|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
NDC 00496088205
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna American Axle |
$6.76
|
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health SBD |
$6.55
|
| Rate for Payer: UMR Bronson Commercial |
$3.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
LIDOCAINE WITH EPINEPHRINE IN NS 50 ML
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
NDC 99000000202
|
| Hospital Charge Code |
158459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.19
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
LIDOCAINE WITH EPINEPHRINE IN NS 50 ML
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
NDC 99000000202
|
| Hospital Charge Code |
158459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 37700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
LIGATION AND DIVISION OF SHORT SAPHENOUS VEIN AT SAPHENOPOPLITEAL JUNCTION (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 37780
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
LIGATION, DIVISION, AND/OR EXCISION OF VARICOSE VEIN CLUSTER(S), 1 LEG
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 37785
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
LIGATION, DIVISION, AND STRIPPING, LONG (GREATER) SAPHENOUS VEINS FROM SAPHENOFEMORAL JUNCTION TO KNEE OR BELOW
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 37722
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
LIGATION, DIVISION, AND STRIPPING, SHORT SAPHENOUS VEIN
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 37718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); NECK
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 37615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
LIGATION OF PERFORATOR VEINS, SUBFASCIAL, RADICAL (LINTON TYPE), INCLUDING SKIN GRAFT, WHEN PERFORMED, OPEN,1 LEG
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 37760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 37607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
LIGATION OR BIOPSY, TEMPORAL ARTERY
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 37609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$3,019.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
LINACLOTIDE 145 MCG CAPSULE
|
Facility
|
IP
|
$226.27
|
|
|
Service Code
|
NDC 00456120104
|
| Hospital Charge Code |
163662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$203.64 |
| Rate for Payer: Aetna American Axle |
$147.08
|
| Rate for Payer: Aetna Commercial |
$192.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.08
|
| Rate for Payer: Cash Price |
$181.02
|
| Rate for Payer: Cofinity Commercial |
$158.39
|
| Rate for Payer: Cofinity Commercial |
$194.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.02
|
| Rate for Payer: Healthscope Commercial |
$203.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.33
|
| Rate for Payer: PHP Commercial |
$192.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.08
|
| Rate for Payer: Priority Health SBD |
$142.55
|
| Rate for Payer: UMR Bronson Commercial |
$99.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.70
|
|
|
LINACLOTIDE 145 MCG CAPSULE
|
Facility
|
IP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120130
|
| Hospital Charge Code |
163662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$859.49 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$859.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINACLOTIDE 145 MCG CAPSULE
|
Facility
|
OP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120130
|
| Hospital Charge Code |
163662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$722.75 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna Medicare |
$976.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: BCBS Complete |
$781.35
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$722.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINACLOTIDE 145 MCG CAPSULE
|
Facility
|
OP
|
$226.27
|
|
|
Service Code
|
NDC 00456120104
|
| Hospital Charge Code |
163662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.72 |
| Max. Negotiated Rate |
$203.64 |
| Rate for Payer: Aetna American Axle |
$147.08
|
| Rate for Payer: Aetna Commercial |
$192.33
|
| Rate for Payer: Aetna Medicare |
$113.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.08
|
| Rate for Payer: BCBS Complete |
$90.51
|
| Rate for Payer: Cash Price |
$181.02
|
| Rate for Payer: Cofinity Commercial |
$158.39
|
| Rate for Payer: Cofinity Commercial |
$194.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.02
|
| Rate for Payer: Healthscope Commercial |
$203.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.33
|
| Rate for Payer: PHP Commercial |
$192.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.08
|
| Rate for Payer: Priority Health SBD |
$142.55
|
| Rate for Payer: UMR Bronson Commercial |
$83.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.70
|
|
|
LINACLOTIDE 290 MCG CAPSULE
|
Facility
|
IP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120230
|
| Hospital Charge Code |
163663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$859.49 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$859.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINACLOTIDE 290 MCG CAPSULE
|
Facility
|
OP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120230
|
| Hospital Charge Code |
163663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$722.75 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna Medicare |
$976.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: BCBS Complete |
$781.35
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$722.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINACLOTIDE 72 MCG CAPSULE
|
Facility
|
OP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120330
|
| Hospital Charge Code |
182047
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$722.75 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna Medicare |
$976.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: BCBS Complete |
$781.35
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$722.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINACLOTIDE 72 MCG CAPSULE
|
Facility
|
IP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120330
|
| Hospital Charge Code |
182047
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$859.49 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$859.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
IP
|
$4,697.89
|
|
|
Service Code
|
NDC 00597014061
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,067.07 |
| Max. Negotiated Rate |
$4,228.10 |
| Rate for Payer: Aetna American Axle |
$3,053.63
|
| Rate for Payer: Aetna Commercial |
$3,993.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,053.63
|
| Rate for Payer: Cash Price |
$3,758.31
|
| Rate for Payer: Cofinity Commercial |
$3,288.52
|
| Rate for Payer: Cofinity Commercial |
$4,040.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,288.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,758.31
|
| Rate for Payer: Healthscope Commercial |
$4,228.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,288.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,523.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,993.21
|
| Rate for Payer: PHP Commercial |
$3,993.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,053.63
|
| Rate for Payer: Priority Health SBD |
$2,959.67
|
| Rate for Payer: UMR Bronson Commercial |
$2,067.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,523.42
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
OP
|
$4,697.89
|
|
|
Service Code
|
NDC 00597014061
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,738.22 |
| Max. Negotiated Rate |
$4,228.10 |
| Rate for Payer: Aetna American Axle |
$3,053.63
|
| Rate for Payer: Aetna Commercial |
$3,993.21
|
| Rate for Payer: Aetna Medicare |
$2,348.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,053.63
|
| Rate for Payer: BCBS Complete |
$1,879.16
|
| Rate for Payer: Cash Price |
$3,758.31
|
| Rate for Payer: Cofinity Commercial |
$3,288.52
|
| Rate for Payer: Cofinity Commercial |
$4,040.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,288.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,758.31
|
| Rate for Payer: Healthscope Commercial |
$4,228.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,288.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,523.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,993.21
|
| Rate for Payer: PHP Commercial |
$3,993.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,053.63
|
| Rate for Payer: Priority Health SBD |
$2,959.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,738.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,523.42
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
NDC 59762130801
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Aetna American Axle |
$724.75
|
| Rate for Payer: Aetna Commercial |
$947.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.75
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cofinity Commercial |
$780.50
|
| Rate for Payer: Cofinity Commercial |
$958.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.00
|
| Rate for Payer: Healthscope Commercial |
$1,003.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$836.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.75
|
| Rate for Payer: PHP Commercial |
$947.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.75
|
| Rate for Payer: Priority Health SBD |
$702.45
|
| Rate for Payer: UMR Bronson Commercial |
$490.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$836.25
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2,352.65
|
|
|
Service Code
|
NDC 00009513601
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$870.48 |
| Max. Negotiated Rate |
$2,117.39 |
| Rate for Payer: Aetna American Axle |
$1,529.22
|
| Rate for Payer: Aetna Commercial |
$1,999.75
|
| Rate for Payer: Aetna Medicare |
$1,176.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,529.22
|
| Rate for Payer: BCBS Complete |
$941.06
|
| Rate for Payer: Cash Price |
$1,882.12
|
| Rate for Payer: Cofinity Commercial |
$1,646.86
|
| Rate for Payer: Cofinity Commercial |
$2,023.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,646.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,882.12
|
| Rate for Payer: Healthscope Commercial |
$2,117.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,646.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,764.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,999.75
|
| Rate for Payer: PHP Commercial |
$1,999.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,529.22
|
| Rate for Payer: Priority Health SBD |
$1,482.17
|
| Rate for Payer: UMR Bronson Commercial |
$870.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,764.49
|
|
