|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$10,174.29
|
|
|
Service Code
|
CPT 36561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,093.74
|
| Rate for Payer: BCN Commercial |
$3,093.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; YOUNGER THAN 5 YEARS OF AGE
|
Facility
|
OP
|
$10,174.29
|
|
|
Service Code
|
CPT 36560
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,400.27
|
| Rate for Payer: BCN Commercial |
$2,400.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$10,174.29
|
|
|
Service Code
|
CPT 36558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,668.21
|
| Rate for Payer: BCN Commercial |
$2,668.21
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN
|
Facility
|
OP
|
$11,537.07
|
|
|
Service Code
|
CPT 49421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,865.82 |
| Max. Negotiated Rate |
$11,537.07 |
| Rate for Payer: Aetna Medicare |
$3,710.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,191.89
|
| Rate for Payer: BCN Commercial |
$3,191.89
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Mclaren Medicaid |
$3,567.53
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$3,745.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Nomi Health Commercial |
$10,702.59
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,537.07
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health Tiered Network |
$9,229.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
|
INSERTION OR REPLACEMENT OF BREAST IMPLANT ON SEPARATE DAY FROM MASTECTOMY
|
Facility
|
OP
|
$26,336.97
|
|
|
Service Code
|
CPT 19342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,259.31 |
| Max. Negotiated Rate |
$26,336.97 |
| Rate for Payer: Aetna Medicare |
$8,469.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,180.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,180.00
|
| Rate for Payer: BCBS Complete |
$4,472.68
|
| Rate for Payer: BCBS MAPPO |
$8,144.00
|
| Rate for Payer: BCBS Trust/PPO |
$8,573.95
|
| Rate for Payer: BCN Commercial |
$8,573.95
|
| Rate for Payer: BCN Medicare Advantage |
$8,144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,144.00
|
| Rate for Payer: Mclaren Medicaid |
$8,144.00
|
| Rate for Payer: Mclaren Medicare |
$8,144.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,551.20
|
| Rate for Payer: Meridian Medicaid |
$8,551.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,365.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,958.40
|
| Rate for Payer: Nomi Health Commercial |
$24,432.00
|
| Rate for Payer: PACE Medicare |
$7,736.80
|
| Rate for Payer: PACE SWMI |
$8,144.00
|
| Rate for Payer: PHP Medicare Advantage |
$8,144.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,259.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,336.97
|
| Rate for Payer: Priority Health Medicare |
$8,144.00
|
| Rate for Payer: Priority Health Tiered Network |
$21,069.58
|
| Rate for Payer: Railroad Medicare Medicare |
$8,144.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,144.00
|
| Rate for Payer: UHC Medicaid |
$4,259.31
|
| Rate for Payer: UHCCP Medicaid |
$4,259.31
|
| Rate for Payer: VA VA |
$8,144.00
|
|
|
INSERTION OR REPLACEMENT OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR SYSTEM WITH SUBSTERNAL ELECTRODE(S), INCLUDING ALL IMAGING GUIDANCE AND ELECTROPHYSIOLOGICAL EVALUATION (INCLUDES DEFIBRILLATION THRESHOLD EVALUATION, INDUCTION OF ARRHYTHMIA, EVALUATION OF SENSING FOR ARRHYTHMIA TERMINATION, AND PROGRAMMING OR REPROGRAMMING OF SENSING OR THERAPEUTIC PARAMETERS), WHEN PERFORMED
|
Facility
|
OP
|
$101,143.75
|
|
|
Service Code
|
CPT 0571T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,357.34 |
| Max. Negotiated Rate |
$101,143.75 |
| Rate for Payer: Aetna Medicare |
$32,527.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,094.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,094.99
|
| Rate for Payer: BCBS Complete |
$17,176.77
|
| Rate for Payer: BCBS MAPPO |
$31,275.99
|
| Rate for Payer: BCBS Trust/PPO |
$34,754.75
|
| Rate for Payer: BCN Commercial |
$34,754.75
|
| Rate for Payer: BCN Medicare Advantage |
$31,275.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,275.99
|
| Rate for Payer: Mclaren Medicaid |
$31,275.99
|
| Rate for Payer: Mclaren Medicare |
$31,275.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,839.79
|
| Rate for Payer: Meridian Medicaid |
$32,839.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,967.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$34,403.59
|
| Rate for Payer: Nomi Health Commercial |
$93,827.97
|
| Rate for Payer: PACE Medicare |
$29,712.19
|
| Rate for Payer: PACE SWMI |
$31,275.99
|
| Rate for Payer: PHP Medicare Advantage |
$31,275.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,357.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$101,143.75
|
| Rate for Payer: Priority Health Medicare |
$31,275.99
|
| Rate for Payer: Priority Health Tiered Network |
$80,915.00
|
| Rate for Payer: Railroad Medicare Medicare |
$31,275.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31,275.99
|
| Rate for Payer: UHC Medicaid |
$16,357.34
|
| Rate for Payer: UHCCP Medicaid |
$16,357.34
|
| Rate for Payer: VA VA |
$31,275.99
|
|
|
INSERTION OR REPLACEMENT OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$62,512.62
|
|
|
Service Code
|
CPT 64590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,109.77 |
| Max. Negotiated Rate |
$62,512.62 |
| Rate for Payer: Aetna Medicare |
$20,103.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,162.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,162.94
|
| Rate for Payer: BCBS Complete |
$10,616.23
|
| Rate for Payer: BCBS MAPPO |
$19,330.35
|
| Rate for Payer: BCBS Trust/PPO |
$30,862.81
|
| Rate for Payer: BCN Commercial |
$30,862.81
|
| Rate for Payer: BCN Medicare Advantage |
$19,330.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,330.35
|
| Rate for Payer: Mclaren Medicaid |
$19,330.35
|
| Rate for Payer: Mclaren Medicare |
$19,330.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,296.87
|
| Rate for Payer: Meridian Medicaid |
$20,296.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,263.38
|
| Rate for Payer: Nomi Health Commercial |
$57,991.05
|
| Rate for Payer: PACE Medicare |
$18,363.83
|
| Rate for Payer: PACE SWMI |
$19,330.35
|
| Rate for Payer: PHP Medicare Advantage |
$19,330.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,109.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62,512.62
|
| Rate for Payer: Priority Health Medicare |
$19,330.35
|
| Rate for Payer: Priority Health Tiered Network |
$50,010.10
|
| Rate for Payer: Railroad Medicare Medicare |
$19,330.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,330.35
|
| Rate for Payer: UHC Medicaid |
$10,109.77
|
| Rate for Payer: UHCCP Medicaid |
$10,109.77
|
| Rate for Payer: VA VA |
$19,330.35
|
|
|
INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$99,432.20
|
|
|
Service Code
|
CPT 63685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,080.55 |
| Max. Negotiated Rate |
$99,432.20 |
| Rate for Payer: Aetna Medicare |
$31,976.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,433.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,433.43
|
| Rate for Payer: BCBS Complete |
$16,886.11
|
| Rate for Payer: BCBS MAPPO |
$30,746.74
|
| Rate for Payer: BCBS Trust/PPO |
$40,527.02
|
| Rate for Payer: BCN Commercial |
$40,527.02
|
| Rate for Payer: BCN Medicare Advantage |
$30,746.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,746.74
|
| Rate for Payer: Mclaren Medicaid |
$30,746.74
|
| Rate for Payer: Mclaren Medicare |
$30,746.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,284.08
|
| Rate for Payer: Meridian Medicaid |
$32,284.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,358.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$33,821.41
|
| Rate for Payer: Nomi Health Commercial |
$92,240.22
|
| Rate for Payer: PACE Medicare |
$29,209.40
|
| Rate for Payer: PACE SWMI |
$30,746.74
|
| Rate for Payer: PHP Medicare Advantage |
$30,746.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,080.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$99,432.20
|
| Rate for Payer: Priority Health Medicare |
$30,746.74
|
| Rate for Payer: Priority Health Tiered Network |
$79,545.76
|
| Rate for Payer: Railroad Medicare Medicare |
$30,746.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30,746.74
|
| Rate for Payer: UHC Medicaid |
$16,080.55
|
| Rate for Payer: UHCCP Medicaid |
$16,080.55
|
| Rate for Payer: VA VA |
$30,746.74
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$42,479.89
|
|
|
Service Code
|
APR-DRG 1764
|
| Min. Negotiated Rate |
$40,457.04 |
| Max. Negotiated Rate |
$42,479.89 |
| Rate for Payer: BCBS Complete |
$42,479.89
|
| Rate for Payer: Mclaren Medicaid |
$40,457.04
|
| Rate for Payer: Meridian Medicaid |
$42,479.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$40,457.04
|
| Rate for Payer: UHC Medicaid |
$40,457.04
|
| Rate for Payer: UHCCP Medicaid |
$40,457.04
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$11,245.73
|
|
|
Service Code
|
APR-DRG 1761
|
| Min. Negotiated Rate |
$10,710.22 |
| Max. Negotiated Rate |
$11,245.73 |
| Rate for Payer: BCBS Complete |
$11,245.73
|
| Rate for Payer: Mclaren Medicaid |
$10,710.22
|
| Rate for Payer: Meridian Medicaid |
$11,245.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,710.22
|
| Rate for Payer: UHC Medicaid |
$10,710.22
|
| Rate for Payer: UHCCP Medicaid |
$10,710.22
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$28,803.78
|
|
|
Service Code
|
APR-DRG 1763
|
| Min. Negotiated Rate |
$27,432.18 |
| Max. Negotiated Rate |
$28,803.78 |
| Rate for Payer: BCBS Complete |
$28,803.78
|
| Rate for Payer: Mclaren Medicaid |
$27,432.18
|
| Rate for Payer: Meridian Medicaid |
$28,803.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$27,432.18
|
| Rate for Payer: UHC Medicaid |
$27,432.18
|
| Rate for Payer: UHCCP Medicaid |
$27,432.18
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$23,050.78
|
|
|
Service Code
|
APR-DRG 1762
|
| Min. Negotiated Rate |
$21,953.12 |
| Max. Negotiated Rate |
$23,050.78 |
| Rate for Payer: BCBS Complete |
$23,050.78
|
| Rate for Payer: Mclaren Medicaid |
$21,953.12
|
| Rate for Payer: Meridian Medicaid |
$23,050.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,953.12
|
| Rate for Payer: UHC Medicaid |
$21,953.12
|
| Rate for Payer: UHCCP Medicaid |
$21,953.12
|
|
|
INSULIN 1 UNIT/ ML INFUSION 100 ML (IV PREMIX)
|
Facility
|
OP
|
$77.40
|
|
|
Service Code
|
NDC 09900001834
|
| Hospital Charge Code |
300906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.64 |
| Max. Negotiated Rate |
$69.66 |
| Rate for Payer: Aetna American Axle |
$50.31
|
| Rate for Payer: Aetna Commercial |
$65.79
|
| Rate for Payer: Aetna Medicare |
$38.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.31
|
| Rate for Payer: BCBS Complete |
$30.96
|
| Rate for Payer: Cash Price |
$61.92
|
| Rate for Payer: Cofinity Advantage |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$66.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.92
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.05
|
| Rate for Payer: PHP Commercial |
$65.79
|
| Rate for Payer: Priority Health SBD |
$48.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.31
|
| Rate for Payer: UHC Core |
$40.33
|
| Rate for Payer: UHC Exchange |
$30.42
|
| Rate for Payer: UMR Bronson Commercial |
$28.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.05
|
|
|
INSULIN 1 UNIT/ ML INFUSION 100 ML (IV PREMIX)
|
Facility
|
IP
|
$77.40
|
|
|
Service Code
|
NDC 09900001834
|
| Hospital Charge Code |
300906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$69.66 |
| Rate for Payer: Aetna American Axle |
$50.31
|
| Rate for Payer: Aetna Commercial |
$65.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.31
|
| Rate for Payer: Cash Price |
$61.92
|
| Rate for Payer: Cofinity Advantage |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$66.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.92
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.05
|
| Rate for Payer: PHP Commercial |
$65.79
|
| Rate for Payer: Priority Health SBD |
$48.76
|
| Rate for Payer: UMR Bronson Commercial |
$34.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.05
|
|
|
INSULIN 5 UNIT/5 ML IV PUSH 5 ML
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 09900001138
|
| Hospital Charge Code |
300205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna American Axle |
$13.00
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Advantage |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
INSULIN 5 UNIT/5 ML IV PUSH 5 ML
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 09900001138
|
| Hospital Charge Code |
300205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna American Axle |
$13.00
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Advantage |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.00
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: UHC Exchange |
$7.86
|
| Rate for Payer: UMR Bronson Commercial |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
INSULIN ASPART 100 UNIT/ML CUSTOM SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
180447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.93 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna American Axle |
$89.47
|
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna Medicare |
$68.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: BCBS Complete |
$55.06
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Advantage |
$96.35
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.23
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health SBD |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.47
|
| Rate for Payer: UHC Core |
$71.71
|
| Rate for Payer: UHC Exchange |
$54.09
|
| Rate for Payer: UMR Bronson Commercial |
$50.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
INSULIN ASPART 100 UNIT/ML CUSTOM SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
180447
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.56 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna American Axle |
$89.47
|
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.47
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Advantage |
$96.35
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.23
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health SBD |
$86.71
|
| Rate for Payer: UMR Bronson Commercial |
$60.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UMR Bronson Commercial |
$50.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UMR Bronson Commercial |
$50.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$31.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: BCBS Complete |
$25.58
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Advantage |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.56
|
| Rate for Payer: UHC Core |
$33.31
|
| Rate for Payer: UHC Exchange |
$25.13
|
| Rate for Payer: UMR Bronson Commercial |
$23.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
IP
|
$63.94
|
|
|
Service Code
|
NDC 00169633910
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$57.55 |
| Rate for Payer: Aetna American Axle |
$41.56
|
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: Cash Price |
$51.15
|
| Rate for Payer: Cofinity Advantage |
$44.76
|
| Rate for Payer: Cofinity Commercial |
$54.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$57.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.95
|
| Rate for Payer: PHP Commercial |
$54.35
|
| Rate for Payer: Priority Health SBD |
$40.28
|
| Rate for Payer: UMR Bronson Commercial |
$28.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.95
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010315
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$57.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.17
|
| Rate for Payer: UHC Core |
$60.25
|
| Rate for Payer: UHC Exchange |
$45.45
|
| Rate for Payer: UMR Bronson Commercial |
$42.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
300798
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$57.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.17
|
| Rate for Payer: UHC Core |
$60.25
|
| Rate for Payer: UHC Exchange |
$45.45
|
| Rate for Payer: UMR Bronson Commercial |
$42.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
|
INSULIN ASPART (U-100) 100 UNIT/ML (3 ML) HIGH DOSE SUBCUTANEOUS PEN CUSTOM OB
|
Facility
|
OP
|
$115.64
|
|
|
Service Code
|
NDC 73070010310
|
| Hospital Charge Code |
301084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$104.08 |
| Rate for Payer: Aetna American Axle |
$75.17
|
| Rate for Payer: Aetna Commercial |
$98.29
|
| Rate for Payer: Aetna Medicare |
$57.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.17
|
| Rate for Payer: BCBS Complete |
$46.26
|
| Rate for Payer: Cash Price |
$92.51
|
| Rate for Payer: Cofinity Advantage |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$99.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.51
|
| Rate for Payer: Healthscope Commercial |
$104.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.73
|
| Rate for Payer: PHP Commercial |
$98.29
|
| Rate for Payer: Priority Health SBD |
$72.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.17
|
| Rate for Payer: UHC Core |
$60.25
|
| Rate for Payer: UHC Exchange |
$45.45
|
| Rate for Payer: UMR Bronson Commercial |
$42.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.73
|
|
