|
INDUCED ABORTION, BY DILATION AND CURETTAGE
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 59840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,350.05
|
| Rate for Payer: BCN Commercial |
$1,350.05
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.24
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$218.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
INDUCED ABORTION, BY DILATION AND EVACUATION
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 59841
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$368.60 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,071.45
|
| Rate for Payer: BCN Commercial |
$4,071.45
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.46
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$368.60
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
INEBILIZUMAB-CDON 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$118,815.92
|
|
|
Service Code
|
HCPCS J1823
|
| Hospital Charge Code |
194137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52,279.00 |
| Max. Negotiated Rate |
$106,934.33 |
| Rate for Payer: Aetna American Axle |
$77,230.35
|
| Rate for Payer: Aetna Commercial |
$100,993.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77,230.35
|
| Rate for Payer: Cash Price |
$95,052.74
|
| Rate for Payer: Cofinity Commercial |
$102,181.69
|
| Rate for Payer: Cofinity Commercial |
$83,171.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$83,171.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95,052.74
|
| Rate for Payer: Healthscope Commercial |
$106,934.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83,171.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89,111.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100,993.53
|
| Rate for Payer: PHP Commercial |
$100,993.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77,230.35
|
| Rate for Payer: Priority Health SBD |
$74,854.03
|
| Rate for Payer: UMR Bronson Commercial |
$52,279.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89,111.94
|
|
|
INEBILIZUMAB-CDON 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$118,815.92
|
|
|
Service Code
|
HCPCS J1823
|
| Hospital Charge Code |
194137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$259.64 |
| Max. Negotiated Rate |
$106,934.33 |
| Rate for Payer: Aetna American Axle |
$77,230.35
|
| Rate for Payer: Aetna Commercial |
$100,993.53
|
| Rate for Payer: Aetna Medicare |
$503.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77,230.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$605.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$605.50
|
| Rate for Payer: BCBS Complete |
$272.62
|
| Rate for Payer: BCBS MAPPO |
$484.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,306.10
|
| Rate for Payer: BCN Commercial |
$1,306.10
|
| Rate for Payer: BCN Medicare Advantage |
$484.40
|
| Rate for Payer: Cash Price |
$95,052.74
|
| Rate for Payer: Cash Price |
$95,052.74
|
| Rate for Payer: Cofinity Commercial |
$83,171.14
|
| Rate for Payer: Cofinity Commercial |
$102,181.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$83,171.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95,052.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.40
|
| Rate for Payer: Healthscope Commercial |
$106,934.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83,171.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89,111.94
|
| Rate for Payer: Mclaren Medicaid |
$259.64
|
| Rate for Payer: Mclaren Medicare |
$484.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$508.62
|
| Rate for Payer: Meridian Medicaid |
$272.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$557.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100,993.53
|
| Rate for Payer: Nomi Health Commercial |
$1,453.20
|
| Rate for Payer: PACE Medicare |
$460.18
|
| Rate for Payer: PACE SWMI |
$484.40
|
| Rate for Payer: PHP Commercial |
$100,993.53
|
| Rate for Payer: PHP Medicare Advantage |
$484.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77,230.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,394.12
|
| Rate for Payer: Priority Health Medicare |
$484.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,115.30
|
| Rate for Payer: Priority Health SBD |
$74,854.03
|
| Rate for Payer: Railroad Medicare Medicare |
$484.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,363.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$484.40
|
| Rate for Payer: UHC Exchange |
$925.74
|
| Rate for Payer: UHC Medicare Advantage |
$484.40
|
| Rate for Payer: UHCCP Medicaid |
$259.64
|
| Rate for Payer: UMR Bronson Commercial |
$43,961.89
|
| Rate for Payer: VA VA |
$484.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89,111.94
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,481.25
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
23796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$1,333.12 |
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cash Price |
$1,185.00
|
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cash Price |
$1,185.00
|
| Rate for Payer: Cofinity Commercial |
$2,549.26
|
| Rate for Payer: Cofinity Commercial |
$1,036.88
|
| Rate for Payer: Cofinity Commercial |
$1,273.88
|
| Rate for Payer: Cofinity Commercial |
$3,131.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,036.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,549.26
|
| Rate for Payer: Aetna American Axle |
$962.81
|
| Rate for Payer: Aetna American Axle |
$2,367.17
|
| Rate for Payer: Aetna Commercial |
$3,095.53
|
| Rate for Payer: Aetna Commercial |
$1,259.06
|
| Rate for Payer: Aetna Medicare |
$31.75
|
| Rate for Payer: Aetna Medicare |
$31.75
|
| 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 |
$38.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.16
|
| Rate for Payer: BCBS Complete |
$17.18
|
| Rate for Payer: BCBS Complete |
$17.18
|
| Rate for Payer: BCBS MAPPO |
$30.53
|
| Rate for Payer: BCBS MAPPO |
$30.53
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$86.88
|
| Rate for Payer: BCN Commercial |
$86.88
|
| Rate for Payer: BCN Medicare Advantage |
$30.53
|
| Rate for Payer: BCN Medicare Advantage |
$30.53
|
| 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 |
$30.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.53
|
| 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 |
$16.36
|
| Rate for Payer: Mclaren Medicaid |
$16.36
|
| Rate for Payer: Mclaren Medicare |
$30.53
|
| Rate for Payer: Mclaren Medicare |
$30.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.06
|
| Rate for Payer: Meridian Medicaid |
$17.18
|
| Rate for Payer: Meridian Medicaid |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.11
|
| 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 |
$91.59
|
| Rate for Payer: Nomi Health Commercial |
$91.59
|
| Rate for Payer: PACE Medicare |
$29.00
|
| Rate for Payer: PACE Medicare |
$29.00
|
| Rate for Payer: PACE SWMI |
$30.53
|
| Rate for Payer: PACE SWMI |
$30.53
|
| Rate for Payer: PHP Commercial |
$1,259.06
|
| Rate for Payer: PHP Commercial |
$3,095.53
|
| Rate for Payer: PHP Medicare Advantage |
$30.53
|
| Rate for Payer: PHP Medicare Advantage |
$30.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$962.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,367.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.75
|
| Rate for Payer: Priority Health Medicare |
$30.53
|
| Rate for Payer: Priority Health Medicare |
$30.53
|
| Rate for Payer: Priority Health Narrow Network |
$74.20
|
| Rate for Payer: Priority Health Narrow Network |
$74.20
|
| Rate for Payer: Priority Health SBD |
$933.19
|
| Rate for Payer: Priority Health SBD |
$2,294.33
|
| Rate for Payer: Railroad Medicare Medicare |
$30.53
|
| Rate for Payer: Railroad Medicare Medicare |
$30.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.53
|
| Rate for Payer: UHC Exchange |
$58.35
|
| Rate for Payer: UHC Exchange |
$58.35
|
| Rate for Payer: UHC Medicare Advantage |
$30.53
|
| Rate for Payer: UHC Medicare Advantage |
$30.53
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: UMR Bronson Commercial |
$548.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,347.47
|
| Rate for Payer: VA VA |
$30.53
|
| Rate for Payer: VA VA |
$30.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,110.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,731.35
|
|
|
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 |
$1,185.00
|
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cofinity Commercial |
$1,273.88
|
| Rate for Payer: Cofinity Commercial |
$1,036.88
|
| Rate for Payer: Cofinity Commercial |
$2,549.26
|
| Rate for Payer: Cofinity Commercial |
$3,131.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,036.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,549.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.00
|
| 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 |
$1,036.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,549.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,731.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,110.94
|
| 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: PHP Commercial |
$1,259.06
|
| Rate for Payer: PHP Commercial |
$3,095.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,367.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$962.81
|
| 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 |
$1,110.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,731.35
|
|
|
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 |
$14.08 |
| 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 |
$27.31
|
| Rate for Payer: Aetna Medicare |
$27.31
|
| 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 |
$32.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.82
|
| Rate for Payer: BCBS Complete |
$14.78
|
| Rate for Payer: BCBS Complete |
$14.78
|
| Rate for Payer: BCBS MAPPO |
$26.26
|
| Rate for Payer: BCBS MAPPO |
$26.26
|
| Rate for Payer: BCBS Trust/PPO |
$70.74
|
| Rate for Payer: BCBS Trust/PPO |
$70.74
|
| Rate for Payer: BCN Commercial |
$70.74
|
| Rate for Payer: BCN Commercial |
$70.74
|
| Rate for Payer: BCN Medicare Advantage |
$26.26
|
| Rate for Payer: BCN Medicare Advantage |
$26.26
|
| Rate for Payer: Cash Price |
$1,185.62
|
| Rate for Payer: Cash Price |
$1,002.50
|
| Rate for Payer: Cash Price |
$1,185.62
|
| Rate for Payer: Cash Price |
$1,002.50
|
| Rate for Payer: Cofinity Commercial |
$1,274.54
|
| Rate for Payer: Cofinity Commercial |
$1,037.41
|
| Rate for Payer: Cofinity Commercial |
$1,077.68
|
| Rate for Payer: Cofinity Commercial |
$877.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$877.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,037.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.26
|
| Rate for Payer: Healthscope Commercial |
$1,333.82
|
| Rate for Payer: Healthscope Commercial |
$1,127.81
|
| 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 |
$939.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.52
|
| Rate for Payer: Mclaren Medicaid |
$14.08
|
| Rate for Payer: Mclaren Medicaid |
$14.08
|
| Rate for Payer: Mclaren Medicare |
$26.26
|
| Rate for Payer: Mclaren Medicare |
$26.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.57
|
| Rate for Payer: Meridian Medicaid |
$14.78
|
| Rate for Payer: Meridian Medicaid |
$14.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.72
|
| Rate for Payer: Nomi Health Commercial |
$78.78
|
| Rate for Payer: Nomi Health Commercial |
$78.78
|
| Rate for Payer: PACE Medicare |
$24.95
|
| Rate for Payer: PACE Medicare |
$24.95
|
| Rate for Payer: PACE SWMI |
$26.26
|
| Rate for Payer: PACE SWMI |
$26.26
|
| Rate for Payer: PHP Commercial |
$1,259.72
|
| Rate for Payer: PHP Commercial |
$1,065.15
|
| Rate for Payer: PHP Medicare Advantage |
$26.26
|
| Rate for Payer: PHP Medicare Advantage |
$26.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.22
|
| Rate for Payer: Priority Health Medicare |
$26.26
|
| Rate for Payer: Priority Health Medicare |
$26.26
|
| Rate for Payer: Priority Health Narrow Network |
$62.58
|
| Rate for Payer: Priority Health Narrow Network |
$62.58
|
| Rate for Payer: Priority Health SBD |
$789.47
|
| Rate for Payer: Priority Health SBD |
$933.67
|
| Rate for Payer: Railroad Medicare Medicare |
$26.26
|
| Rate for Payer: Railroad Medicare Medicare |
$26.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.26
|
| Rate for Payer: UHC Exchange |
$50.19
|
| Rate for Payer: UHC Exchange |
$50.19
|
| Rate for Payer: UHC Medicare Advantage |
$26.26
|
| Rate for Payer: UHC Medicare Advantage |
$26.26
|
| Rate for Payer: UHCCP Medicaid |
$14.08
|
| Rate for Payer: UHCCP Medicaid |
$14.08
|
| Rate for Payer: UMR Bronson Commercial |
$463.65
|
| Rate for Payer: UMR Bronson Commercial |
$548.35
|
| Rate for Payer: VA VA |
$26.26
|
| Rate for Payer: VA VA |
$26.26
|
| 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 Commercial |
$1,037.41
|
| Rate for Payer: Cofinity Commercial |
$1,274.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,037.41
|
| 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: PHP Commercial |
$1,259.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.31
|
| 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 |
$10.63 |
| 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 |
$20.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.79
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: BCBS MAPPO |
$19.83
|
| Rate for Payer: BCBS Trust/PPO |
$92.89
|
| Rate for Payer: BCN Commercial |
$92.89
|
| Rate for Payer: BCN Medicare Advantage |
$19.83
|
| Rate for Payer: Cash Price |
$960.98
|
| Rate for Payer: Cash Price |
$960.98
|
| Rate for Payer: Cofinity Commercial |
$840.85
|
| Rate for Payer: Cofinity Commercial |
$1,033.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$840.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.83
|
| 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 |
$900.92
|
| Rate for Payer: Mclaren Medicaid |
$10.63
|
| Rate for Payer: Mclaren Medicare |
$19.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.82
|
| Rate for Payer: Meridian Medicaid |
$11.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.04
|
| Rate for Payer: Nomi Health Commercial |
$59.49
|
| Rate for Payer: PACE Medicare |
$18.84
|
| Rate for Payer: PACE SWMI |
$19.83
|
| Rate for Payer: PHP Commercial |
$1,021.04
|
| Rate for Payer: PHP Medicare Advantage |
$19.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.28
|
| Rate for Payer: Priority Health Medicare |
$19.83
|
| Rate for Payer: Priority Health Narrow Network |
$49.02
|
| Rate for Payer: Priority Health SBD |
$756.77
|
| Rate for Payer: Railroad Medicare Medicare |
$19.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.83
|
| Rate for Payer: UHC Exchange |
$37.90
|
| Rate for Payer: UHC Medicare Advantage |
$19.83
|
| Rate for Payer: UHCCP Medicaid |
$10.63
|
| Rate for Payer: UMR Bronson Commercial |
$444.45
|
| Rate for Payer: VA VA |
$19.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.92
|
|
|
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 Commercial |
$1,273.29
|
| Rate for Payer: Cofinity Commercial |
$1,564.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,273.29
|
| 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 |
$1,364.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,546.13
|
| Rate for Payer: PHP Commercial |
$1,546.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,182.34
|
| 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 |
$1,364.24
|
|
|
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 |
$6.19 |
| 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 |
$12.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.44
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: BCBS MAPPO |
$11.55
|
| Rate for Payer: BCBS Trust/PPO |
$120.20
|
| Rate for Payer: BCN Commercial |
$120.20
|
| Rate for Payer: BCN Medicare Advantage |
$11.55
|
| Rate for Payer: Cash Price |
$1,455.18
|
| Rate for Payer: Cash Price |
$1,455.18
|
| Rate for Payer: Cofinity Commercial |
$1,564.32
|
| Rate for Payer: Cofinity Commercial |
$1,273.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,273.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,455.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.55
|
| 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 |
$1,364.24
|
| Rate for Payer: Mclaren Medicaid |
$6.19
|
| Rate for Payer: Mclaren Medicare |
$11.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.13
|
| Rate for Payer: Meridian Medicaid |
$6.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,546.13
|
| Rate for Payer: Nomi Health Commercial |
$34.65
|
| Rate for Payer: PACE Medicare |
$10.97
|
| Rate for Payer: PACE SWMI |
$11.55
|
| Rate for Payer: PHP Commercial |
$1,546.13
|
| Rate for Payer: PHP Medicare Advantage |
$11.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,182.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.19
|
| Rate for Payer: Priority Health Medicare |
$11.55
|
| Rate for Payer: Priority Health Narrow Network |
$31.35
|
| Rate for Payer: Priority Health SBD |
$1,145.96
|
| Rate for Payer: Railroad Medicare Medicare |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.55
|
| Rate for Payer: UHC Exchange |
$22.07
|
| Rate for Payer: UHC Medicare Advantage |
$11.55
|
| Rate for Payer: UHCCP Medicaid |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$673.02
|
| Rate for Payer: VA VA |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,364.24
|
|
|
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 Commercial |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$33.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.36
|
| 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: PHP Commercial |
$33.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.40
|
| 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
|
OP
|
$29.35
|
|
|
Service Code
|
NDC 08373077478
|
| Hospital Charge Code |
113188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$26.42 |
| 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 Commercial |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$25.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.48
|
| Rate for Payer: Healthscope Commercial |
$26.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.95
|
| Rate for Payer: PHP Commercial |
$24.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.08
|
| Rate for Payer: Priority Health SBD |
$18.49
|
| Rate for Payer: UMR Bronson Commercial |
$10.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.01
|
|
|
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 Commercial |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$33.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.36
|
| 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: PHP Commercial |
$33.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.40
|
| Rate for Payer: Priority Health SBD |
$24.62
|
| Rate for Payer: UMR Bronson Commercial |
$14.46
|
| 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 |
$26.42 |
| 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 Commercial |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$25.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.48
|
| Rate for Payer: Healthscope Commercial |
$26.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.95
|
| Rate for Payer: PHP Commercial |
$24.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.08
|
| 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, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)
|
Facility
|
OP
|
$2,741.59
|
|
|
Service Code
|
CPT 64510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.19 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$657.20
|
| Rate for Payer: BCN Commercial |
$657.20
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.51
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$73.19
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
INJECTION, INTRALESIONAL; UP TO AND INCLUDING 7 LESIONS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28.58 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$223.52
|
| Rate for Payer: BCN Commercial |
$223.52
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.44
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$28.58
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
INJECTION OF SCLEROSANT; MULTIPLE INCOMPETENT VEINS (OTHER THAN TELANGIECTASIA), SAME LEG
|
Facility
|
OP
|
$1,230.33
|
|
|
Service Code
|
CPT 36471
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$73.47 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$309.25
|
| Rate for Payer: BCN Commercial |
$309.25
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.82
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$73.47
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
INJECTION OF SCLEROSANT; SINGLE INCOMPETENT VEIN (OTHER THAN TELANGIECTASIA)
|
Facility
|
OP
|
$1,230.33
|
|
|
Service Code
|
CPT 36470
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.88 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$137.22
|
| Rate for Payer: BCN Commercial |
$137.22
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.57
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$36.88
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 24220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$431.05
|
| Rate for Payer: BCN Commercial |
$431.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.74
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$63.40
|
|
|
INJECTION PROCEDURE FOR EXTREMITY VENOGRAPHY (INCLUDING INTRODUCTION OF NEEDLE OR INTRACATHETER)
|
Facility
|
OP
|
$1,903.11
|
|
|
Service Code
|
CPT 36005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$1,903.11 |
| Rate for Payer: BCBS Trust/PPO |
$1,903.11
|
| Rate for Payer: BCN Commercial |
$1,903.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.16
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$45.60
|
|
|
INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITH ANESTHESIA
|
Facility
|
OP
|
$1,568.57
|
|
|
Service Code
|
CPT 27095
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$1,568.57 |
| Rate for Payer: BCBS Trust/PPO |
$1,568.57
|
| Rate for Payer: BCN Commercial |
$1,568.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.62
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$78.75
|
|
|
INJECTION PROCEDURE FOR RETROGRADE URETHROCYSTOGRAPHY
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 51610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$61.06 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$496.41
|
| Rate for Payer: BCN Commercial |
$496.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.17
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$61.06
|
|
|
INJECTION PROCEDURE FOR SACROILIAC JOINT, ANESTHETIC/STEROID, WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) INCLUDING ARTHROGRAPHY WHEN PERFORMED
|
Facility
|
OP
|
$769.63
|
|
|
Service Code
|
CPT 27096
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$79.19 |
| Max. Negotiated Rate |
$769.63 |
| Rate for Payer: BCBS Trust/PPO |
$769.63
|
| Rate for Payer: BCN Commercial |
$769.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.52
|
| Rate for Payer: Priority Health Narrow Network |
$258.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.11
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$79.19
|
|
|
INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY
|
Facility
|
OP
|
$2,132.58
|
|
|
Service Code
|
CPT G0260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$596.35
|
| Rate for Payer: BCN Commercial |
$596.35
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,909.97
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,296.72
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
