|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,641.80
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
23796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,602.39 |
| Max. Negotiated Rate |
$3,277.62 |
| Rate for Payer: Aetna American Axle |
$2,367.17
|
| Rate for Payer: Aetna American Axle |
$962.81
|
| Rate for Payer: Aetna Commercial |
$1,259.06
|
| Rate for Payer: Aetna Commercial |
$3,095.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$962.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,367.17
|
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cash Price |
$1,185.00
|
| Rate for Payer: Cofinity Advantage |
$2,549.26
|
| Rate for Payer: Cofinity Advantage |
$1,036.88
|
| Rate for Payer: Cofinity Commercial |
$1,273.88
|
| Rate for Payer: Cofinity Commercial |
$3,131.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.44
|
| Rate for Payer: Healthscope Commercial |
$3,277.62
|
| Rate for Payer: Healthscope Commercial |
$1,333.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,036.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,549.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,110.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,731.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,095.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,110.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,731.35
|
| Rate for Payer: PHP Commercial |
$1,259.06
|
| Rate for Payer: PHP Commercial |
$3,095.53
|
| Rate for Payer: Priority Health SBD |
$933.19
|
| Rate for Payer: Priority Health SBD |
$2,294.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,602.39
|
| Rate for Payer: UMR Bronson Commercial |
$651.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,731.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,110.94
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,641.80
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
23796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$3,277.62 |
| Rate for Payer: Aetna American Axle |
$2,367.17
|
| Rate for Payer: Aetna American Axle |
$962.81
|
| Rate for Payer: Aetna Commercial |
$1,259.06
|
| Rate for Payer: Aetna Commercial |
$3,095.53
|
| Rate for Payer: Aetna Medicare |
$32.28
|
| Rate for Payer: Aetna Medicare |
$32.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$962.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,367.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.80
|
| Rate for Payer: BCBS Complete |
$17.05
|
| Rate for Payer: BCBS Complete |
$17.05
|
| Rate for Payer: BCBS MAPPO |
$31.04
|
| Rate for Payer: BCBS MAPPO |
$31.04
|
| Rate for Payer: BCBS Trust/PPO |
$105.12
|
| Rate for Payer: BCBS Trust/PPO |
$105.12
|
| Rate for Payer: BCN Commercial |
$105.12
|
| Rate for Payer: BCN Commercial |
$105.12
|
| Rate for Payer: BCN Medicare Advantage |
$31.04
|
| Rate for Payer: BCN Medicare Advantage |
$31.04
|
| Rate for Payer: Cash Price |
$1,185.00
|
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cash Price |
$1,185.00
|
| Rate for Payer: Cofinity Advantage |
$2,549.26
|
| Rate for Payer: Cofinity Advantage |
$1,036.88
|
| Rate for Payer: Cofinity Commercial |
$1,273.88
|
| Rate for Payer: Cofinity Commercial |
$3,131.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.04
|
| Rate for Payer: Healthscope Commercial |
$1,333.12
|
| Rate for Payer: Healthscope Commercial |
$3,277.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,549.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,036.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,110.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,731.35
|
| Rate for Payer: Mclaren Medicaid |
$31.04
|
| Rate for Payer: Mclaren Medicaid |
$31.04
|
| Rate for Payer: Mclaren Medicare |
$31.04
|
| Rate for Payer: Mclaren Medicare |
$31.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.59
|
| Rate for Payer: Meridian Medicaid |
$32.59
|
| Rate for Payer: Meridian Medicaid |
$32.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,095.53
|
| Rate for Payer: Nomi Health Commercial |
$93.12
|
| Rate for Payer: Nomi Health Commercial |
$93.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,731.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,110.94
|
| Rate for Payer: PACE Medicare |
$29.49
|
| Rate for Payer: PACE Medicare |
$29.49
|
| Rate for Payer: PACE SWMI |
$31.04
|
| Rate for Payer: PACE SWMI |
$31.04
|
| Rate for Payer: PHP Commercial |
$1,259.06
|
| Rate for Payer: PHP Commercial |
$3,095.53
|
| Rate for Payer: PHP Medicare Advantage |
$31.04
|
| Rate for Payer: PHP Medicare Advantage |
$31.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$98.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$98.06
|
| Rate for Payer: Priority Health Medicare |
$31.04
|
| Rate for Payer: Priority Health Medicare |
$31.04
|
| Rate for Payer: Priority Health SBD |
$933.19
|
| Rate for Payer: Priority Health SBD |
$2,294.33
|
| Rate for Payer: Priority Health Tiered Network |
$78.45
|
| Rate for Payer: Priority Health Tiered Network |
$78.45
|
| Rate for Payer: Railroad Medicare Medicare |
$31.04
|
| Rate for Payer: Railroad Medicare Medicare |
$31.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.49
|
| Rate for Payer: UHC Core |
$53.49
|
| Rate for Payer: UHC Core |
$53.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.04
|
| Rate for Payer: UHC Exchange |
$53.49
|
| Rate for Payer: UHC Exchange |
$53.49
|
| Rate for Payer: UHC Medicaid |
$16.23
|
| Rate for Payer: UHC Medicaid |
$16.23
|
| Rate for Payer: UHCCP Medicaid |
$16.23
|
| Rate for Payer: UHCCP Medicaid |
$16.23
|
| Rate for Payer: UMR Bronson Commercial |
$548.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,347.47
|
| Rate for Payer: VA VA |
$31.04
|
| Rate for Payer: VA VA |
$31.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,731.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,110.94
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,253.12
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
184064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$1,127.81 |
| Rate for Payer: Aetna American Axle |
$814.53
|
| Rate for Payer: Aetna American Axle |
$963.31
|
| Rate for Payer: Aetna Commercial |
$1,065.15
|
| Rate for Payer: Aetna Commercial |
$1,259.72
|
| Rate for Payer: Aetna Medicare |
$27.87
|
| Rate for Payer: Aetna Medicare |
$27.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.50
|
| Rate for Payer: BCBS Complete |
$14.72
|
| Rate for Payer: BCBS Complete |
$14.72
|
| Rate for Payer: BCBS MAPPO |
$26.80
|
| Rate for Payer: BCBS MAPPO |
$26.80
|
| Rate for Payer: BCBS Trust/PPO |
$86.98
|
| Rate for Payer: BCBS Trust/PPO |
$86.98
|
| Rate for Payer: BCN Commercial |
$86.98
|
| Rate for Payer: BCN Commercial |
$86.98
|
| Rate for Payer: BCN Medicare Advantage |
$26.80
|
| Rate for Payer: BCN Medicare Advantage |
$26.80
|
| Rate for Payer: Cash Price |
$1,185.62
|
| Rate for Payer: Cash Price |
$1,002.50
|
| Rate for Payer: Cash Price |
$1,002.50
|
| Rate for Payer: Cash Price |
$1,185.62
|
| Rate for Payer: Cofinity Advantage |
$1,037.41
|
| Rate for Payer: Cofinity Advantage |
$877.18
|
| Rate for Payer: Cofinity Commercial |
$1,077.68
|
| Rate for Payer: Cofinity Commercial |
$1,274.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.80
|
| Rate for Payer: Healthscope Commercial |
$1,127.81
|
| Rate for Payer: Healthscope Commercial |
$1,333.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$877.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,037.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$939.84
|
| Rate for Payer: Mclaren Medicaid |
$26.80
|
| Rate for Payer: Mclaren Medicaid |
$26.80
|
| Rate for Payer: Mclaren Medicare |
$26.80
|
| Rate for Payer: Mclaren Medicare |
$26.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.14
|
| Rate for Payer: Meridian Medicaid |
$28.14
|
| Rate for Payer: Meridian Medicaid |
$28.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.15
|
| Rate for Payer: Nomi Health Commercial |
$80.40
|
| Rate for Payer: Nomi Health Commercial |
$80.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$939.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,111.52
|
| Rate for Payer: PACE Medicare |
$25.46
|
| Rate for Payer: PACE Medicare |
$25.46
|
| Rate for Payer: PACE SWMI |
$26.80
|
| Rate for Payer: PACE SWMI |
$26.80
|
| Rate for Payer: PHP Commercial |
$1,065.15
|
| Rate for Payer: PHP Commercial |
$1,259.72
|
| Rate for Payer: PHP Medicare Advantage |
$26.80
|
| Rate for Payer: PHP Medicare Advantage |
$26.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$85.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$85.14
|
| Rate for Payer: Priority Health Medicare |
$26.80
|
| Rate for Payer: Priority Health Medicare |
$26.80
|
| Rate for Payer: Priority Health SBD |
$933.67
|
| Rate for Payer: Priority Health SBD |
$789.47
|
| Rate for Payer: Priority Health Tiered Network |
$68.11
|
| Rate for Payer: Priority Health Tiered Network |
$68.11
|
| Rate for Payer: Railroad Medicare Medicare |
$26.80
|
| Rate for Payer: Railroad Medicare Medicare |
$26.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.79
|
| Rate for Payer: UHC Core |
$45.79
|
| Rate for Payer: UHC Core |
$45.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.80
|
| Rate for Payer: UHC Exchange |
$45.79
|
| Rate for Payer: UHC Exchange |
$45.79
|
| Rate for Payer: UHC Medicaid |
$14.02
|
| Rate for Payer: UHC Medicaid |
$14.02
|
| Rate for Payer: UHCCP Medicaid |
$14.02
|
| Rate for Payer: UHCCP Medicaid |
$14.02
|
| Rate for Payer: UMR Bronson Commercial |
$463.65
|
| Rate for Payer: UMR Bronson Commercial |
$548.35
|
| Rate for Payer: VA VA |
$26.80
|
| Rate for Payer: VA VA |
$26.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$939.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.52
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,482.02
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
184064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$652.09 |
| Max. Negotiated Rate |
$1,333.82 |
| Rate for Payer: Aetna American Axle |
$963.31
|
| Rate for Payer: Aetna Commercial |
$1,259.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.31
|
| Rate for Payer: Cash Price |
$1,185.62
|
| Rate for Payer: Cofinity Advantage |
$1,037.41
|
| Rate for Payer: Cofinity Commercial |
$1,274.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.62
|
| Rate for Payer: Healthscope Commercial |
$1,333.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,037.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,111.52
|
| Rate for Payer: PHP Commercial |
$1,259.72
|
| Rate for Payer: Priority Health SBD |
$933.67
|
| Rate for Payer: UMR Bronson Commercial |
$652.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.52
|
|
|
INFLIXIMAB-AXXQ 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,201.22
|
|
|
Service Code
|
HCPCS Q5121
|
| Hospital Charge Code |
193365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$1,081.10 |
| Rate for Payer: Aetna American Axle |
$780.79
|
| Rate for Payer: Aetna Commercial |
$1,021.04
|
| Rate for Payer: Aetna Medicare |
$29.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.05
|
| Rate for Payer: BCBS Complete |
$15.40
|
| Rate for Payer: BCBS MAPPO |
$28.04
|
| Rate for Payer: BCBS Trust/PPO |
$111.23
|
| Rate for Payer: BCN Commercial |
$111.23
|
| Rate for Payer: BCN Medicare Advantage |
$28.04
|
| Rate for Payer: Cash Price |
$960.98
|
| Rate for Payer: Cash Price |
$960.98
|
| Rate for Payer: Cofinity Advantage |
$840.85
|
| Rate for Payer: Cofinity Commercial |
$1,033.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.04
|
| Rate for Payer: Healthscope Commercial |
$1,081.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$840.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.91
|
| Rate for Payer: Mclaren Medicaid |
$28.04
|
| Rate for Payer: Mclaren Medicare |
$28.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.44
|
| Rate for Payer: Meridian Medicaid |
$29.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.04
|
| Rate for Payer: Nomi Health Commercial |
$84.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$900.91
|
| Rate for Payer: PACE Medicare |
$26.64
|
| Rate for Payer: PACE SWMI |
$28.04
|
| Rate for Payer: PHP Commercial |
$1,021.04
|
| Rate for Payer: PHP Medicare Advantage |
$28.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$64.35
|
| Rate for Payer: Priority Health Medicare |
$28.04
|
| Rate for Payer: Priority Health SBD |
$756.77
|
| Rate for Payer: Priority Health Tiered Network |
$51.48
|
| Rate for Payer: Railroad Medicare Medicare |
$28.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.29
|
| Rate for Payer: UHC Core |
$39.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.04
|
| Rate for Payer: UHC Exchange |
$39.29
|
| Rate for Payer: UHC Medicaid |
$14.66
|
| Rate for Payer: UHCCP Medicaid |
$14.66
|
| Rate for Payer: UMR Bronson Commercial |
$444.45
|
| Rate for Payer: VA VA |
$28.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.91
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,818.98
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
181037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$800.35 |
| Max. Negotiated Rate |
$1,637.08 |
| Rate for Payer: Aetna American Axle |
$1,182.34
|
| Rate for Payer: Aetna Commercial |
$1,546.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.34
|
| Rate for Payer: Cash Price |
$1,455.18
|
| Rate for Payer: Cofinity Advantage |
$1,273.29
|
| Rate for Payer: Cofinity Commercial |
$1,564.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,455.18
|
| Rate for Payer: Healthscope Commercial |
$1,637.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,273.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,364.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,546.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,364.23
|
| Rate for Payer: PHP Commercial |
$1,546.13
|
| Rate for Payer: Priority Health SBD |
$1,145.96
|
| Rate for Payer: UMR Bronson Commercial |
$800.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,364.23
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,818.98
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
181037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$1,637.08 |
| Rate for Payer: Aetna American Axle |
$1,182.34
|
| Rate for Payer: Aetna Commercial |
$1,546.13
|
| Rate for Payer: Aetna Medicare |
$27.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.55
|
| Rate for Payer: BCBS Complete |
$14.30
|
| Rate for Payer: BCBS MAPPO |
$26.04
|
| Rate for Payer: BCBS Trust/PPO |
$143.63
|
| Rate for Payer: BCN Commercial |
$143.63
|
| Rate for Payer: BCN Medicare Advantage |
$26.04
|
| Rate for Payer: Cash Price |
$1,455.18
|
| Rate for Payer: Cash Price |
$1,455.18
|
| Rate for Payer: Cofinity Advantage |
$1,273.29
|
| Rate for Payer: Cofinity Commercial |
$1,564.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,455.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$1,637.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,273.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,364.23
|
| Rate for Payer: Mclaren Medicaid |
$26.04
|
| Rate for Payer: Mclaren Medicare |
$26.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.34
|
| Rate for Payer: Meridian Medicaid |
$27.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,546.13
|
| Rate for Payer: Nomi Health Commercial |
$78.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,364.23
|
| Rate for Payer: PACE Medicare |
$24.74
|
| Rate for Payer: PACE SWMI |
$26.04
|
| Rate for Payer: PHP Commercial |
$1,546.13
|
| Rate for Payer: PHP Medicare Advantage |
$26.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$63.06
|
| Rate for Payer: Priority Health Medicare |
$26.04
|
| Rate for Payer: Priority Health SBD |
$1,145.96
|
| Rate for Payer: Priority Health Tiered Network |
$50.45
|
| Rate for Payer: Railroad Medicare Medicare |
$26.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.96
|
| Rate for Payer: UHC Core |
$39.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.04
|
| Rate for Payer: UHC Exchange |
$39.96
|
| Rate for Payer: UHC Medicaid |
$13.62
|
| Rate for Payer: UHCCP Medicaid |
$13.62
|
| Rate for Payer: UMR Bronson Commercial |
$673.02
|
| Rate for Payer: VA VA |
$26.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,364.23
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC
|
Facility
|
IP
|
$32,683.16
|
|
|
Service Code
|
MSDRG 351
|
| Min. Negotiated Rate |
$12,674.81 |
| Max. Negotiated Rate |
$32,683.16 |
| Rate for Payer: Aetna Medicare |
$13,875.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,677.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,677.38
|
| Rate for Payer: BCBS MAPPO |
$13,341.90
|
| Rate for Payer: BCBS Trust/PPO |
$32,683.16
|
| Rate for Payer: BCN Commercial |
$32,683.16
|
| Rate for Payer: BCN Medicare Advantage |
$13,341.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,341.90
|
| Rate for Payer: Mclaren Medicare |
$13,341.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,009.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,343.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,676.09
|
| Rate for Payer: Nomi Health Commercial |
$19,666.05
|
| Rate for Payer: PACE Medicare |
$12,674.81
|
| Rate for Payer: PACE SWMI |
$13,341.90
|
| Rate for Payer: PHP Medicare Advantage |
$13,341.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,578.20
|
| Rate for Payer: Priority Health Medicare |
$13,341.90
|
| Rate for Payer: Priority Health Tiered Network |
$19,662.56
|
| Rate for Payer: Railroad Medicare Medicare |
$13,341.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,849.35
|
| Rate for Payer: UHC Core |
$20,789.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,341.90
|
| Rate for Payer: UHC Exchange |
$16,978.36
|
| Rate for Payer: VA VA |
$13,341.90
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC
|
Facility
|
IP
|
$40,617.97
|
|
|
Service Code
|
MSDRG 350
|
| Min. Negotiated Rate |
$20,360.35 |
| Max. Negotiated Rate |
$40,617.97 |
| Rate for Payer: Aetna Medicare |
$22,289.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,789.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,789.94
|
| Rate for Payer: BCBS MAPPO |
$21,431.95
|
| Rate for Payer: BCBS Trust/PPO |
$38,036.11
|
| Rate for Payer: BCN Commercial |
$38,036.11
|
| Rate for Payer: BCN Medicare Advantage |
$21,431.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,431.95
|
| Rate for Payer: Mclaren Medicare |
$21,431.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,503.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,646.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,575.15
|
| Rate for Payer: Nomi Health Commercial |
$32,145.51
|
| Rate for Payer: PACE Medicare |
$20,360.35
|
| Rate for Payer: PACE SWMI |
$21,431.95
|
| Rate for Payer: PHP Medicare Advantage |
$21,431.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$40,174.76
|
| Rate for Payer: Priority Health Medicare |
$21,431.95
|
| Rate for Payer: Priority Health Tiered Network |
$32,139.80
|
| Rate for Payer: Railroad Medicare Medicare |
$21,431.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40,617.97
|
| Rate for Payer: UHC Core |
$33,982.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,431.95
|
| Rate for Payer: UHC Exchange |
$27,752.29
|
| Rate for Payer: VA VA |
$21,431.95
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$32,296.10
|
|
|
Service Code
|
MSDRG 352
|
| Min. Negotiated Rate |
$9,840.97 |
| Max. Negotiated Rate |
$32,296.10 |
| Rate for Payer: Aetna Medicare |
$10,773.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,948.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,948.65
|
| Rate for Payer: BCBS MAPPO |
$10,358.92
|
| Rate for Payer: BCBS Trust/PPO |
$32,296.10
|
| Rate for Payer: BCN Commercial |
$32,296.10
|
| Rate for Payer: BCN Medicare Advantage |
$10,358.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,358.92
|
| Rate for Payer: Mclaren Medicare |
$10,358.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,876.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,912.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,394.81
|
| Rate for Payer: Nomi Health Commercial |
$15,064.62
|
| Rate for Payer: PACE Medicare |
$9,840.97
|
| Rate for Payer: PACE SWMI |
$10,358.92
|
| Rate for Payer: PHP Medicare Advantage |
$10,358.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,827.44
|
| Rate for Payer: Priority Health Medicare |
$10,358.92
|
| Rate for Payer: Priority Health Tiered Network |
$15,061.95
|
| Rate for Payer: Railroad Medicare Medicare |
$10,358.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,035.14
|
| Rate for Payer: UHC Core |
$15,925.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,358.92
|
| Rate for Payer: UHC Exchange |
$13,005.79
|
| Rate for Payer: VA VA |
$10,358.92
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$20,814.10
|
|
|
Service Code
|
APR-DRG 2284
|
| Min. Negotiated Rate |
$19,822.95 |
| Max. Negotiated Rate |
$20,814.10 |
| Rate for Payer: BCBS Complete |
$20,814.10
|
| Rate for Payer: Mclaren Medicaid |
$19,822.95
|
| Rate for Payer: Meridian Medicaid |
$20,814.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,822.95
|
| Rate for Payer: UHC Medicaid |
$19,822.95
|
| Rate for Payer: UHCCP Medicaid |
$19,822.95
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$7,395.26
|
|
|
Service Code
|
APR-DRG 2281
|
| Min. Negotiated Rate |
$7,043.10 |
| Max. Negotiated Rate |
$7,395.26 |
| Rate for Payer: BCBS Complete |
$7,395.26
|
| Rate for Payer: Mclaren Medicaid |
$7,043.10
|
| Rate for Payer: Meridian Medicaid |
$7,395.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,043.10
|
| Rate for Payer: UHC Medicaid |
$7,043.10
|
| Rate for Payer: UHCCP Medicaid |
$7,043.10
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$10,102.27
|
|
|
Service Code
|
APR-DRG 2282
|
| Min. Negotiated Rate |
$9,621.21 |
| Max. Negotiated Rate |
$10,102.27 |
| Rate for Payer: BCBS Complete |
$10,102.27
|
| Rate for Payer: Mclaren Medicaid |
$9,621.21
|
| Rate for Payer: Meridian Medicaid |
$10,102.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,621.21
|
| Rate for Payer: UHC Medicaid |
$9,621.21
|
| Rate for Payer: UHCCP Medicaid |
$9,621.21
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$11,870.42
|
|
|
Service Code
|
APR-DRG 2283
|
| Min. Negotiated Rate |
$11,305.17 |
| Max. Negotiated Rate |
$11,870.42 |
| Rate for Payer: BCBS Complete |
$11,870.42
|
| Rate for Payer: Mclaren Medicaid |
$11,305.17
|
| Rate for Payer: Meridian Medicaid |
$11,870.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,305.17
|
| Rate for Payer: UHC Medicaid |
$11,305.17
|
| Rate for Payer: UHCCP Medicaid |
$11,305.17
|
|
|
INHALATIONAL SPACING DEVICE
|
Facility
|
OP
|
$39.08
|
|
|
Service Code
|
NDC 08373747800
|
| Hospital Charge Code |
113188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna American Axle |
$25.40
|
| Rate for Payer: Aetna Commercial |
$33.22
|
| Rate for Payer: Aetna Medicare |
$19.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.40
|
| Rate for Payer: BCBS Complete |
$15.63
|
| Rate for Payer: Cash Price |
$31.26
|
| Rate for Payer: Cofinity Advantage |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$33.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.26
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.31
|
| Rate for Payer: PHP Commercial |
$33.22
|
| Rate for Payer: Priority Health SBD |
$24.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.40
|
| Rate for Payer: UHC Core |
$20.36
|
| Rate for Payer: UHC Exchange |
$15.36
|
| Rate for Payer: UMR Bronson Commercial |
$14.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.31
|
|
|
INHALATIONAL SPACING DEVICE
|
Facility
|
OP
|
$39.08
|
|
|
Service Code
|
NDC 8373747800
|
| Hospital Charge Code |
113188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna American Axle |
$25.40
|
| Rate for Payer: Aetna Commercial |
$33.22
|
| Rate for Payer: Aetna Medicare |
$19.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.40
|
| Rate for Payer: BCBS Complete |
$15.63
|
| Rate for Payer: Cash Price |
$31.26
|
| Rate for Payer: Cofinity Advantage |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$33.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.26
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.31
|
| Rate for Payer: PHP Commercial |
$33.22
|
| Rate for Payer: Priority Health SBD |
$24.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.40
|
| Rate for Payer: UHC Core |
$20.36
|
| Rate for Payer: UHC Exchange |
$15.36
|
| Rate for Payer: UMR Bronson Commercial |
$14.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.31
|
|
|
INHALATIONAL SPACING DEVICE
|
Facility
|
OP
|
$29.35
|
|
|
Service Code
|
NDC 08373077478
|
| Hospital Charge Code |
113188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$26.41 |
| Rate for Payer: Aetna American Axle |
$19.08
|
| Rate for Payer: Aetna Commercial |
$24.95
|
| Rate for Payer: Aetna Medicare |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.08
|
| Rate for Payer: BCBS Complete |
$11.74
|
| Rate for Payer: Cash Price |
$23.48
|
| Rate for Payer: Cofinity Advantage |
$20.55
|
| Rate for Payer: Cofinity Commercial |
$25.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.48
|
| Rate for Payer: Healthscope Commercial |
$26.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.01
|
| Rate for Payer: PHP Commercial |
$24.95
|
| Rate for Payer: Priority Health SBD |
$18.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.08
|
| Rate for Payer: UHC Core |
$15.29
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UMR Bronson Commercial |
$10.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.01
|
|
|
INHALATIONAL SPACING DEVICE
|
Facility
|
IP
|
$39.08
|
|
|
Service Code
|
NDC 08373747800
|
| Hospital Charge Code |
113188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna American Axle |
$25.40
|
| Rate for Payer: Aetna Commercial |
$33.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.40
|
| Rate for Payer: Cash Price |
$31.26
|
| Rate for Payer: Cofinity Advantage |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$33.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.26
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.31
|
| Rate for Payer: PHP Commercial |
$33.22
|
| Rate for Payer: Priority Health SBD |
$24.62
|
| Rate for Payer: UMR Bronson Commercial |
$17.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.31
|
|
|
INHALATIONAL SPACING DEVICE
|
Facility
|
IP
|
$29.35
|
|
|
Service Code
|
NDC 08373077478
|
| Hospital Charge Code |
113188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$26.41 |
| Rate for Payer: Aetna American Axle |
$19.08
|
| Rate for Payer: Aetna Commercial |
$24.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.08
|
| Rate for Payer: Cash Price |
$23.48
|
| Rate for Payer: Cofinity Advantage |
$20.55
|
| Rate for Payer: Cofinity Commercial |
$25.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.48
|
| Rate for Payer: Healthscope Commercial |
$26.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.01
|
| Rate for Payer: PHP Commercial |
$24.95
|
| Rate for Payer: Priority Health SBD |
$18.49
|
| Rate for Payer: UMR Bronson Commercial |
$12.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.01
|
|
|
INJECTION, EPINEPHRINE (ADRENALIN), NOT THERAPEUTICALLY EQUIVALENT TO J0165, 0.1 MG
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
CPT J0169
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: BCBS Trust/PPO |
$4.46
|
| Rate for Payer: BCN Commercial |
$4.46
|
|
|
INJECTION OF SCLEROSANT; MULTIPLE INCOMPETENT VEINS (OTHER THAN TELANGIECTASIA), SAME LEG
|
Facility
|
OP
|
$1,309.90
|
|
|
Service Code
|
CPT 36471
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$373.60
|
| Rate for Payer: BCN Commercial |
$373.60
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITH ANESTHESIA
|
Facility
|
OP
|
$1,894.98
|
|
|
Service Code
|
CPT 27095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,894.98 |
| Max. Negotiated Rate |
$1,894.98 |
| Rate for Payer: BCBS Trust/PPO |
$1,894.98
|
| Rate for Payer: BCN Commercial |
$1,894.98
|
|
|
INJECTION PROCEDURE FOR SACROILIAC JOINT, ANESTHETIC/STEROID, WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) INCLUDING ARTHROGRAPHY WHEN PERFORMED
|
Facility
|
OP
|
$929.79
|
|
|
Service Code
|
CPT 27096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$258.82 |
| Max. Negotiated Rate |
$929.79 |
| Rate for Payer: BCBS Trust/PPO |
$929.79
|
| Rate for Payer: BCN Commercial |
$929.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$323.52
|
| Rate for Payer: Priority Health Tiered Network |
$258.82
|
|
|
INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY
|
Facility
|
OP
|
$2,274.56
|
|
|
Service Code
|
CPT G0260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$720.45
|
| Rate for Payer: BCN Commercial |
$720.45
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
INJECTION PROCEDURE; RADIOACTIVE TRACER FOR IDENTIFICATION OF SENTINEL NODE
|
Facility
|
OP
|
$1,288.18
|
|
|
Service Code
|
CPT 38792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$177.13 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$177.13
|
| Rate for Payer: BCN Commercial |
$177.13
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
