|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
OP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$30.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: BCBS Complete |
$24.14
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - HUMAN (HUMULIN R)
|
Facility
|
IP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
180910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$26.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)
|
Facility
|
IP
|
$290.23
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
180908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.70 |
| Max. Negotiated Rate |
$261.21 |
| Rate for Payer: Aetna American Axle |
$188.65
|
| Rate for Payer: Aetna Commercial |
$246.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.65
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Commercial |
$203.16
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Healthscope Commercial |
$261.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.70
|
| Rate for Payer: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.65
|
| Rate for Payer: Priority Health SBD |
$182.84
|
| Rate for Payer: UMR Bronson Commercial |
$127.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.67
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - INSULIN GLULISINE (APIDRA)
|
Facility
|
OP
|
$290.23
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
180908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$261.21 |
| Rate for Payer: Aetna American Axle |
$188.65
|
| Rate for Payer: Aetna Commercial |
$246.70
|
| Rate for Payer: Aetna Medicare |
$145.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.65
|
| Rate for Payer: BCBS Complete |
$116.09
|
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cash Price |
$232.18
|
| Rate for Payer: Cofinity Commercial |
$203.16
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.18
|
| Rate for Payer: Healthscope Commercial |
$261.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.70
|
| Rate for Payer: PHP Commercial |
$246.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.65
|
| Rate for Payer: Priority Health SBD |
$182.84
|
| Rate for Payer: UMR Bronson Commercial |
$107.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.67
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
IP
|
$177.23
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.98 |
| Max. Negotiated Rate |
$159.51 |
| Rate for Payer: Aetna American Axle |
$115.20
|
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.20
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cofinity Commercial |
$124.06
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.78
|
| Rate for Payer: Healthscope Commercial |
$159.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.65
|
| Rate for Payer: PHP Commercial |
$150.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.20
|
| Rate for Payer: Priority Health SBD |
$111.65
|
| Rate for Payer: UMR Bronson Commercial |
$77.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.92
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - LISPRO (HUMALOG)
|
Facility
|
OP
|
$177.23
|
|
|
Service Code
|
NDC 00002751001
|
| Hospital Charge Code |
180914
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$159.51 |
| Rate for Payer: Aetna American Axle |
$115.20
|
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna Medicare |
$88.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.20
|
| Rate for Payer: BCBS Complete |
$70.89
|
| Rate for Payer: Cash Price |
$141.78
|
| Rate for Payer: Cofinity Commercial |
$124.06
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.78
|
| Rate for Payer: Healthscope Commercial |
$159.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.65
|
| Rate for Payer: PHP Commercial |
$150.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.20
|
| Rate for Payer: Priority Health SBD |
$111.65
|
| Rate for Payer: UMR Bronson Commercial |
$65.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.92
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)
|
Facility
|
IP
|
$5,065.60
|
|
|
Service Code
|
NDC 00002850101
|
| Hospital Charge Code |
180916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,228.86 |
| Max. Negotiated Rate |
$4,559.04 |
| Rate for Payer: Aetna American Axle |
$3,292.64
|
| Rate for Payer: Aetna Commercial |
$4,305.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,292.64
|
| Rate for Payer: Cash Price |
$4,052.48
|
| Rate for Payer: Cofinity Commercial |
$3,545.92
|
| Rate for Payer: Cofinity Commercial |
$4,356.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,545.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,052.48
|
| Rate for Payer: Healthscope Commercial |
$4,559.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,545.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,799.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,305.76
|
| Rate for Payer: PHP Commercial |
$4,305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,292.64
|
| Rate for Payer: Priority Health SBD |
$3,191.33
|
| Rate for Payer: UMR Bronson Commercial |
$2,228.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,799.20
|
|
|
INSULIN SUBCUTANEOUS BASAL PUMP - REGULAR HUMAN (U-500)
|
Facility
|
OP
|
$5,065.60
|
|
|
Service Code
|
NDC 00002850101
|
| Hospital Charge Code |
180916
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,874.27 |
| Max. Negotiated Rate |
$4,559.04 |
| Rate for Payer: Aetna American Axle |
$3,292.64
|
| Rate for Payer: Aetna Commercial |
$4,305.76
|
| Rate for Payer: Aetna Medicare |
$2,532.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,292.64
|
| Rate for Payer: BCBS Complete |
$2,026.24
|
| Rate for Payer: Cash Price |
$4,052.48
|
| Rate for Payer: Cofinity Commercial |
$3,545.92
|
| Rate for Payer: Cofinity Commercial |
$4,356.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,545.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,052.48
|
| Rate for Payer: Healthscope Commercial |
$4,559.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,545.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,799.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,305.76
|
| Rate for Payer: PHP Commercial |
$4,305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,292.64
|
| Rate for Payer: Priority Health SBD |
$3,191.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,874.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,799.20
|
|
|
INSULIN SUBCUTANEOUS BOLUS PUMP - INSULIN GLULISINE (APIDRA)
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
180909
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: BCBS Trust/PPO |
$1.46
|
| Rate for Payer: BCN Commercial |
$1.46
|
|
|
INSULIN SUBCUTANEOUS CONTINUOUS BASAL PUMP - ASPARTATE (NOVOLOG)
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
180912
|
|
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 Commercial |
$118.37
|
| Rate for Payer: Cofinity Commercial |
$96.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.35
|
| 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: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health SBD |
$86.71
|
| Rate for Payer: UMR Bronson Commercial |
$50.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
INSULIN SUBCUTANEOUS CONTINUOUS BASAL PUMP - ASPARTATE (NOVOLOG)
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
NDC 00169750111
|
| Hospital Charge Code |
180912
|
|
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 Commercial |
$118.37
|
| Rate for Payer: Cofinity Commercial |
$96.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.35
|
| 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: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| 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 U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$30.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: BCBS Complete |
$24.14
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
10289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$26.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
IP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
301806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$26.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INSULIN U-100 REGULAR HUMAN 100 UNIT/ML SQ FOR INSULIN PUMP REFILL
|
Facility
|
OP
|
$60.35
|
|
|
Service Code
|
NDC 00002821501
|
| Hospital Charge Code |
301806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$54.32 |
| Rate for Payer: Aetna American Axle |
$39.23
|
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Medicare |
$30.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: BCBS Complete |
$24.14
|
| Rate for Payer: Cash Price |
$48.28
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.28
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.30
|
| Rate for Payer: PHP Commercial |
$51.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.26
|
|
|
INTERFERON ALFA-2B 50 MILLION UNIT (1 ML) SOLUTION FOR INJECTION
|
Facility
|
OP
|
$6,726.43
|
|
|
Service Code
|
HCPCS J9214
|
| Hospital Charge Code |
10304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.81 |
| Max. Negotiated Rate |
$6,053.79 |
| Rate for Payer: Aetna American Axle |
$4,372.18
|
| Rate for Payer: Aetna Commercial |
$5,717.47
|
| Rate for Payer: Aetna Medicare |
$3,363.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,372.18
|
| Rate for Payer: BCBS Complete |
$2,690.57
|
| Rate for Payer: BCBS Trust/PPO |
$87.81
|
| Rate for Payer: BCN Commercial |
$87.81
|
| Rate for Payer: Cash Price |
$5,381.14
|
| Rate for Payer: Cash Price |
$5,381.14
|
| Rate for Payer: Cofinity Commercial |
$4,708.50
|
| Rate for Payer: Cofinity Commercial |
$5,784.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,708.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,381.14
|
| Rate for Payer: Healthscope Commercial |
$6,053.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,708.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,044.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,717.47
|
| Rate for Payer: PHP Commercial |
$5,717.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,372.18
|
| Rate for Payer: Priority Health SBD |
$4,237.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,488.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,044.82
|
|
|
INTERFERON ALFA-2B 50 MILLION UNIT (1 ML) SOLUTION FOR INJECTION
|
Facility
|
IP
|
$6,726.43
|
|
|
Service Code
|
HCPCS J9214
|
| Hospital Charge Code |
10304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,959.63 |
| Max. Negotiated Rate |
$6,053.79 |
| Rate for Payer: Aetna American Axle |
$4,372.18
|
| Rate for Payer: Aetna Commercial |
$5,717.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,372.18
|
| Rate for Payer: Cash Price |
$5,381.14
|
| Rate for Payer: Cofinity Commercial |
$4,708.50
|
| Rate for Payer: Cofinity Commercial |
$5,784.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,708.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,381.14
|
| Rate for Payer: Healthscope Commercial |
$6,053.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,708.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,044.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,717.47
|
| Rate for Payer: PHP Commercial |
$5,717.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,372.18
|
| Rate for Payer: Priority Health SBD |
$4,237.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,959.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,044.82
|
|
|
INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL NEUROLYSIS)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 64727
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$170.56 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$675.95
|
| Rate for Payer: BCN Commercial |
$675.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.62
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$170.56
|
|
|
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF TONGUE OR FLOOR OF MOUTH; SUBMANDIBULAR SPACE
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 41008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$245.47 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,464.71
|
| Rate for Payer: BCN Commercial |
$1,464.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.02
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$245.47
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; EACH ADDITIONAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$850.88
|
|
|
Service Code
|
CPT 37253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.96 |
| Max. Negotiated Rate |
$850.88 |
| Rate for Payer: BCBS Trust/PPO |
$850.88
|
| Rate for Payer: BCN Commercial |
$850.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.76
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$67.96
|
|
|
INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; INITIAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$5,766.76
|
|
|
Service Code
|
CPT 37252
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.51 |
| Max. Negotiated Rate |
$5,766.76 |
| Rate for Payer: BCBS Trust/PPO |
$5,766.76
|
| Rate for Payer: BCN Commercial |
$5,766.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.06
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$85.51
|
|
|
INTRAVENOUS INJECTION OF AGENT (EG, FLUORESCEIN) TO TEST VASCULAR FLOW IN FLAP OR GRAFT
|
Facility
|
OP
|
$1,228.82
|
|
|
Service Code
|
CPT 15860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$103.12 |
| Max. Negotiated Rate |
$1,228.82 |
| Rate for Payer: Aetna Medicare |
$406.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$246.22
|
| Rate for Payer: BCN Commercial |
$246.22
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Nomi Health Commercial |
$1,172.91
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.82
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$983.06
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.43
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Exchange |
$103.12
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$209.56
|
| Rate for Payer: VA VA |
$390.97
|
|
|
INTRODUCTION OF CATHETER, AORTA
|
Facility
|
OP
|
$1,923.02
|
|
|
Service Code
|
CPT 36200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.71 |
| Max. Negotiated Rate |
$1,923.02 |
| Rate for Payer: BCBS Trust/PPO |
$1,923.02
|
| Rate for Payer: BCN Commercial |
$1,923.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.18
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$134.71
|
|
|
INTRODUCTION OF CATHETER, AORTA
|
Facility
|
OP
|
$1,923.02
|
|
|
Service Code
|
CPT 36200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$134.71 |
| Max. Negotiated Rate |
$1,923.02 |
| Rate for Payer: BCBS Trust/PPO |
$1,923.02
|
| Rate for Payer: BCN Commercial |
$1,923.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.18
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$134.71
|
|
|
INTRODUCTION OF CATHETER, SUPERIOR OR INFERIOR VENA CAVA
|
Facility
|
OP
|
$1,732.21
|
|
|
Service Code
|
CPT 36010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$1,732.21 |
| Rate for Payer: BCBS Trust/PPO |
$1,732.21
|
| Rate for Payer: BCN Commercial |
$1,732.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.78
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$104.35
|
|
