|
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
|
OP
|
$34,252.33
|
|
|
Service Code
|
CPT 58554
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,539.41 |
| Max. Negotiated Rate |
$34,252.33 |
| Rate for Payer: Aetna Medicare |
$11,015.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,239.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,239.51
|
| Rate for Payer: BCBS Complete |
$5,816.91
|
| Rate for Payer: BCBS MAPPO |
$10,591.61
|
| Rate for Payer: BCBS Trust/PPO |
$9,084.65
|
| Rate for Payer: BCN Commercial |
$9,084.65
|
| Rate for Payer: BCN Medicare Advantage |
$10,591.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,591.61
|
| Rate for Payer: Mclaren Medicaid |
$10,591.61
|
| Rate for Payer: Mclaren Medicare |
$10,591.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,121.19
|
| Rate for Payer: Meridian Medicaid |
$11,121.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,180.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,650.77
|
| Rate for Payer: Nomi Health Commercial |
$31,774.83
|
| Rate for Payer: PACE Medicare |
$10,062.03
|
| Rate for Payer: PACE SWMI |
$10,591.61
|
| Rate for Payer: PHP Medicare Advantage |
$10,591.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,539.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,252.33
|
| Rate for Payer: Priority Health Medicare |
$10,591.61
|
| Rate for Payer: Priority Health Tiered Network |
$27,401.86
|
| Rate for Payer: Railroad Medicare Medicare |
$10,591.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,591.61
|
| Rate for Payer: UHC Medicaid |
$5,539.41
|
| Rate for Payer: UHCCP Medicaid |
$5,539.41
|
| Rate for Payer: VA VA |
$10,591.61
|
|
|
LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,425.80
|
|
|
Service Code
|
HCPCS J1931
|
| Hospital Charge Code |
35779
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.89 |
| Max. Negotiated Rate |
$3,083.22 |
| Rate for Payer: Aetna American Axle |
$2,226.77
|
| Rate for Payer: Aetna Commercial |
$2,911.93
|
| Rate for Payer: Aetna Medicare |
$41.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,226.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.94
|
| Rate for Payer: BCBS Complete |
$21.94
|
| Rate for Payer: BCBS MAPPO |
$39.95
|
| Rate for Payer: BCBS Trust/PPO |
$129.53
|
| Rate for Payer: BCN Commercial |
$129.53
|
| Rate for Payer: BCN Medicare Advantage |
$39.95
|
| Rate for Payer: Cash Price |
$2,740.64
|
| Rate for Payer: Cash Price |
$2,740.64
|
| Rate for Payer: Cofinity Advantage |
$2,398.06
|
| Rate for Payer: Cofinity Commercial |
$2,946.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,740.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$3,083.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,398.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,569.35
|
| Rate for Payer: Mclaren Medicaid |
$39.95
|
| Rate for Payer: Mclaren Medicare |
$39.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.95
|
| Rate for Payer: Meridian Medicaid |
$41.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,911.93
|
| Rate for Payer: Nomi Health Commercial |
$119.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,569.35
|
| Rate for Payer: PACE Medicare |
$37.95
|
| Rate for Payer: PACE SWMI |
$39.95
|
| Rate for Payer: PHP Commercial |
$2,911.93
|
| Rate for Payer: PHP Medicare Advantage |
$39.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$125.74
|
| Rate for Payer: Priority Health Medicare |
$39.95
|
| Rate for Payer: Priority Health SBD |
$2,158.25
|
| Rate for Payer: Priority Health Tiered Network |
$100.59
|
| Rate for Payer: Railroad Medicare Medicare |
$39.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.92
|
| Rate for Payer: UHC Core |
$65.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$39.95
|
| Rate for Payer: UHC Exchange |
$65.92
|
| Rate for Payer: UHC Medicaid |
$20.89
|
| Rate for Payer: UHCCP Medicaid |
$20.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,267.55
|
| Rate for Payer: VA VA |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,569.35
|
|
|
LARONIDASE 2.9 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,425.80
|
|
|
Service Code
|
HCPCS J1931
|
| Hospital Charge Code |
35779
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,507.35 |
| Max. Negotiated Rate |
$3,083.22 |
| Rate for Payer: Aetna American Axle |
$2,226.77
|
| Rate for Payer: Aetna Commercial |
$2,911.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,226.77
|
| Rate for Payer: Cash Price |
$2,740.64
|
| Rate for Payer: Cofinity Advantage |
$2,398.06
|
| Rate for Payer: Cofinity Commercial |
$2,946.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,740.64
|
| Rate for Payer: Healthscope Commercial |
$3,083.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,398.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,569.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,911.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,569.35
|
| Rate for Payer: PHP Commercial |
$2,911.93
|
| Rate for Payer: Priority Health SBD |
$2,158.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,507.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,569.35
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;
|
Facility
|
OP
|
$12,013.78
|
|
|
Service Code
|
CPT 31535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,455.29
|
| Rate for Payer: BCN Commercial |
$3,455.29
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Mclaren Medicaid |
$3,714.94
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$12,013.78
|
|
|
Service Code
|
CPT 31536
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$4,236.34
|
| Rate for Payer: BCN Commercial |
$4,236.34
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Mclaren Medicaid |
$3,714.94
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$12,013.78
|
|
|
Service Code
|
CPT 31541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,259.74
|
| Rate for Payer: BCN Commercial |
$5,259.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Mclaren Medicaid |
$3,714.94
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL;
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,249.58
|
| Rate for Payer: BCN Commercial |
$1,249.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$12,013.78
|
|
|
Service Code
|
CPT 31571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,060.37
|
| Rate for Payer: BCN Commercial |
$5,060.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Mclaren Medicaid |
$3,714.94
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, EXCEPT NEWBORN
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,560.49
|
| Rate for Payer: BCN Commercial |
$3,560.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MICROSCOPE OR TELESCOPE
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 31526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$927.54 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,166.05
|
| Rate for Payer: BCN Commercial |
$2,166.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH DILATION, INITIAL
|
Facility
|
OP
|
$12,013.78
|
|
|
Service Code
|
CPT 31528
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.91 |
| Max. Negotiated Rate |
$12,013.78 |
| Rate for Payer: Aetna Medicare |
$3,863.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,643.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,643.68
|
| Rate for Payer: BCBS Complete |
$2,040.25
|
| Rate for Payer: BCBS MAPPO |
$3,714.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,103.15
|
| Rate for Payer: BCN Commercial |
$2,103.15
|
| Rate for Payer: BCN Medicare Advantage |
$3,714.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,714.94
|
| Rate for Payer: Mclaren Medicaid |
$3,714.94
|
| Rate for Payer: Mclaren Medicare |
$3,714.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,900.69
|
| Rate for Payer: Meridian Medicaid |
$3,900.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,272.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,086.43
|
| Rate for Payer: Nomi Health Commercial |
$11,144.82
|
| Rate for Payer: PACE Medicare |
$3,529.19
|
| Rate for Payer: PACE SWMI |
$3,714.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,714.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,942.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,013.78
|
| Rate for Payer: Priority Health Medicare |
$3,714.94
|
| Rate for Payer: Priority Health Tiered Network |
$9,611.02
|
| Rate for Payer: Railroad Medicare Medicare |
$3,714.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,714.94
|
| Rate for Payer: UHC Medicaid |
$1,942.91
|
| Rate for Payer: UHCCP Medicaid |
$1,942.91
|
| Rate for Payer: VA VA |
$3,714.94
|
|
|
LARYNGOSCOPY, FLEXIBLE; DIAGNOSTIC
|
Facility
|
OP
|
$643.18
|
|
|
Service Code
|
CPT 31575
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$643.18 |
| Rate for Payer: Aetna Medicare |
$206.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.61
|
| Rate for Payer: BCBS Complete |
$109.23
|
| Rate for Payer: BCBS MAPPO |
$198.89
|
| Rate for Payer: BCBS Trust/PPO |
$244.10
|
| Rate for Payer: BCN Commercial |
$244.10
|
| Rate for Payer: BCN Medicare Advantage |
$198.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.89
|
| Rate for Payer: Mclaren Medicaid |
$198.89
|
| Rate for Payer: Mclaren Medicare |
$198.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.83
|
| Rate for Payer: Meridian Medicaid |
$208.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.78
|
| Rate for Payer: Nomi Health Commercial |
$596.67
|
| Rate for Payer: PACE Medicare |
$188.95
|
| Rate for Payer: PACE SWMI |
$198.89
|
| Rate for Payer: PHP Medicare Advantage |
$198.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$643.18
|
| Rate for Payer: Priority Health Medicare |
$198.89
|
| Rate for Payer: Priority Health Tiered Network |
$514.54
|
| Rate for Payer: Railroad Medicare Medicare |
$198.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$198.89
|
| Rate for Payer: UHC Medicaid |
$104.02
|
| Rate for Payer: UHCCP Medicaid |
$104.02
|
| Rate for Payer: VA VA |
$198.89
|
|
|
LARYNGOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$1,260.30
|
|
|
Service Code
|
CPT 31577
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$203.82 |
| Max. Negotiated Rate |
$1,260.30 |
| Rate for Payer: Aetna Medicare |
$405.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.14
|
| Rate for Payer: BCBS Complete |
$214.03
|
| Rate for Payer: BCBS MAPPO |
$389.71
|
| Rate for Payer: BCBS Trust/PPO |
$460.01
|
| Rate for Payer: BCN Commercial |
$460.01
|
| Rate for Payer: BCN Medicare Advantage |
$389.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.71
|
| Rate for Payer: Mclaren Medicaid |
$389.71
|
| Rate for Payer: Mclaren Medicare |
$389.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.20
|
| Rate for Payer: Meridian Medicaid |
$409.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$428.68
|
| Rate for Payer: Nomi Health Commercial |
$1,169.13
|
| Rate for Payer: PACE Medicare |
$370.22
|
| Rate for Payer: PACE SWMI |
$389.71
|
| Rate for Payer: PHP Medicare Advantage |
$389.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,260.30
|
| Rate for Payer: Priority Health Medicare |
$389.71
|
| Rate for Payer: Priority Health Tiered Network |
$1,008.24
|
| Rate for Payer: Railroad Medicare Medicare |
$389.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$389.71
|
| Rate for Payer: UHC Medicaid |
$203.82
|
| Rate for Payer: UHCCP Medicaid |
$203.82
|
| Rate for Payer: VA VA |
$389.71
|
|
|
LARYNGO-TRACHEAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
OP
|
$7.61
|
|
|
Service Code
|
NDC 09900000914
|
| Hospital Charge Code |
180497
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Aetna American Axle |
$4.95
|
| Rate for Payer: Aetna Commercial |
$6.47
|
| Rate for Payer: Aetna Medicare |
$3.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.95
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Cofinity Advantage |
$5.33
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.09
|
| Rate for Payer: Healthscope Commercial |
$6.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.71
|
| Rate for Payer: PHP Commercial |
$6.47
|
| Rate for Payer: Priority Health SBD |
$4.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.95
|
| Rate for Payer: UHC Core |
$3.96
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.71
|
|
|
LARYNGO-TRACHEAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$7.61
|
|
|
Service Code
|
NDC 09900000914
|
| Hospital Charge Code |
180497
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Aetna American Axle |
$4.95
|
| Rate for Payer: Aetna Commercial |
$6.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.95
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Cofinity Advantage |
$5.33
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.09
|
| Rate for Payer: Healthscope Commercial |
$6.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.71
|
| Rate for Payer: PHP Commercial |
$6.47
|
| Rate for Payer: Priority Health SBD |
$4.79
|
| Rate for Payer: UMR Bronson Commercial |
$3.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.71
|
|
|
LASER ENUCLEATION OF THE PROSTATE WITH MORCELLATION, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, INTERNAL URETHROTOMY AND TRANSURETHRAL RESECTION OF PROSTATE ARE INCLUDED IF PERFORMED)
|
Facility
|
OP
|
$17,277.20
|
|
|
Service Code
|
CPT 52649
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,794.14 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$9,024.88
|
| Rate for Payer: BCN Commercial |
$9,024.88
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
LASER VAPORIZATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, INTERNAL URETHROTOMY AND TRANSURETHRAL RESECTION OF PROSTATE ARE INCLUDED IF PERFORMED)
|
Facility
|
OP
|
$17,277.20
|
|
|
Service Code
|
CPT 52648
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,794.14 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,945.03
|
| Rate for Payer: BCN Commercial |
$4,945.03
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$50.75
|
|
|
Service Code
|
NDC 17478062512
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna Medicare |
$25.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: BCBS Complete |
$20.30
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cofinity Advantage |
$35.52
|
| Rate for Payer: Cofinity Commercial |
$43.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.60
|
| Rate for Payer: Healthscope Commercial |
$45.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.06
|
| Rate for Payer: PHP Commercial |
$43.14
|
| Rate for Payer: Priority Health SBD |
$31.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.99
|
| Rate for Payer: UHC Core |
$26.44
|
| Rate for Payer: UHC Exchange |
$19.94
|
| Rate for Payer: UMR Bronson Commercial |
$18.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.06
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$861.95
|
|
|
Service Code
|
NDC 00013830304
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$775.75 |
| Rate for Payer: Aetna American Axle |
$560.27
|
| Rate for Payer: Aetna Commercial |
$732.66
|
| Rate for Payer: Aetna Medicare |
$430.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.27
|
| Rate for Payer: BCBS Complete |
$344.78
|
| Rate for Payer: Cash Price |
$689.56
|
| Rate for Payer: Cofinity Advantage |
$603.37
|
| Rate for Payer: Cofinity Commercial |
$741.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.56
|
| Rate for Payer: Healthscope Commercial |
$775.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$603.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$646.46
|
| Rate for Payer: PHP Commercial |
$732.66
|
| Rate for Payer: Priority Health SBD |
$543.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.27
|
| Rate for Payer: UHC Core |
$449.08
|
| Rate for Payer: UHC Exchange |
$338.75
|
| Rate for Payer: UMR Bronson Commercial |
$318.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.46
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$26.28
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$23.65 |
| Rate for Payer: Aetna American Axle |
$17.08
|
| Rate for Payer: Aetna Commercial |
$22.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.08
|
| Rate for Payer: Cash Price |
$21.02
|
| Rate for Payer: Cofinity Advantage |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.02
|
| Rate for Payer: Healthscope Commercial |
$23.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.71
|
| Rate for Payer: PHP Commercial |
$22.34
|
| Rate for Payer: Priority Health SBD |
$16.56
|
| Rate for Payer: UMR Bronson Commercial |
$11.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.71
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$23.91
|
|
|
Service Code
|
NDC 59762033302
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$21.52 |
| Rate for Payer: Aetna American Axle |
$15.54
|
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: Cash Price |
$19.13
|
| Rate for Payer: Cofinity Advantage |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.13
|
| Rate for Payer: Healthscope Commercial |
$21.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.93
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: Priority Health SBD |
$15.06
|
| Rate for Payer: UMR Bronson Commercial |
$10.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.93
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$26.28
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$23.65 |
| Rate for Payer: Aetna American Axle |
$17.08
|
| Rate for Payer: Aetna Commercial |
$22.34
|
| Rate for Payer: Aetna Medicare |
$13.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.08
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: Cash Price |
$21.02
|
| Rate for Payer: Cofinity Advantage |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.02
|
| Rate for Payer: Healthscope Commercial |
$23.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.71
|
| Rate for Payer: PHP Commercial |
$22.34
|
| Rate for Payer: Priority Health SBD |
$16.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.08
|
| Rate for Payer: UHC Core |
$13.69
|
| Rate for Payer: UHC Exchange |
$10.33
|
| Rate for Payer: UMR Bronson Commercial |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.71
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$29.96
|
|
|
Service Code
|
NDC 24208046325
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna American Axle |
$19.47
|
| Rate for Payer: Aetna Commercial |
$25.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Cash Price |
$23.97
|
| Rate for Payer: Cofinity Advantage |
$20.97
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.97
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.47
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: Priority Health SBD |
$18.87
|
| Rate for Payer: UMR Bronson Commercial |
$13.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.47
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$50.75
|
|
|
Service Code
|
NDC 17478062512
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cofinity Advantage |
$35.52
|
| Rate for Payer: Cofinity Commercial |
$43.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.60
|
| Rate for Payer: Healthscope Commercial |
$45.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.06
|
| Rate for Payer: PHP Commercial |
$43.14
|
| Rate for Payer: Priority Health SBD |
$31.97
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.06
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$23.91
|
|
|
Service Code
|
NDC 59762033302
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$21.52 |
| Rate for Payer: Aetna American Axle |
$15.54
|
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$11.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: BCBS Complete |
$9.56
|
| Rate for Payer: Cash Price |
$19.13
|
| Rate for Payer: Cofinity Advantage |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.13
|
| Rate for Payer: Healthscope Commercial |
$21.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.93
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: Priority Health SBD |
$15.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.54
|
| Rate for Payer: UHC Core |
$12.46
|
| Rate for Payer: UHC Exchange |
$9.40
|
| Rate for Payer: UMR Bronson Commercial |
$8.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.93
|
|
