|
MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE
|
Facility
|
OP
|
$20,082.39
|
|
|
Service Code
|
CPT 19307
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,151.92 |
| Max. Negotiated Rate |
$20,082.39 |
| Rate for Payer: Aetna Medicare |
$6,645.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$7,057.20
|
| Rate for Payer: BCN Commercial |
$7,057.20
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Nomi Health Commercial |
$13,418.16
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,082.39
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$16,065.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,267.11
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Exchange |
$1,151.92
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,424.83
|
| Rate for Payer: VA VA |
$6,389.60
|
|
|
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);
|
Facility
|
OP
|
$11,792.02
|
|
|
Service Code
|
CPT 19301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$645.99 |
| Max. Negotiated Rate |
$11,792.02 |
| Rate for Payer: Aetna Medicare |
$3,901.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$3,965.42
|
| Rate for Payer: BCN Commercial |
$3,965.42
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Nomi Health Commercial |
$7,878.88
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,792.02
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$9,433.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.59
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$645.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,010.99
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); WITH AXILLARY LYMPHADENECTOMY
|
Facility
|
OP
|
$20,082.39
|
|
|
Service Code
|
CPT 19302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$887.29 |
| Max. Negotiated Rate |
$20,082.39 |
| Rate for Payer: Aetna Medicare |
$6,645.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,516.87
|
| Rate for Payer: BCN Commercial |
$3,516.87
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Nomi Health Commercial |
$13,418.16
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,082.39
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$16,065.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$976.02
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Exchange |
$887.29
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,424.83
|
| Rate for Payer: VA VA |
$6,389.60
|
|
|
MASTECTOMY, SIMPLE, COMPLETE
|
Facility
|
OP
|
$20,082.39
|
|
|
Service Code
|
CPT 19303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$937.55 |
| Max. Negotiated Rate |
$20,082.39 |
| Rate for Payer: Aetna Medicare |
$6,645.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$7,690.31
|
| Rate for Payer: BCN Commercial |
$7,690.31
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Nomi Health Commercial |
$13,418.16
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,082.39
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$16,065.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,031.30
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Exchange |
$937.55
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,424.83
|
| Rate for Payer: VA VA |
$6,389.60
|
|
|
MASTOPEXY
|
Facility
|
OP
|
$20,082.39
|
|
|
Service Code
|
CPT 19316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$762.76 |
| Max. Negotiated Rate |
$20,082.39 |
| Rate for Payer: Aetna Medicare |
$6,645.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$6,659.72
|
| Rate for Payer: BCN Commercial |
$6,659.72
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Nomi Health Commercial |
$13,418.16
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,082.39
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$16,065.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$839.04
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Exchange |
$762.76
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,424.83
|
| Rate for Payer: VA VA |
$6,389.60
|
|
|
MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
OP
|
$4,989.41
|
|
|
Service Code
|
CPT 19020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.12 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,334.61
|
| Rate for Payer: BCN Commercial |
$2,334.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.43
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$303.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT
|
Facility
|
OP
|
$299.53
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
10512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.83 |
| Max. Negotiated Rate |
$269.58 |
| Rate for Payer: Aetna American Axle |
$194.69
|
| Rate for Payer: Aetna Commercial |
$254.60
|
| Rate for Payer: Aetna Medicare |
$149.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.69
|
| Rate for Payer: BCBS Complete |
$119.81
|
| Rate for Payer: BCBS Trust/PPO |
$246.91
|
| Rate for Payer: BCN Commercial |
$246.91
|
| Rate for Payer: Cash Price |
$239.62
|
| Rate for Payer: Cash Price |
$239.62
|
| Rate for Payer: Cofinity Commercial |
$209.67
|
| Rate for Payer: Cofinity Commercial |
$257.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.62
|
| Rate for Payer: Healthscope Commercial |
$269.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.60
|
| Rate for Payer: PHP Commercial |
$254.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.69
|
| Rate for Payer: Priority Health SBD |
$188.70
|
| Rate for Payer: UMR Bronson Commercial |
$110.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.65
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT
|
Facility
|
IP
|
$299.53
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
10512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.79 |
| Max. Negotiated Rate |
$269.58 |
| Rate for Payer: Aetna American Axle |
$194.69
|
| Rate for Payer: Aetna Commercial |
$254.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.69
|
| Rate for Payer: Cash Price |
$239.62
|
| Rate for Payer: Cofinity Commercial |
$209.67
|
| Rate for Payer: Cofinity Commercial |
$257.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.62
|
| Rate for Payer: Healthscope Commercial |
$269.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.60
|
| Rate for Payer: PHP Commercial |
$254.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.69
|
| Rate for Payer: Priority Health SBD |
$188.70
|
| Rate for Payer: UMR Bronson Commercial |
$131.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.65
|
|
|
MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON-IMAGING
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 51798
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$124.78
|
| Rate for Payer: BCN Commercial |
$124.78
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.25
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$10.23
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON-IMAGING
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 51798
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$124.78
|
| Rate for Payer: BCN Commercial |
$124.78
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.25
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$10.23
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); EXCEPT INFANT
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 53020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.66 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,439.79
|
| Rate for Payer: BCN Commercial |
$1,439.79
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.93
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$92.66
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); INFANT
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 53025
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.65 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,048.99
|
| Rate for Payer: BCN Commercial |
$1,048.99
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.22
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$65.65
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$366.70
|
|
|
Service Code
|
NDC 00904651661
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$330.03 |
| Rate for Payer: Aetna American Axle |
$238.36
|
| Rate for Payer: Aetna Commercial |
$311.70
|
| Rate for Payer: Aetna Medicare |
$183.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.36
|
| Rate for Payer: BCBS Complete |
$146.68
|
| Rate for Payer: Cash Price |
$293.36
|
| Rate for Payer: Cofinity Commercial |
$256.69
|
| Rate for Payer: Cofinity Commercial |
$315.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.36
|
| Rate for Payer: Healthscope Commercial |
$330.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.70
|
| Rate for Payer: PHP Commercial |
$311.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.36
|
| Rate for Payer: Priority Health SBD |
$231.02
|
| Rate for Payer: UMR Bronson Commercial |
$135.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.02
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$467.40
|
|
|
Service Code
|
NDC 51079042320
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.94 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Aetna American Axle |
$303.81
|
| Rate for Payer: Aetna Commercial |
$397.29
|
| Rate for Payer: Aetna Medicare |
$233.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.81
|
| Rate for Payer: BCBS Complete |
$186.96
|
| Rate for Payer: Cash Price |
$373.92
|
| Rate for Payer: Cofinity Commercial |
$327.18
|
| Rate for Payer: Cofinity Commercial |
$401.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.92
|
| Rate for Payer: Healthscope Commercial |
$420.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.29
|
| Rate for Payer: PHP Commercial |
$397.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.81
|
| Rate for Payer: Priority Health SBD |
$294.46
|
| Rate for Payer: UMR Bronson Commercial |
$172.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.55
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$467.40
|
|
|
Service Code
|
NDC 51079042320
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.66 |
| Max. Negotiated Rate |
$420.66 |
| Rate for Payer: Aetna American Axle |
$303.81
|
| Rate for Payer: Aetna Commercial |
$397.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.81
|
| Rate for Payer: Cash Price |
$373.92
|
| Rate for Payer: Cofinity Commercial |
$327.18
|
| Rate for Payer: Cofinity Commercial |
$401.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.92
|
| Rate for Payer: Healthscope Commercial |
$420.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.29
|
| Rate for Payer: PHP Commercial |
$397.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.81
|
| Rate for Payer: Priority Health SBD |
$294.46
|
| Rate for Payer: UMR Bronson Commercial |
$205.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.55
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$179.55
|
|
|
Service Code
|
NDC 60687077565
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.43 |
| Max. Negotiated Rate |
$161.60 |
| Rate for Payer: Aetna American Axle |
$116.71
|
| Rate for Payer: Aetna Commercial |
$152.62
|
| Rate for Payer: Aetna Medicare |
$89.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.71
|
| Rate for Payer: BCBS Complete |
$71.82
|
| Rate for Payer: Cash Price |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$154.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.64
|
| Rate for Payer: Healthscope Commercial |
$161.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.62
|
| Rate for Payer: PHP Commercial |
$152.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.71
|
| Rate for Payer: Priority Health SBD |
$113.12
|
| Rate for Payer: UMR Bronson Commercial |
$66.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.66
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 51079042301
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna American Axle |
$3.04
|
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.04
|
| Rate for Payer: Priority Health SBD |
$2.95
|
| Rate for Payer: UMR Bronson Commercial |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.51
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 51079042301
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna American Axle |
$3.04
|
| Rate for Payer: Aetna Commercial |
$3.98
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.04
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.04
|
| Rate for Payer: Priority Health SBD |
$2.95
|
| Rate for Payer: UMR Bronson Commercial |
$1.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.51
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
OP
|
$4.09
|
|
|
Service Code
|
NDC 60687077511
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna American Axle |
$2.66
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.66
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$366.70
|
|
|
Service Code
|
NDC 00904651661
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.35 |
| Max. Negotiated Rate |
$330.03 |
| Rate for Payer: Aetna American Axle |
$238.36
|
| Rate for Payer: Aetna Commercial |
$311.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.36
|
| Rate for Payer: Cash Price |
$293.36
|
| Rate for Payer: Cofinity Commercial |
$256.69
|
| Rate for Payer: Cofinity Commercial |
$315.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.36
|
| Rate for Payer: Healthscope Commercial |
$330.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.70
|
| Rate for Payer: PHP Commercial |
$311.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.36
|
| Rate for Payer: Priority Health SBD |
$231.02
|
| Rate for Payer: UMR Bronson Commercial |
$161.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.02
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$179.55
|
|
|
Service Code
|
NDC 60687077565
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.00 |
| Max. Negotiated Rate |
$161.60 |
| Rate for Payer: Aetna American Axle |
$116.71
|
| Rate for Payer: Aetna Commercial |
$152.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.71
|
| Rate for Payer: Cash Price |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$125.68
|
| Rate for Payer: Cofinity Commercial |
$154.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.64
|
| Rate for Payer: Healthscope Commercial |
$161.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.62
|
| Rate for Payer: PHP Commercial |
$152.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.71
|
| Rate for Payer: Priority Health SBD |
$113.12
|
| Rate for Payer: UMR Bronson Commercial |
$79.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.66
|
|
|
MECLIZINE 12.5 MG TABLET
|
Facility
|
IP
|
$4.09
|
|
|
Service Code
|
NDC 60687077511
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna American Axle |
$2.66
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.66
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
MECLIZINE 25 MG CHEWABLE TABLET
|
Facility
|
IP
|
$21.66
|
|
|
Service Code
|
NDC 65197027508
|
| Hospital Charge Code |
26024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna American Axle |
$14.08
|
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.08
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.33
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.41
|
| Rate for Payer: PHP Commercial |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.08
|
| Rate for Payer: Priority Health SBD |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.24
|
|
|
MECLIZINE 25 MG CHEWABLE TABLET
|
Facility
|
OP
|
$21.66
|
|
|
Service Code
|
NDC 65197027508
|
| Hospital Charge Code |
26024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna American Axle |
$14.08
|
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna Medicare |
$10.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.08
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.33
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.41
|
| Rate for Payer: PHP Commercial |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.08
|
| Rate for Payer: Priority Health SBD |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.24
|
|
|
MECLIZINE 25 MG CHEWABLE TABLET
|
Facility
|
OP
|
$63.45
|
|
|
Service Code
|
NDC 16571082401
|
| Hospital Charge Code |
26024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna Medicare |
$31.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$23.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
