|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$1,146.60 |
| Rate for Payer: Aetna American Axle |
$828.10
|
| Rate for Payer: Aetna Commercial |
$1,082.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.10
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$891.80
|
| Rate for Payer: Cofinity Commercial |
$1,095.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,019.20
|
| Rate for Payer: Healthscope Commercial |
$1,146.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$891.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$955.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,082.90
|
| Rate for Payer: PHP Commercial |
$1,082.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health SBD |
$802.62
|
| Rate for Payer: UMR Bronson Commercial |
$560.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$955.50
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
14040
|
| Min. Negotiated Rate |
$344.90 |
| Max. Negotiated Rate |
$891.80 |
| Rate for Payer: Aetna Commercial |
$663.21
|
| Rate for Payer: BCBS Complete |
$418.90
|
| Rate for Payer: BCBS Trust/PPO |
$344.90
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Meridian Medicaid |
$418.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$762.07
|
| Rate for Payer: Priority Health Narrow Network |
$762.07
|
| Rate for Payer: Priority Health SBD |
$762.07
|
| Rate for Payer: UMR Bronson Commercial |
$586.04
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$344.90 |
| Max. Negotiated Rate |
$891.80 |
| Rate for Payer: Aetna Commercial |
$663.21
|
| Rate for Payer: BCBS Complete |
$418.90
|
| Rate for Payer: BCBS Trust/PPO |
$344.90
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Meridian Medicaid |
$418.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$762.07
|
| Rate for Payer: Priority Health Narrow Network |
$762.07
|
| Rate for Payer: Priority Health SBD |
$762.07
|
| Rate for Payer: UMR Bronson Commercial |
$586.04
|
|
|
PR ADJUSTMENT GASTRIC BAND
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS S2083
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$486.56 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS Trust/PPO |
$486.56
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: UMR Bronson Commercial |
$51.98
|
|
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$588.13
|
| Rate for Payer: BCBS Complete |
$303.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Meridian Medicaid |
$303.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$703.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$679.16
|
| Rate for Payer: Priority Health Narrow Network |
$679.16
|
| Rate for Payer: Priority Health SBD |
$679.16
|
| Rate for Payer: UMR Bronson Commercial |
$462.30
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS G0010
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$1,469.20 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.97
|
| Rate for Payer: Priority Health Narrow Network |
$39.97
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$13.34
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0008
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$4,626.85 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,626.85
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.97
|
| Rate for Payer: Priority Health Narrow Network |
$39.97
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0009
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$1,331.32 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,331.32
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.97
|
| Rate for Payer: Priority Health Narrow Network |
$39.97
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
PR ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP
|
Professional
|
Both
|
$83.04
|
|
|
Service Code
|
HCPCS 96380
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$58.13 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: BCBS Complete |
$33.22
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: UMR Bronson Commercial |
$38.20
|
|
|
PR ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX
|
Professional
|
Both
|
$83.04
|
|
|
Service Code
|
HCPCS 96381
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$58.13 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: BCBS Complete |
$33.22
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
| Rate for Payer: UMR Bronson Commercial |
$38.20
|
|
|
PR ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR
|
Professional
|
Both
|
$4,350.00
|
|
|
Service Code
|
HCPCS 60545
|
| Min. Negotiated Rate |
$341.28 |
| Max. Negotiated Rate |
$3,045.00 |
| Rate for Payer: Aetna Commercial |
$1,609.79
|
| Rate for Payer: BCBS Complete |
$838.91
|
| Rate for Payer: BCBS Trust/PPO |
$341.28
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Meridian Medicaid |
$838.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$798.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,045.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,759.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,759.61
|
| Rate for Payer: Priority Health SBD |
$1,759.61
|
| Rate for Payer: UMR Bronson Commercial |
$2,001.00
|
|
|
PR ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX
|
Professional
|
Both
|
$3,303.00
|
|
|
Service Code
|
HCPCS 60540
|
| Min. Negotiated Rate |
$432.15 |
| Max. Negotiated Rate |
$2,312.10 |
| Rate for Payer: Aetna Commercial |
$1,390.93
|
| Rate for Payer: BCBS Complete |
$723.95
|
| Rate for Payer: BCBS Trust/PPO |
$432.15
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Meridian Medicaid |
$723.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$689.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,312.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,517.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,517.36
|
| Rate for Payer: Priority Health SBD |
$1,517.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,519.38
|
|
|
PR ADRENALIN EPINEPHRINE INJECT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J0171
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$0.77
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 99498
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$533.05 |
| Rate for Payer: Aetna Commercial |
$72.67
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$533.05
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.17
|
| Rate for Payer: Priority Health Narrow Network |
$92.17
|
| Rate for Payer: Priority Health SBD |
$92.17
|
| Rate for Payer: UMR Bronson Commercial |
$36.80
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 99497
|
| Min. Negotiated Rate |
$46.46 |
| Max. Negotiated Rate |
$569.51 |
| Rate for Payer: Aetna Commercial |
$77.18
|
| Rate for Payer: BCBS Complete |
$50.10
|
| Rate for Payer: BCBS Trust/PPO |
$569.51
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Meridian Medicaid |
$50.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.42
|
| Rate for Payer: Priority Health Narrow Network |
$97.42
|
| Rate for Payer: Priority Health SBD |
$97.42
|
| Rate for Payer: UMR Bronson Commercial |
$46.46
|
|
|
PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 92651
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$3,831.23 |
| Rate for Payer: Aetna Commercial |
$96.89
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,831.23
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.63
|
| Rate for Payer: Priority Health Narrow Network |
$113.63
|
| Rate for Payer: Priority Health SBD |
$113.63
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 92653
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$1,917.20 |
| Rate for Payer: Aetna Commercial |
$93.15
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,917.20
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.19
|
| Rate for Payer: Priority Health Narrow Network |
$113.19
|
| Rate for Payer: Priority Health SBD |
$113.19
|
| Rate for Payer: UMR Bronson Commercial |
$76.36
|
|
|
PR AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 92650
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$1,517.28 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.28
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.28
|
| Rate for Payer: Priority Health Narrow Network |
$37.28
|
| Rate for Payer: Priority Health SBD |
$37.28
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
|
|
PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 92652
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$4,564.51 |
| Rate for Payer: Aetna Commercial |
$127.57
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,564.51
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.81
|
| Rate for Payer: Priority Health Narrow Network |
$151.81
|
| Rate for Payer: Priority Health SBD |
$151.81
|
| Rate for Payer: UMR Bronson Commercial |
$104.88
|
|
|
PR AFO ANKLE GAUNTLET PRE OTS
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS L1902
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$44.96
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$33.12
|
|
|
PR AFO MULTILIG ANK SUP PRE OTS
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS L1906
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna Commercial |
$67.73
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: UMR Bronson Commercial |
$49.68
|
|
|
PR AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE
|
Professional
|
Both
|
$178.26
|
|
|
Service Code
|
HCPCS 90694
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| Rate for Payer: BCBS Complete |
$71.30
|
| Rate for Payer: BCBS Trust/PPO |
$77.36
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.78
|
| Rate for Payer: UMR Bronson Commercial |
$82.00
|
|
|
PR AK SLEEVE SUSP NEOPRENE/EQUA
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS L5695
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: UMR Bronson Commercial |
$71.76
|
|
|
PRALATREXATE 20 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20,803.16
|
|
|
Service Code
|
HCPCS J9307
|
| Hospital Charge Code |
99982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.16 |
| Max. Negotiated Rate |
$18,722.84 |
| Rate for Payer: Aetna American Axle |
$13,522.05
|
| Rate for Payer: Aetna Commercial |
$17,682.69
|
| Rate for Payer: Aetna Medicare |
$300.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,522.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.43
|
| Rate for Payer: BCBS Complete |
$166.08
|
| Rate for Payer: BCBS MAPPO |
$289.14
|
| Rate for Payer: BCBS Trust/PPO |
$934.35
|
| Rate for Payer: BCN Medicare Advantage |
$289.14
|
| Rate for Payer: Cash Price |
$16,642.53
|
| Rate for Payer: Cash Price |
$16,642.53
|
| Rate for Payer: Cofinity Commercial |
$17,890.72
|
| Rate for Payer: Cofinity Commercial |
$14,562.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,642.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.14
|
| Rate for Payer: Healthscope Commercial |
$18,722.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,562.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,602.37
|
| Rate for Payer: Mclaren Medicaid |
$158.16
|
| Rate for Payer: Mclaren Medicare |
$289.14
|
| Rate for Payer: Meridian Medicaid |
$166.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$303.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17,682.69
|
| Rate for Payer: PACE Medicare |
$274.68
|
| Rate for Payer: PACE SWMI |
$289.14
|
| Rate for Payer: PHP Commercial |
$17,682.69
|
| Rate for Payer: PHP Medicare Advantage |
$289.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,562.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.72
|
| Rate for Payer: Priority Health Medicare |
$289.14
|
| Rate for Payer: Priority Health Narrow Network |
$700.58
|
| Rate for Payer: Priority Health SBD |
$13,105.99
|
| Rate for Payer: Railroad Medicare Medicare |
$289.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.14
|
| Rate for Payer: UHC Medicare Advantage |
$297.82
|
| Rate for Payer: UMR Bronson Commercial |
$7,697.17
|
| Rate for Payer: VA VA |
$289.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,602.37
|
|
|
PRALATREXATE 40 MG/2 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$41,606.37
|
|
|
Service Code
|
HCPCS J9307
|
| Hospital Charge Code |
119254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.16 |
| Max. Negotiated Rate |
$37,445.73 |
| Rate for Payer: Aetna American Axle |
$27,044.14
|
| Rate for Payer: Aetna American Axle |
$41,163.87
|
| Rate for Payer: Aetna Commercial |
$53,829.68
|
| Rate for Payer: Aetna Commercial |
$35,365.41
|
| Rate for Payer: Aetna Medicare |
$300.71
|
| Rate for Payer: Aetna Medicare |
$300.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,044.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41,163.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.43
|
| Rate for Payer: BCBS Complete |
$166.08
|
| Rate for Payer: BCBS Complete |
$166.08
|
| Rate for Payer: BCBS MAPPO |
$289.14
|
| Rate for Payer: BCBS MAPPO |
$289.14
|
| Rate for Payer: BCBS Trust/PPO |
$934.35
|
| Rate for Payer: BCBS Trust/PPO |
$934.35
|
| Rate for Payer: BCN Medicare Advantage |
$289.14
|
| Rate for Payer: BCN Medicare Advantage |
$289.14
|
| Rate for Payer: Cash Price |
$33,285.10
|
| Rate for Payer: Cash Price |
$33,285.10
|
| Rate for Payer: Cash Price |
$50,663.22
|
| Rate for Payer: Cash Price |
$50,663.22
|
| Rate for Payer: Cofinity Commercial |
$54,462.97
|
| Rate for Payer: Cofinity Commercial |
$35,781.48
|
| Rate for Payer: Cofinity Commercial |
$29,124.46
|
| Rate for Payer: Cofinity Commercial |
$44,330.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50,663.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,285.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.14
|
| Rate for Payer: Healthscope Commercial |
$37,445.73
|
| Rate for Payer: Healthscope Commercial |
$56,996.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44,330.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,124.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,204.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47,496.77
|
| Rate for Payer: Mclaren Medicaid |
$158.16
|
| Rate for Payer: Mclaren Medicaid |
$158.16
|
| Rate for Payer: Mclaren Medicare |
$289.14
|
| Rate for Payer: Mclaren Medicare |
$289.14
|
| Rate for Payer: Meridian Medicaid |
$166.08
|
| Rate for Payer: Meridian Medicaid |
$166.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$303.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$303.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35,365.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53,829.68
|
| Rate for Payer: PACE Medicare |
$274.68
|
| Rate for Payer: PACE Medicare |
$274.68
|
| Rate for Payer: PACE SWMI |
$289.14
|
| Rate for Payer: PACE SWMI |
$289.14
|
| Rate for Payer: PHP Commercial |
$35,365.41
|
| Rate for Payer: PHP Commercial |
$53,829.68
|
| Rate for Payer: PHP Medicare Advantage |
$289.14
|
| Rate for Payer: PHP Medicare Advantage |
$289.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44,330.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29,124.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.72
|
| Rate for Payer: Priority Health Medicare |
$289.14
|
| Rate for Payer: Priority Health Medicare |
$289.14
|
| Rate for Payer: Priority Health Narrow Network |
$700.58
|
| Rate for Payer: Priority Health Narrow Network |
$700.58
|
| Rate for Payer: Priority Health SBD |
$39,897.29
|
| Rate for Payer: Priority Health SBD |
$26,212.01
|
| Rate for Payer: Railroad Medicare Medicare |
$289.14
|
| Rate for Payer: Railroad Medicare Medicare |
$289.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.14
|
| Rate for Payer: UHC Medicare Advantage |
$297.82
|
| Rate for Payer: UHC Medicare Advantage |
$297.82
|
| Rate for Payer: UMR Bronson Commercial |
$23,431.74
|
| Rate for Payer: UMR Bronson Commercial |
$15,394.36
|
| Rate for Payer: VA VA |
$289.14
|
| Rate for Payer: VA VA |
$289.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,204.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47,496.77
|
|
