|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
14868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
14868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION (ANES ANALGESIA)
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
301050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION (ANES ANALGESIA)
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
301050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$50.09
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna American Axle |
$32.56
|
| Rate for Payer: Aetna American Axle |
$48.02
|
| Rate for Payer: Aetna Commercial |
$42.58
|
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.02
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Cofinity Commercial |
$51.71
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$43.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$45.08
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.58
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: PHP Commercial |
$42.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health SBD |
$31.56
|
| Rate for Payer: Priority Health SBD |
$46.54
|
| Rate for Payer: UMR Bronson Commercial |
$22.04
|
| Rate for Payer: UMR Bronson Commercial |
$32.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.40
|
|
|
LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$50.09
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna American Axle |
$32.56
|
| Rate for Payer: Aetna American Axle |
$48.02
|
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: Aetna Commercial |
$42.58
|
| Rate for Payer: Aetna Medicare |
$25.04
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.02
|
| Rate for Payer: BCBS Complete |
$29.55
|
| Rate for Payer: BCBS Complete |
$20.04
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$51.71
|
| Rate for Payer: Cofinity Commercial |
$43.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.07
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Healthscope Commercial |
$45.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: PHP Commercial |
$42.58
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health SBD |
$46.54
|
| Rate for Payer: Priority Health SBD |
$31.56
|
| Rate for Payer: UMR Bronson Commercial |
$18.53
|
| Rate for Payer: UMR Bronson Commercial |
$27.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.57
|
|
|
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.54
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
105635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Aetna American Axle |
$10.10
|
| Rate for Payer: Aetna American Axle |
$37.02
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.02
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$45.57
|
| Rate for Payer: Cofinity Commercial |
$48.99
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Cofinity Commercial |
$10.88
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.57
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$48.42
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.02
|
| Rate for Payer: Priority Health SBD |
$9.79
|
| Rate for Payer: Priority Health SBD |
$35.88
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: UMR Bronson Commercial |
$25.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.72
|
|
|
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
OP
|
$15.54
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
105635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Aetna American Axle |
$10.10
|
| Rate for Payer: Aetna American Axle |
$37.02
|
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna Medicare |
$28.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.02
|
| Rate for Payer: BCBS Complete |
$22.78
|
| Rate for Payer: BCBS Complete |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$45.57
|
| Rate for Payer: Cash Price |
$45.57
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$48.99
|
| Rate for Payer: Cofinity Commercial |
$10.88
|
| Rate for Payer: Cofinity Commercial |
$39.87
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.43
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.42
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$48.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.02
|
| Rate for Payer: Priority Health SBD |
$35.88
|
| Rate for Payer: Priority Health SBD |
$9.79
|
| Rate for Payer: UMR Bronson Commercial |
$5.75
|
| Rate for Payer: UMR Bronson Commercial |
$21.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.66
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
OP
|
$9.55
|
|
|
Service Code
|
NDC 24357070105
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna American Axle |
$6.21
|
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$8.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.64
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.12
|
| Rate for Payer: PHP Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.21
|
| Rate for Payer: Priority Health SBD |
$6.02
|
| Rate for Payer: UMR Bronson Commercial |
$3.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.16
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
NDC 00496088205
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna American Axle |
$6.76
|
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| 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 |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
IP
|
$9.55
|
|
|
Service Code
|
NDC 24357070105
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna American Axle |
$6.21
|
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$8.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.64
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.12
|
| Rate for Payer: PHP Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.21
|
| Rate for Payer: Priority Health SBD |
$6.02
|
| Rate for Payer: UMR Bronson Commercial |
$4.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.16
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
IP
|
$9.55
|
|
|
Service Code
|
NDC 24357070106
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna American Axle |
$6.21
|
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$8.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.64
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.12
|
| Rate for Payer: PHP Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.21
|
| Rate for Payer: Priority Health SBD |
$6.02
|
| Rate for Payer: UMR Bronson Commercial |
$4.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.16
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
OP
|
$9.55
|
|
|
Service Code
|
NDC 24357070106
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna American Axle |
$6.21
|
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna Medicare |
$4.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$8.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.64
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.12
|
| Rate for Payer: PHP Commercial |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.21
|
| Rate for Payer: Priority Health SBD |
$6.02
|
| Rate for Payer: UMR Bronson Commercial |
$3.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.16
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
IP
|
$14.18
|
|
|
Service Code
|
NDC 00496088207
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna American Axle |
$9.22
|
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.22
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.22
|
| Rate for Payer: Priority Health SBD |
$8.93
|
| Rate for Payer: UMR Bronson Commercial |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.64
|
|
|
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-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
OP
|
$14.18
|
|
|
Service Code
|
NDC 00496088207
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna American Axle |
$9.22
|
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: Aetna Medicare |
$7.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.22
|
| Rate for Payer: BCBS Complete |
$5.67
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Cofinity Commercial |
$9.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.22
|
| Rate for Payer: Priority Health SBD |
$8.93
|
| Rate for Payer: UMR Bronson Commercial |
$5.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.64
|
|
|
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 |
$3.22
|
| 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
|
|
|
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 |
$3.22
|
| 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
|
|
|
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$687.75 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$6,999.70
|
| Rate for Payer: BCN Commercial |
$6,999.70
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$756.52
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$687.75
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 37700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$235.85 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,986.82
|
| Rate for Payer: BCN Commercial |
$1,986.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.44
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$235.85
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
LIGATION AND DIVISION OF SHORT SAPHENOUS VEIN AT SAPHENOPOPLITEAL JUNCTION (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 37780
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$228.97 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,760.59
|
| Rate for Payer: BCN Commercial |
$1,760.59
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.87
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$228.97
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
LIGATION, DIVISION, AND/OR EXCISION OF VARICOSE VEIN CLUSTER(S), 1 LEG
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 37785
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$245.89 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,986.82
|
| Rate for Payer: BCN Commercial |
$1,986.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.48
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$245.89
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
LIGATION, DIVISION, AND STRIPPING, LONG (GREATER) SAPHENOUS VEINS FROM SAPHENOFEMORAL JUNCTION TO KNEE OR BELOW
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 37722
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$447.78 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.94
|
| Rate for Payer: BCN Commercial |
$2,317.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.56
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$447.78
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
LIGATION, DIVISION, AND STRIPPING, SHORT SAPHENOUS VEIN
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 37718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,986.82
|
| Rate for Payer: BCN Commercial |
$1,986.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.42
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$382.20
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); EXTREMITY
|
Facility
|
OP
|
$1,879.00
|
|
|
Service Code
|
CPT 37618
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$379.83 |
| Max. Negotiated Rate |
$1,879.00 |
| Rate for Payer: BCBS Trust/PPO |
$1,407.52
|
| Rate for Payer: BCN Commercial |
$1,407.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$417.81
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$379.83
|
|
