|
OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); BICONDYLAR, WITH OR WITHOUT INTERNAL FIXATION
|
Facility
|
OP
|
$8,040.93
|
|
|
Service Code
|
CPT 27536
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,173.55 |
| Max. Negotiated Rate |
$8,040.93 |
| Rate for Payer: BCBS Trust/PPO |
$8,040.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,290.90
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Exchange |
$1,173.55
|
|
|
OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$8,127.84
|
|
|
Service Code
|
CPT 27535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$885.40 |
| Max. Negotiated Rate |
$8,127.84 |
| Rate for Payer: BCBS Trust/PPO |
$8,127.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$973.94
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Exchange |
$885.40
|
|
|
OPEN TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE), WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE
|
Facility
|
OP
|
$36,827.89
|
|
|
Service Code
|
CPT 27758
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$889.66 |
| Max. Negotiated Rate |
$36,827.89 |
| Rate for Payer: Aetna Medicare |
$12,166.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,623.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,623.31
|
| Rate for Payer: BCBS Complete |
$6,719.70
|
| Rate for Payer: BCBS MAPPO |
$11,698.65
|
| Rate for Payer: BCBS Trust/PPO |
$4,369.34
|
| Rate for Payer: BCN Medicare Advantage |
$11,698.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,698.65
|
| Rate for Payer: Mclaren Medicaid |
$6,399.16
|
| Rate for Payer: Mclaren Medicare |
$11,698.65
|
| Rate for Payer: Meridian Medicaid |
$6,719.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,283.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,453.45
|
| Rate for Payer: PACE Medicare |
$11,113.72
|
| Rate for Payer: PACE SWMI |
$11,698.65
|
| Rate for Payer: PHP Medicare Advantage |
$11,698.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,399.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,827.89
|
| Rate for Payer: Priority Health Medicare |
$11,698.65
|
| Rate for Payer: Priority Health Narrow Network |
$29,462.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11,698.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$978.63
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,698.65
|
| Rate for Payer: UHC Exchange |
$889.66
|
| Rate for Payer: UHC Medicare Advantage |
$12,049.61
|
| Rate for Payer: VA VA |
$11,698.65
|
|
|
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITH FIXATION OF POSTERIOR LIP
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$976.10 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$7,413.28
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,073.71
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$976.10
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITHOUT FIXATION OF POSTERIOR LIP
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$867.07 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$6,017.88
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$953.78
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$867.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES]), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 24685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$653.90 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$6,253.56
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.29
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$653.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
OPEN TREATMENT OF ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 25545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$626.07 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.75
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$688.68
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$626.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
OPEN TREATMENT OF ULNAR STYLOID FRACTURE
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 25652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$624.10 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.75
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.51
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$624.10
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
IP
|
$2,240.26
|
|
|
Service Code
|
NDC 42799-217-01
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$985.71 |
| Max. Negotiated Rate |
$2,016.23 |
| Rate for Payer: Aetna American Axle |
$1,456.17
|
| Rate for Payer: Aetna Commercial |
$1,904.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,456.17
|
| Rate for Payer: Cash Price |
$1,792.21
|
| Rate for Payer: Cofinity Commercial |
$1,568.18
|
| Rate for Payer: Cofinity Commercial |
$1,926.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,792.21
|
| Rate for Payer: Healthscope Commercial |
$2,016.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,568.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,680.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,904.22
|
| Rate for Payer: PHP Commercial |
$1,904.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,568.18
|
| Rate for Payer: Priority Health SBD |
$1,411.36
|
| Rate for Payer: UMR Bronson Commercial |
$985.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,680.20
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
IP
|
$11.46
|
|
|
Service Code
|
NDC 9900-0019-24
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna American Axle |
$7.45
|
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.45
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.17
|
| Rate for Payer: Healthscope Commercial |
$10.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.74
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.02
|
| Rate for Payer: Priority Health SBD |
$7.22
|
| Rate for Payer: UMR Bronson Commercial |
$5.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.60
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
IP
|
$1,130.72
|
|
|
Service Code
|
NDC 62559-153-04
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$497.52 |
| Max. Negotiated Rate |
$1,017.65 |
| Rate for Payer: Aetna American Axle |
$734.97
|
| Rate for Payer: Aetna Commercial |
$961.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.97
|
| Rate for Payer: Cash Price |
$904.58
|
| Rate for Payer: Cofinity Commercial |
$791.50
|
| Rate for Payer: Cofinity Commercial |
$972.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$904.58
|
| Rate for Payer: Healthscope Commercial |
$1,017.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$791.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$848.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$961.11
|
| Rate for Payer: PHP Commercial |
$961.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.50
|
| Rate for Payer: Priority Health SBD |
$712.35
|
| Rate for Payer: UMR Bronson Commercial |
$497.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$848.04
|
|
|
OPPONENSPLASTY; SUPERFICIALIS TENDON TRANSFER TYPE, EACH TENDON
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$834.65 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,262.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$918.12
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$834.65
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$45,772.47
|
|
|
Service Code
|
MS-DRG 113
|
| Min. Negotiated Rate |
$18,842.01 |
| Max. Negotiated Rate |
$45,772.47 |
| Rate for Payer: Aetna Medicare |
$20,627.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,792.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,792.11
|
| Rate for Payer: BCBS MAPPO |
$19,833.69
|
| Rate for Payer: BCBS Trust/PPO |
$45,772.47
|
| Rate for Payer: BCN Medicare Advantage |
$19,833.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,833.69
|
| Rate for Payer: Mclaren Medicare |
$19,833.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,825.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,808.74
|
| Rate for Payer: PACE Medicare |
$18,842.01
|
| Rate for Payer: PACE SWMI |
$19,833.69
|
| Rate for Payer: PHP Medicare Advantage |
$19,833.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,979.55
|
| Rate for Payer: Priority Health Medicare |
$19,833.69
|
| Rate for Payer: Priority Health Narrow Network |
$28,783.64
|
| Rate for Payer: Railroad Medicare Medicare |
$19,833.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,246.35
|
| Rate for Payer: UHC Core |
$31,361.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,833.69
|
| Rate for Payer: UHC Exchange |
$24,932.59
|
| Rate for Payer: UHC Medicare Advantage |
$20,428.70
|
| Rate for Payer: VA VA |
$19,833.69
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,232.70
|
|
|
Service Code
|
MS-DRG 114
|
| Min. Negotiated Rate |
$9,504.41 |
| Max. Negotiated Rate |
$30,232.70 |
| Rate for Payer: Aetna Medicare |
$10,404.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,505.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,505.80
|
| Rate for Payer: BCBS MAPPO |
$10,004.64
|
| Rate for Payer: BCBS Trust/PPO |
$30,232.70
|
| Rate for Payer: BCN Medicare Advantage |
$10,004.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,004.64
|
| Rate for Payer: Mclaren Medicare |
$10,004.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,504.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,505.34
|
| Rate for Payer: PACE Medicare |
$9,504.41
|
| Rate for Payer: PACE SWMI |
$10,004.64
|
| Rate for Payer: PHP Medicare Advantage |
$10,004.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,676.23
|
| Rate for Payer: Priority Health Medicare |
$10,004.64
|
| Rate for Payer: Priority Health Narrow Network |
$14,140.98
|
| Rate for Payer: Railroad Medicare Medicare |
$10,004.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,789.88
|
| Rate for Payer: UHC Core |
$15,407.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,004.64
|
| Rate for Payer: UHC Exchange |
$12,249.02
|
| Rate for Payer: UHC Medicare Advantage |
$10,304.78
|
| Rate for Payer: VA VA |
$10,004.64
|
|
|
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
|
Facility
|
OP
|
$9,680.93
|
|
|
Service Code
|
CPT 54530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$500.99 |
| Max. Negotiated Rate |
$9,680.93 |
| Rate for Payer: Aetna Medicare |
$3,198.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,805.52
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,680.93
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$7,744.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$551.09
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,075.22
|
| Rate for Payer: UHC Exchange |
$500.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: VA VA |
$3,075.22
|
|
|
ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR INGUINAL APPROACH
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 54520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$323.84 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,543.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.22
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$323.84
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
ORCHIOPEXY, INGUINAL OR SCROTAL APPROACH
|
Facility
|
OP
|
$9,680.93
|
|
|
Service Code
|
CPT 54640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$423.06 |
| Max. Negotiated Rate |
$9,680.93 |
| Rate for Payer: Aetna Medicare |
$3,198.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,528.31
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,680.93
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$7,744.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.37
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,075.22
|
| Rate for Payer: UHC Exchange |
$423.06
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: VA VA |
$3,075.22
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$26,799.75
|
|
|
Service Code
|
MS-DRG 884
|
| Min. Negotiated Rate |
$13,348.53 |
| Max. Negotiated Rate |
$26,799.75 |
| Rate for Payer: Aetna Medicare |
$14,613.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,563.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,563.85
|
| Rate for Payer: BCBS MAPPO |
$14,051.08
|
| Rate for Payer: BCBS Trust/PPO |
$21,490.32
|
| Rate for Payer: BCN Medicare Advantage |
$14,051.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,051.08
|
| Rate for Payer: Mclaren Medicare |
$14,051.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,753.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,158.74
|
| Rate for Payer: PACE Medicare |
$13,348.53
|
| Rate for Payer: PACE SWMI |
$14,051.08
|
| Rate for Payer: PHP Medicare Advantage |
$14,051.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,211.37
|
| Rate for Payer: Priority Health Medicare |
$14,051.08
|
| Rate for Payer: Priority Health Narrow Network |
$20,169.10
|
| Rate for Payer: Railroad Medicare Medicare |
$14,051.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,799.75
|
| Rate for Payer: UHC Core |
$21,975.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,051.08
|
| Rate for Payer: UHC Exchange |
$17,470.61
|
| Rate for Payer: UHC Medicare Advantage |
$14,472.61
|
| Rate for Payer: VA VA |
$14,051.08
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,511.80
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
197251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,505.19 |
| Max. Negotiated Rate |
$11,260.62 |
| Rate for Payer: Aetna American Axle |
$8,132.67
|
| Rate for Payer: Aetna Commercial |
$10,635.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,132.67
|
| Rate for Payer: Cash Price |
$10,009.44
|
| Rate for Payer: Cofinity Commercial |
$10,760.15
|
| Rate for Payer: Cofinity Commercial |
$8,758.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,009.44
|
| Rate for Payer: Healthscope Commercial |
$11,260.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,758.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,383.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,635.03
|
| Rate for Payer: PHP Commercial |
$10,635.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,758.26
|
| Rate for Payer: Priority Health SBD |
$7,882.43
|
| Rate for Payer: UMR Bronson Commercial |
$5,505.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,383.85
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,511.80
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
197251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.38 |
| Max. Negotiated Rate |
$11,260.62 |
| Rate for Payer: Aetna American Axle |
$8,132.67
|
| Rate for Payer: Aetna Commercial |
$10,635.03
|
| Rate for Payer: Aetna Medicare |
$42.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,132.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.15
|
| Rate for Payer: BCBS Complete |
$23.50
|
| Rate for Payer: BCBS MAPPO |
$40.92
|
| Rate for Payer: BCBS Trust/PPO |
$132.20
|
| Rate for Payer: BCN Medicare Advantage |
$40.92
|
| Rate for Payer: Cash Price |
$10,009.44
|
| Rate for Payer: Cash Price |
$10,009.44
|
| Rate for Payer: Cofinity Commercial |
$10,760.15
|
| Rate for Payer: Cofinity Commercial |
$8,758.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,009.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.92
|
| Rate for Payer: Healthscope Commercial |
$11,260.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,758.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,383.85
|
| Rate for Payer: Mclaren Medicaid |
$22.38
|
| Rate for Payer: Mclaren Medicare |
$40.92
|
| Rate for Payer: Meridian Medicaid |
$23.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,635.03
|
| Rate for Payer: PACE Medicare |
$38.87
|
| Rate for Payer: PACE SWMI |
$40.92
|
| Rate for Payer: PHP Commercial |
$10,635.03
|
| Rate for Payer: PHP Medicare Advantage |
$40.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,758.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.51
|
| Rate for Payer: Priority Health Medicare |
$40.92
|
| Rate for Payer: Priority Health Narrow Network |
$95.61
|
| Rate for Payer: Priority Health SBD |
$7,882.43
|
| Rate for Payer: Railroad Medicare Medicare |
$40.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.92
|
| Rate for Payer: UHC Medicare Advantage |
$42.14
|
| Rate for Payer: UMR Bronson Commercial |
$4,629.37
|
| Rate for Payer: VA VA |
$40.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,383.85
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,447.63
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
172319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.09 |
| Max. Negotiated Rate |
$3,102.87 |
| Rate for Payer: Aetna American Axle |
$2,240.96
|
| Rate for Payer: Aetna American Axle |
$6,722.87
|
| Rate for Payer: Aetna Commercial |
$8,791.45
|
| Rate for Payer: Aetna Commercial |
$2,930.49
|
| Rate for Payer: Aetna Medicare |
$28.70
|
| Rate for Payer: Aetna Medicare |
$28.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,722.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,240.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.49
|
| Rate for Payer: BCBS Complete |
$15.85
|
| Rate for Payer: BCBS Complete |
$15.85
|
| Rate for Payer: BCBS MAPPO |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$27.60
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCBS Trust/PPO |
$89.16
|
| Rate for Payer: BCN Medicare Advantage |
$27.60
|
| Rate for Payer: BCN Medicare Advantage |
$27.60
|
| Rate for Payer: Cash Price |
$8,274.30
|
| Rate for Payer: Cash Price |
$8,274.30
|
| Rate for Payer: Cash Price |
$2,758.10
|
| Rate for Payer: Cash Price |
$2,758.10
|
| Rate for Payer: Cofinity Commercial |
$2,413.34
|
| Rate for Payer: Cofinity Commercial |
$2,964.96
|
| Rate for Payer: Cofinity Commercial |
$7,240.02
|
| Rate for Payer: Cofinity Commercial |
$8,894.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,758.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,274.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.60
|
| Rate for Payer: Healthscope Commercial |
$3,102.87
|
| Rate for Payer: Healthscope Commercial |
$9,308.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,413.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,240.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,757.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,585.72
|
| Rate for Payer: Mclaren Medicaid |
$15.09
|
| Rate for Payer: Mclaren Medicaid |
$15.09
|
| Rate for Payer: Mclaren Medicare |
$27.60
|
| Rate for Payer: Mclaren Medicare |
$27.60
|
| Rate for Payer: Meridian Medicaid |
$15.85
|
| Rate for Payer: Meridian Medicaid |
$15.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,930.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,791.45
|
| Rate for Payer: PACE Medicare |
$26.22
|
| Rate for Payer: PACE Medicare |
$26.22
|
| Rate for Payer: PACE SWMI |
$27.60
|
| Rate for Payer: PACE SWMI |
$27.60
|
| Rate for Payer: PHP Commercial |
$8,791.45
|
| Rate for Payer: PHP Commercial |
$2,930.49
|
| Rate for Payer: PHP Medicare Advantage |
$27.60
|
| Rate for Payer: PHP Medicare Advantage |
$27.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,413.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,240.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.86
|
| Rate for Payer: Priority Health Medicare |
$27.60
|
| Rate for Payer: Priority Health Medicare |
$27.60
|
| Rate for Payer: Priority Health Narrow Network |
$64.69
|
| Rate for Payer: Priority Health Narrow Network |
$64.69
|
| Rate for Payer: Priority Health SBD |
$6,516.01
|
| Rate for Payer: Priority Health SBD |
$2,172.01
|
| Rate for Payer: Railroad Medicare Medicare |
$27.60
|
| Rate for Payer: Railroad Medicare Medicare |
$27.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.60
|
| Rate for Payer: UHC Medicare Advantage |
$28.42
|
| Rate for Payer: UHC Medicare Advantage |
$28.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,275.62
|
| Rate for Payer: UMR Bronson Commercial |
$3,826.87
|
| Rate for Payer: VA VA |
$27.60
|
| Rate for Payer: VA VA |
$27.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,757.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,585.72
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,447.63
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
172319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,516.96 |
| Max. Negotiated Rate |
$3,102.87 |
| Rate for Payer: Aetna American Axle |
$2,240.96
|
| Rate for Payer: Aetna American Axle |
$6,722.87
|
| Rate for Payer: Aetna Commercial |
$2,930.49
|
| Rate for Payer: Aetna Commercial |
$8,791.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,722.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,240.96
|
| Rate for Payer: Cash Price |
$8,274.30
|
| Rate for Payer: Cash Price |
$2,758.10
|
| Rate for Payer: Cofinity Commercial |
$7,240.02
|
| Rate for Payer: Cofinity Commercial |
$8,894.88
|
| Rate for Payer: Cofinity Commercial |
$2,964.96
|
| Rate for Payer: Cofinity Commercial |
$2,413.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,758.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,274.30
|
| Rate for Payer: Healthscope Commercial |
$9,308.59
|
| Rate for Payer: Healthscope Commercial |
$3,102.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,240.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,413.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,585.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,757.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,791.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,930.49
|
| Rate for Payer: PHP Commercial |
$8,791.45
|
| Rate for Payer: PHP Commercial |
$2,930.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,413.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,240.02
|
| Rate for Payer: Priority Health SBD |
$2,172.01
|
| Rate for Payer: Priority Health SBD |
$6,516.01
|
| Rate for Payer: UMR Bronson Commercial |
$4,550.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,516.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,585.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,757.16
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$43.19
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna American Axle |
$28.07
|
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.07
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$30.23
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.55
|
| Rate for Payer: Healthscope Commercial |
$38.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.71
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.23
|
| Rate for Payer: Priority Health SBD |
$27.21
|
| Rate for Payer: UMR Bronson Commercial |
$19.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.39
|
|
|
ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$417.60
|
|
|
Service Code
|
NDC 0185-0022-01
|
| Hospital Charge Code |
27146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.74 |
| Max. Negotiated Rate |
$375.84 |
| Rate for Payer: Aetna American Axle |
$271.44
|
| Rate for Payer: Aetna Commercial |
$354.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.44
|
| Rate for Payer: Cash Price |
$334.08
|
| Rate for Payer: Cofinity Commercial |
$292.32
|
| Rate for Payer: Cofinity Commercial |
$359.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.08
|
| Rate for Payer: Healthscope Commercial |
$375.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$354.96
|
| Rate for Payer: PHP Commercial |
$354.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.32
|
| Rate for Payer: Priority Health SBD |
$263.09
|
| Rate for Payer: UMR Bronson Commercial |
$183.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.20
|
|
|
ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 43386-480-24
|
| Hospital Charge Code |
27146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.86
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.86
|
| Rate for Payer: Priority Health SBD |
$171.77
|
| Rate for Payer: UMR Bronson Commercial |
$119.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
