for Payer: UMR Bronson Commercial |
$122.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.24
|
|
|
NEONATAL PARENTERAL NUTRITION (2 IN 1) CUSTOM
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
NDC 0090-0002-35
|
| Hospital Charge Code |
158489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna American Axle |
$234.00
|
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$309.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.00
|
| Rate for Payer: PHP Commercial |
$306.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health SBD |
$226.80
|
| Rate for Payer: UMR Bronson Commercial |
$158.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.00
|
|
|
NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY
|
Facility
|
IP
|
$27,753.13
|
|
|
Service Code
|
MS-DRG 789
|
| Min. Negotiated Rate |
$4,673.99 |
| Max. Negotiated Rate |
$27,753.13 |
| Rate for Payer: Aetna Medicare |
$15,114.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,165.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,165.89
|
| Rate for Payer: BCBS MAPPO |
$14,532.71
|
| Rate for Payer: BCBS Trust/PPO |
$4,673.99
|
| Rate for Payer: BCN Medicare Advantage |
$14,532.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,532.71
|
| Rate for Payer: Mclaren Medicare |
$14,532.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,259.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,712.62
|
| Rate for Payer: PACE Medicare |
$13,806.07
|
| Rate for Payer: PACE SWMI |
$14,532.71
|
| Rate for Payer: PHP Medicare Advantage |
$14,532.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,108.24
|
| Rate for Payer: Priority Health Medicare |
$14,532.71
|
| Rate for Payer: Priority Health Narrow Network |
$20,886.59
|
| Rate for Payer: Railroad Medicare Medicare |
$14,532.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,753.13
|
| Rate for Payer: UHC Core |
$22,757.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,532.71
|
| Rate for Payer: UHC Exchange |
$18,092.11
|
| Rate for Payer: UHC Medicare Advantage |
$14,968.69
|
| Rate for Payer: VA VA |
$14,532.71
|
|
|
NEONATE WITH OTHER SIGNIFICANT PROBLEMS
|
Facility
|
IP
|
$22,726.93
|
|
|
Service Code
|
MS-DRG 794
|
| Min. Negotiated Rate |
$3,530.62 |
| Max. Negotiated Rate |
$22,726.93 |
| Rate for Payer: Aetna Medicare |
$12,473.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,991.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,991.96
|
| Rate for Payer: BCBS MAPPO |
$11,993.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,530.62
|
| Rate for Payer: BCN Medicare Advantage |
$11,993.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,993.57
|
| Rate for Payer: Mclaren Medicare |
$11,993.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,593.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,792.61
|
| Rate for Payer: PACE Medicare |
$11,393.89
|
| Rate for Payer: PACE SWMI |
$11,993.57
|
| Rate for Payer: PHP Medicare Advantage |
$11,993.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,379.95
|
| Rate for Payer: Priority Health Medicare |
$11,993.57
|
| Rate for Payer: Priority Health Narrow Network |
$17,103.96
|
| Rate for Payer: Railroad Medicare Medicare |
$11,993.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,726.93
|
| Rate for Payer: UHC Core |
$18,635.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,993.57
|
| Rate for Payer: UHC Exchange |
$14,815.57
|
| Rate for Payer: UHC Medicare Advantage |
$12,353.38
|
| Rate for Payer: VA VA |
$11,993.57
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.97
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
167219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna American Axle |
$11.78
|
| Rate for Payer: Aetna American Axle |
$14.20
|
| Rate for Payer: Aetna American Axle |
$13.77
|
| Rate for Payer: Aetna American Axle |
$13.68
|
| Rate for Payer: Aetna American Axle |
$17.37
|
| Rate for Payer: Aetna American Axle |
$13.08
|
| Rate for Payer: Aetna American Axle |
$49.38
|
| Rate for Payer: Aetna American Axle |
$11.98
|
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Commercial |
$17.89
|
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Aetna Commercial |
$64.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$60.78
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$16.84
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$14.08
|
| Rate for Payer: Cofinity Commercial |
$17.30
|
| Rate for Payer: Cofinity Commercial |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$15.30
|
| Rate for Payer: Cofinity Commercial |
$53.18
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$65.33
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Healthscope Commercial |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$68.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.57
|
| Rate for Payer: PHP Commercial |
$17.89
|
| Rate for Payer: PHP Commercial |
$64.57
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: PHP Commercial |
$15.40
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: PHP Commercial |
$22.71
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: PHP Commercial |
$17.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.90
|
| Rate for Payer: Priority Health SBD |
$16.83
|
| Rate for Payer: Priority Health SBD |
$13.26
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: Priority Health SBD |
$47.86
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| Rate for Payer: Priority Health SBD |
$13.35
|
| Rate for Payer: Priority Health SBD |
$13.77
|
| Rate for Payer: Priority Health SBD |
$12.68
|
| Rate for Payer: UMR Bronson Commercial |
$11.87
|
| Rate for Payer: UMR Bronson Commercial |
$7.97
|
| Rate for Payer: UMR Bronson Commercial |
$8.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.76
|
| Rate for Payer: UMR Bronson Commercial |
$8.85
|
| Rate for Payer: UMR Bronson Commercial |
$9.26
|
| Rate for Payer: UMR Bronson Commercial |
$33.43
|
| Rate for Payer: UMR Bronson Commercial |
$9.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.98
|
|
|
NERVE REPAIR; WITH NERVE ALLOGRAFT, EACH NERVE, FIRST STRAND (CABLE)
|
Facility
|
OP
|
$18,640.24
|
|
|
Service Code
|
CPT 64912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$882.78 |
| Max. Negotiated Rate |
$18,640.24 |
| Rate for Payer: Aetna Medicare |
$6,158.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,401.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,401.52
|
| Rate for Payer: BCBS Complete |
$3,401.15
|
| Rate for Payer: BCBS MAPPO |
$5,921.22
|
| Rate for Payer: BCN Medicare Advantage |
$5,921.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,921.22
|
| Rate for Payer: Mclaren Medicaid |
$3,238.91
|
| Rate for Payer: Mclaren Medicare |
$5,921.22
|
| Rate for Payer: Meridian Medicaid |
$3,401.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,217.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,809.40
|
| Rate for Payer: PACE Medicare |
$5,625.16
|
| Rate for Payer: PACE SWMI |
$5,921.22
|
| Rate for Payer: PHP Medicare Advantage |
$5,921.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,238.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,640.24
|
| Rate for Payer: Priority Health Medicare |
$5,921.22
|
| Rate for Payer: Priority Health Narrow Network |
$14,912.19
|
| Rate for Payer: Railroad Medicare Medicare |
$5,921.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.06
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,921.22
|
| Rate for Payer: UHC Exchange |
$882.78
|
| Rate for Payer: UHC Medicare Advantage |
$6,098.86
|
| Rate for Payer: VA VA |
$5,921.22
|
|
|
NERVE REPAIR; WITH SYNTHETIC CONDUIT OR VEIN ALLOGRAFT (EG, NERVE TUBE), EACH NERVE
|
Facility
|
OP
|
$18,640.24
|
|
|
Service Code
|
CPT 64910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$752.46 |
| Max. Negotiated Rate |
$18,640.24 |
| Rate for Payer: Aetna Medicare |
$6,158.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,401.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,401.52
|
| Rate for Payer: BCBS Complete |
$3,401.15
|
| Rate for Payer: BCBS MAPPO |
$5,921.22
|
| Rate for Payer: BCBS Trust/PPO |
$5,031.28
|
| Rate for Payer: BCN Medicare Advantage |
$5,921.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,921.22
|
| Rate for Payer: Mclaren Medicaid |
$3,238.91
|
| Rate for Payer: Mclaren Medicare |
$5,921.22
|
| Rate for Payer: Meridian Medicaid |
$3,401.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,217.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,809.40
|
| Rate for Payer: PACE Medicare |
$5,625.16
|
| Rate for Payer: PACE SWMI |
$5,921.22
|
| Rate for Payer: PHP Medicare Advantage |
$5,921.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,238.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,640.24
|
| Rate for Payer: Priority Health Medicare |
$5,921.22
|
| Rate for Payer: Priority Health Narrow Network |
$14,912.19
|
| Rate for Payer: Railroad Medicare Medicare |
$5,921.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.71
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,921.22
|
| Rate for Payer: UHC Exchange |
$752.46
|
| Rate for Payer: UHC Medicare Advantage |
$6,098.86
|
| Rate for Payer: VA VA |
$5,921.22
|
|
|
NERVOUS SYSTEM NEOPLASMS WITH MCC
|
Facility
|
IP
|
$25,395.37
|
|
|
Service Code
|
MS-DRG 054
|
| Min. Negotiated Rate |
$11,273.84 |
| Max. Negotiated Rate |
$25,395.37 |
| Rate for Payer: Aetna Medicare |
$12,341.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,834.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,834.00
|
| Rate for Payer: BCBS MAPPO |
$11,867.20
|
| Rate for Payer: BCBS Trust/PPO |
$25,395.37
|
| Rate for Payer: BCN Medicare Advantage |
$11,867.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,867.20
|
| Rate for Payer: Mclaren Medicare |
$11,867.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,460.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,647.28
|
| Rate for Payer: PACE Medicare |
$11,273.84
|
| Rate for Payer: PACE SWMI |
$11,867.20
|
| Rate for Payer: PHP Medicare Advantage |
$11,867.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,144.61
|
| Rate for Payer: Priority Health Medicare |
$11,867.20
|
| Rate for Payer: Priority Health Narrow Network |
$16,915.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11,867.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,476.77
|
| Rate for Payer: UHC Core |
$18,430.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,867.20
|
| Rate for Payer: UHC Exchange |
$14,652.48
|
| Rate for Payer: UHC Medicare Advantage |
$12,223.22
|
| Rate for Payer: VA VA |
$11,867.20
|
|
|
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC
|
Facility
|
IP
|
$23,922.81
|
|
|
Service Code
|
MS-DRG 055
|
| Min. Negotiated Rate |
$8,343.35 |
| Max. Negotiated Rate |
$23,922.81 |
| Rate for Payer: Aetna Medicare |
$9,133.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,978.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,978.09
|
| Rate for Payer: BCBS MAPPO |
$8,782.47
|
| Rate for Payer: BCBS Trust/PPO |
$23,922.81
|
| Rate for Payer: BCN Medicare Advantage |
$8,782.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,782.47
|
| Rate for Payer: Mclaren Medicare |
$8,782.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,221.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,099.84
|
| Rate for Payer: PACE Medicare |
$8,343.35
|
| Rate for Payer: PACE SWMI |
$8,782.47
|
| Rate for Payer: PHP Medicare Advantage |
$8,782.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,400.33
|
| Rate for Payer: Priority Health Medicare |
$8,782.47
|
| Rate for Payer: Priority Health Narrow Network |
$12,320.26
|
| Rate for Payer: Railroad Medicare Medicare |
$8,782.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,370.59
|
| Rate for Payer: UHC Core |
$13,423.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,782.47
|
| Rate for Payer: UHC Exchange |
$10,671.90
|
| Rate for Payer: UHC Medicare Advantage |
$9,045.94
|
| Rate for Payer: VA VA |
$8,782.47
|
|
|
NEUROENDOSCOPY, INTRACRANIAL; WITH EXCISION OF PITUITARY TUMOR, TRANSNASAL OR TRANS-SPHENOIDAL APPROACH
|
Facility
|
OP
|
$5,406.55
|
|
|
Service Code
|
CPT 62165
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,504.60 |
| Max. Negotiated Rate |
$5,406.55 |
| Rate for Payer: BCBS Trust/PPO |
$5,406.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,655.06
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$1,504.60
|
|
|
NEUROLOGICAL EYE DISORDERS
|
Facility
|
IP
|
$21,098.31
|
|
|
Service Code
|
MS-DRG 123
|
| Min. Negotiated Rate |
$6,372.61 |
| Max. Negotiated Rate |
$21,098.31 |
| Rate for Payer: Aetna Medicare |
$6,976.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,385.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,385.01
|
| Rate for Payer: BCBS MAPPO |
$6,708.01
|
| Rate for Payer: BCBS Trust/PPO |
$21,098.31
|
| Rate for Payer: BCN Medicare Advantage |
$6,708.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,708.01
|
| Rate for Payer: Mclaren Medicare |
$6,708.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,043.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,714.21
|
| Rate for Payer: PACE Medicare |
$6,372.61
|
| Rate for Payer: PACE SWMI |
$6,708.01
|
| Rate for Payer: PHP Medicare Advantage |
$6,708.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,537.34
|
| Rate for Payer: Priority Health Medicare |
$6,708.01
|
| Rate for Payer: Priority Health Narrow Network |
$9,229.87
|
| Rate for Payer: Railroad Medicare Medicare |
$6,708.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,264.22
|
| Rate for Payer: UHC Core |
$10,056.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,708.01
|
| Rate for Payer: UHC Exchange |
$7,994.98
|
| Rate for Payer: UHC Medicare Advantage |
$6,909.25
|
| Rate for Payer: VA VA |
$6,708.01
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (SPECIFY)
|
Facility
|
OP
|
$5,402.75
|
|
|
Service Code
|
CPT 64716
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$507.21 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,415.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.93
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$507.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$5,402.75
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$437.79 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,906.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$481.57
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$437.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$5,402.75
|
|
|
Service Code
|
CPT 64718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$602.82 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,025.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.10
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$602.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST
|
Facility
|
OP
|
$5,402.75
|
|
|
Service Code
|
CPT 64719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$407.99 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,366.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.79
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$407.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
NEUROPLASTY; DIGITAL, 1 OR BOTH, SAME DIGIT
|
Facility
|
OP
|
$5,402.75
|
|
|
Service Code
|
CPT 64702
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$513.10 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,366.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.41
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$513.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
