|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna American Axle |
$16.42
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Medicare |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.06
|
| Rate for Payer: BCN Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: UMR Bronson Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.94
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$39.13
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
39477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$35.22 |
| Rate for Payer: Aetna American Axle |
$25.43
|
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Medicare |
$19.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: BCBS Complete |
$15.65
|
| Rate for Payer: BCBS Trust/PPO |
$1.06
|
| Rate for Payer: BCN Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.30
|
| Rate for Payer: Healthscope Commercial |
$35.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.26
|
| Rate for Payer: PHP Commercial |
$33.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.43
|
| Rate for Payer: Priority Health SBD |
$24.65
|
| Rate for Payer: UMR Bronson Commercial |
$14.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.35
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$39.13
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
39477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$35.22 |
| Rate for Payer: Aetna American Axle |
$25.43
|
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.30
|
| Rate for Payer: Healthscope Commercial |
$35.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.26
|
| Rate for Payer: PHP Commercial |
$33.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.43
|
| Rate for Payer: Priority Health SBD |
$24.65
|
| Rate for Payer: UMR Bronson Commercial |
$17.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.35
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
IP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna American Axle |
$16.42
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: UMR Bronson Commercial |
$11.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.94
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna American Axle |
$16.42
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Medicare |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.06
|
| Rate for Payer: BCN Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: UMR Bronson Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.94
|
|
|
ADENOSINE 6 MG/500 ML NS IV
|
Facility
|
IP
|
$236.64
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
151053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.12 |
| Max. Negotiated Rate |
$212.98 |
| Rate for Payer: Aetna American Axle |
$153.82
|
| Rate for Payer: Aetna Commercial |
$201.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.82
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cofinity Commercial |
$165.65
|
| Rate for Payer: Cofinity Commercial |
$203.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
| Rate for Payer: Healthscope Commercial |
$212.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.14
|
| Rate for Payer: PHP Commercial |
$201.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.82
|
| Rate for Payer: Priority Health SBD |
$149.08
|
| Rate for Payer: UMR Bronson Commercial |
$104.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.48
|
|
|
ADENOSINE 6 MG/500 ML NS IV
|
Facility
|
OP
|
$236.64
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
151053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$212.98 |
| Rate for Payer: Aetna American Axle |
$153.82
|
| Rate for Payer: Aetna Commercial |
$201.14
|
| Rate for Payer: Aetna Medicare |
$118.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.82
|
| Rate for Payer: BCBS Complete |
$94.66
|
| Rate for Payer: BCBS Trust/PPO |
$1.06
|
| Rate for Payer: BCN Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cofinity Commercial |
$165.65
|
| Rate for Payer: Cofinity Commercial |
$203.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
| Rate for Payer: Healthscope Commercial |
$212.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.14
|
| Rate for Payer: PHP Commercial |
$201.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.82
|
| Rate for Payer: Priority Health SBD |
$149.08
|
| Rate for Payer: UMR Bronson Commercial |
$87.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.48
|
|
|
ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$114.46
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
15330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.36 |
| Max. Negotiated Rate |
$103.01 |
| Rate for Payer: Aetna American Axle |
$74.40
|
| Rate for Payer: Aetna American Axle |
$49.55
|
| Rate for Payer: Aetna American Axle |
$52.06
|
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Commercial |
$97.29
|
| Rate for Payer: Aetna Commercial |
$68.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.55
|
| Rate for Payer: Cash Price |
$64.08
|
| Rate for Payer: Cash Price |
$60.98
|
| Rate for Payer: Cash Price |
$91.57
|
| Rate for Payer: Cofinity Commercial |
$98.44
|
| Rate for Payer: Cofinity Commercial |
$65.56
|
| Rate for Payer: Cofinity Commercial |
$53.36
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Cofinity Commercial |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$80.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.98
|
| Rate for Payer: Healthscope Commercial |
$68.61
|
| Rate for Payer: Healthscope Commercial |
$103.01
|
| Rate for Payer: Healthscope Commercial |
$72.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.80
|
| Rate for Payer: PHP Commercial |
$68.08
|
| Rate for Payer: PHP Commercial |
$64.80
|
| Rate for Payer: PHP Commercial |
$97.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.40
|
| Rate for Payer: Priority Health SBD |
$50.46
|
| Rate for Payer: Priority Health SBD |
$48.02
|
| Rate for Payer: Priority Health SBD |
$72.11
|
| Rate for Payer: UMR Bronson Commercial |
$50.36
|
| Rate for Payer: UMR Bronson Commercial |
$35.24
|
| Rate for Payer: UMR Bronson Commercial |
$33.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.17
|
|
|
ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$80.10
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
15330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$72.09 |
| Rate for Payer: Aetna American Axle |
$52.06
|
| Rate for Payer: Aetna American Axle |
$49.55
|
| Rate for Payer: Aetna American Axle |
$74.40
|
| Rate for Payer: Aetna Commercial |
$68.08
|
| Rate for Payer: Aetna Commercial |
$97.29
|
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Medicare |
$38.12
|
| Rate for Payer: Aetna Medicare |
$57.23
|
| Rate for Payer: Aetna Medicare |
$40.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.55
|
| Rate for Payer: BCBS Complete |
$30.49
|
| Rate for Payer: BCBS Complete |
$32.04
|
| Rate for Payer: BCBS Complete |
$45.78
|
| Rate for Payer: BCBS Trust/PPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$1.06
|
| Rate for Payer: BCN Commercial |
$1.06
|
| Rate for Payer: BCN Commercial |
$1.06
|
| Rate for Payer: BCN Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$60.98
|
| Rate for Payer: Cash Price |
$64.08
|
| Rate for Payer: Cash Price |
$91.57
|
| Rate for Payer: Cash Price |
$60.98
|
| Rate for Payer: Cash Price |
$91.57
|
| Rate for Payer: Cash Price |
$64.08
|
| Rate for Payer: Cofinity Commercial |
$65.56
|
| Rate for Payer: Cofinity Commercial |
$80.12
|
| Rate for Payer: Cofinity Commercial |
$98.44
|
| Rate for Payer: Cofinity Commercial |
$53.36
|
| Rate for Payer: Cofinity Commercial |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.08
|
| Rate for Payer: Healthscope Commercial |
$72.09
|
| Rate for Payer: Healthscope Commercial |
$68.61
|
| Rate for Payer: Healthscope Commercial |
$103.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.08
|
| Rate for Payer: PHP Commercial |
$68.08
|
| Rate for Payer: PHP Commercial |
$97.29
|
| Rate for Payer: PHP Commercial |
$64.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.06
|
| Rate for Payer: Priority Health SBD |
$48.02
|
| Rate for Payer: Priority Health SBD |
$50.46
|
| Rate for Payer: Priority Health SBD |
$72.11
|
| Rate for Payer: UMR Bronson Commercial |
$29.64
|
| Rate for Payer: UMR Bronson Commercial |
$42.35
|
| Rate for Payer: UMR Bronson Commercial |
$28.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.08
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM
|
Facility
|
OP
|
$11,273.70
|
|
|
Service Code
|
CPT 14301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$831.52 |
| Max. Negotiated Rate |
$11,273.70 |
| Rate for Payer: Aetna Medicare |
$3,730.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,483.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,483.69
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.09
|
| Rate for Payer: BCN Commercial |
$2,108.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,586.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,586.95
|
| Rate for Payer: Mclaren Medicaid |
$1,922.61
|
| Rate for Payer: Mclaren Medicare |
$3,586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,766.30
|
| Rate for Payer: Meridian Medicaid |
$2,018.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,124.99
|
| Rate for Payer: Nomi Health Commercial |
$7,532.60
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,586.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,922.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,273.70
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$9,018.96
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.67
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Exchange |
$831.52
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$1,922.61
|
| Rate for Payer: VA VA |
$3,586.95
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITIONAL 30.0 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$808.63
|
|
|
Service Code
|
CPT 14302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.62 |
| Max. Negotiated Rate |
$808.63 |
| Rate for Payer: BCBS Trust/PPO |
$808.63
|
| Rate for Payer: BCN Commercial |
$808.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.38
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$207.62
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$777.54 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,719.22
|
| Rate for Payer: BCN Commercial |
$2,719.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$855.29
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$777.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$631.79 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,428.57
|
| Rate for Payer: BCN Commercial |
$1,428.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$694.97
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$631.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$724.37 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,428.57
|
| Rate for Payer: BCN Commercial |
$1,428.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.81
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$724.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.39 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,066.09
|
| Rate for Payer: BCN Commercial |
$2,066.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$652.73
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$593.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$674.48 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,428.57
|
| Rate for Payer: BCN Commercial |
$1,428.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$741.93
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$674.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$538.95 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,428.57
|
| Rate for Payer: BCN Commercial |
$1,428.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.84
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$538.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$626.20 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,428.57
|
| Rate for Payer: BCN Commercial |
$1,428.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$688.82
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$626.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 14000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$481.76 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,428.57
|
| Rate for Payer: BCN Commercial |
$1,428.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$529.94
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$481.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17,913.44
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$16,122.10 |
| Rate for Payer: Aetna American Axle |
$11,643.74
|
| Rate for Payer: Aetna Commercial |
$15,226.42
|
| Rate for Payer: Aetna Medicare |
$42.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,643.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.21
|
| Rate for Payer: BCBS Complete |
$23.06
|
| Rate for Payer: BCBS MAPPO |
$40.97
|
| Rate for Payer: BCBS Trust/PPO |
$107.02
|
| Rate for Payer: BCN Commercial |
$107.02
|
| Rate for Payer: BCN Medicare Advantage |
$40.97
|
| Rate for Payer: Cash Price |
$14,330.75
|
| Rate for Payer: Cash Price |
$14,330.75
|
| Rate for Payer: Cofinity Commercial |
$15,405.56
|
| Rate for Payer: Cofinity Commercial |
$12,539.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,539.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,330.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.97
|
| Rate for Payer: Healthscope Commercial |
$16,122.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,539.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,435.08
|
| Rate for Payer: Mclaren Medicaid |
$21.96
|
| Rate for Payer: Mclaren Medicare |
$40.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.02
|
| Rate for Payer: Meridian Medicaid |
$23.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,226.42
|
| Rate for Payer: Nomi Health Commercial |
$122.91
|
| Rate for Payer: PACE Medicare |
$38.92
|
| Rate for Payer: PACE SWMI |
$40.97
|
| Rate for Payer: PHP Commercial |
$15,226.42
|
| Rate for Payer: PHP Medicare Advantage |
$40.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,643.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.41
|
| Rate for Payer: Priority Health Medicare |
$40.97
|
| Rate for Payer: Priority Health Narrow Network |
$93.13
|
| Rate for Payer: Priority Health SBD |
$11,285.47
|
| Rate for Payer: Railroad Medicare Medicare |
$40.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.97
|
| Rate for Payer: UHC Exchange |
$78.30
|
| Rate for Payer: UHC Medicare Advantage |
$40.97
|
| Rate for Payer: UHCCP Medicaid |
$21.96
|
| Rate for Payer: UMR Bronson Commercial |
$6,627.97
|
| Rate for Payer: VA VA |
$40.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,435.08
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17,913.44
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,881.91 |
| Max. Negotiated Rate |
$16,122.10 |
| Rate for Payer: Aetna American Axle |
$11,643.74
|
| Rate for Payer: Aetna Commercial |
$15,226.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,643.74
|
| Rate for Payer: Cash Price |
$14,330.75
|
| Rate for Payer: Cofinity Commercial |
$12,539.41
|
| Rate for Payer: Cofinity Commercial |
$15,405.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,539.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,330.75
|
| Rate for Payer: Healthscope Commercial |
$16,122.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,539.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,435.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,226.42
|
| Rate for Payer: PHP Commercial |
$15,226.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,643.74
|
| Rate for Payer: Priority Health SBD |
$11,285.47
|
| Rate for Payer: UMR Bronson Commercial |
$7,881.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,435.08
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28,661.47
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$25,795.32 |
| Rate for Payer: Aetna American Axle |
$18,629.96
|
| Rate for Payer: Aetna Commercial |
$24,362.25
|
| Rate for Payer: Aetna Medicare |
$42.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,629.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.21
|
| Rate for Payer: BCBS Complete |
$23.06
|
| Rate for Payer: BCBS MAPPO |
$40.97
|
| Rate for Payer: BCBS Trust/PPO |
$107.02
|
| Rate for Payer: BCN Commercial |
$107.02
|
| Rate for Payer: BCN Medicare Advantage |
$40.97
|
| Rate for Payer: Cash Price |
$22,929.18
|
| Rate for Payer: Cash Price |
$22,929.18
|
| Rate for Payer: Cofinity Commercial |
$24,648.86
|
| Rate for Payer: Cofinity Commercial |
$20,063.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,063.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,929.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.97
|
| Rate for Payer: Healthscope Commercial |
$25,795.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,063.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,496.10
|
| Rate for Payer: Mclaren Medicaid |
$21.96
|
| Rate for Payer: Mclaren Medicare |
$40.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.02
|
| Rate for Payer: Meridian Medicaid |
$23.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,362.25
|
| Rate for Payer: Nomi Health Commercial |
$122.91
|
| Rate for Payer: PACE Medicare |
$38.92
|
| Rate for Payer: PACE SWMI |
$40.97
|
| Rate for Payer: PHP Commercial |
$24,362.25
|
| Rate for Payer: PHP Medicare Advantage |
$40.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,629.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.41
|
| Rate for Payer: Priority Health Medicare |
$40.97
|
| Rate for Payer: Priority Health Narrow Network |
$93.13
|
| Rate for Payer: Priority Health SBD |
$18,056.73
|
| Rate for Payer: Railroad Medicare Medicare |
$40.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.97
|
| Rate for Payer: UHC Exchange |
$78.30
|
| Rate for Payer: UHC Medicare Advantage |
$40.97
|
| Rate for Payer: UHCCP Medicaid |
$21.96
|
| Rate for Payer: UMR Bronson Commercial |
$10,604.74
|
| Rate for Payer: VA VA |
$40.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,496.10
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15,018.28
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
35775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.81 |
| Max. Negotiated Rate |
$13,516.45 |
| Rate for Payer: Aetna American Axle |
$9,761.88
|
| Rate for Payer: Aetna Commercial |
$12,765.54
|
| Rate for Payer: Aetna Medicare |
$232.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,761.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.40
|
| Rate for Payer: BCBS Complete |
$125.80
|
| Rate for Payer: BCBS MAPPO |
$223.52
|
| Rate for Payer: BCBS Trust/PPO |
$602.66
|
| Rate for Payer: BCN Commercial |
$602.66
|
| Rate for Payer: BCN Medicare Advantage |
$223.52
|
| Rate for Payer: Cash Price |
$12,014.62
|
| Rate for Payer: Cash Price |
$12,014.62
|
| Rate for Payer: Cofinity Commercial |
$12,915.72
|
| Rate for Payer: Cofinity Commercial |
$10,512.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,512.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,014.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.52
|
| Rate for Payer: Healthscope Commercial |
$13,516.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,512.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,263.71
|
| Rate for Payer: Mclaren Medicaid |
$119.81
|
| Rate for Payer: Mclaren Medicare |
$223.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.70
|
| Rate for Payer: Meridian Medicaid |
$125.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,765.54
|
| Rate for Payer: Nomi Health Commercial |
$670.56
|
| Rate for Payer: PACE Medicare |
$212.34
|
| Rate for Payer: PACE SWMI |
$223.52
|
| Rate for Payer: PHP Commercial |
$12,765.54
|
| Rate for Payer: PHP Medicare Advantage |
$223.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,761.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$643.29
|
| Rate for Payer: Priority Health Medicare |
$223.52
|
| Rate for Payer: Priority Health Narrow Network |
$514.63
|
| Rate for Payer: Priority Health SBD |
$9,461.52
|
| Rate for Payer: Railroad Medicare Medicare |
$223.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.52
|
| Rate for Payer: UHC Exchange |
$427.17
|
| Rate for Payer: UHC Medicare Advantage |
$223.52
|
| Rate for Payer: UHCCP Medicaid |
$119.81
|
| Rate for Payer: UMR Bronson Commercial |
$5,556.76
|
| Rate for Payer: VA VA |
$223.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,263.71
|
|
|
AGALSIDASE BETA 35 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15,018.28
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
35775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,608.04 |
| Max. Negotiated Rate |
$13,516.45 |
| Rate for Payer: Aetna American Axle |
$9,761.88
|
| Rate for Payer: Aetna Commercial |
$12,765.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,761.88
|
| Rate for Payer: Cash Price |
$12,014.62
|
| Rate for Payer: Cofinity Commercial |
$10,512.80
|
| Rate for Payer: Cofinity Commercial |
$12,915.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,512.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,014.62
|
| Rate for Payer: Healthscope Commercial |
$13,516.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,512.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,263.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,765.54
|
| Rate for Payer: PHP Commercial |
$12,765.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,761.88
|
| Rate for Payer: Priority Health SBD |
$9,461.52
|
| Rate for Payer: UMR Bronson Commercial |
$6,608.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,263.71
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,640.58
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
38494
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.81 |
| Max. Negotiated Rate |
$2,376.52 |
| Rate for Payer: Aetna American Axle |
$1,716.38
|
| Rate for Payer: Aetna Commercial |
$2,244.49
|
| Rate for Payer: Aetna Medicare |
$232.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.40
|
| Rate for Payer: BCBS Complete |
$125.80
|
| Rate for Payer: BCBS MAPPO |
$223.52
|
| Rate for Payer: BCBS Trust/PPO |
$602.66
|
| Rate for Payer: BCN Commercial |
$602.66
|
| Rate for Payer: BCN Medicare Advantage |
$223.52
|
| Rate for Payer: Cash Price |
$2,112.46
|
| Rate for Payer: Cash Price |
$2,112.46
|
| Rate for Payer: Cofinity Commercial |
$2,270.90
|
| Rate for Payer: Cofinity Commercial |
$1,848.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,848.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,112.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.52
|
| Rate for Payer: Healthscope Commercial |
$2,376.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,848.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,980.44
|
| Rate for Payer: Mclaren Medicaid |
$119.81
|
| Rate for Payer: Mclaren Medicare |
$223.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.70
|
| Rate for Payer: Meridian Medicaid |
$125.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,244.49
|
| Rate for Payer: Nomi Health Commercial |
$670.56
|
| Rate for Payer: PACE Medicare |
$212.34
|
| Rate for Payer: PACE SWMI |
$223.52
|
| Rate for Payer: PHP Commercial |
$2,244.49
|
| Rate for Payer: PHP Medicare Advantage |
$223.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,716.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$643.29
|
| Rate for Payer: Priority Health Medicare |
$223.52
|
| Rate for Payer: Priority Health Narrow Network |
$514.63
|
| Rate for Payer: Priority Health SBD |
$1,663.57
|
| Rate for Payer: Railroad Medicare Medicare |
$223.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.52
|
| Rate for Payer: UHC Exchange |
$427.17
|
| Rate for Payer: UHC Medicare Advantage |
$223.52
|
| Rate for Payer: UHCCP Medicaid |
$119.81
|
| Rate for Payer: UMR Bronson Commercial |
$977.01
|
| Rate for Payer: VA VA |
$223.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,980.44
|
|
