|
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 |
$14.48 |
| 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 |
$19.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: BCBS Complete |
$15.65
|
| 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
|
OP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.35 |
| 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: 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 |
$18.95
|
| 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 |
$18.95
|
|
|
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 |
$18.95
|
| 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 |
$18.95
|
|
|
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 |
$87.56 |
| 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: 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 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 (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 |
$29.64 |
| Max. Negotiated Rate |
$72.09 |
| Rate for Payer: Aetna American Axle |
$52.06
|
| Rate for Payer: Aetna American Axle |
$74.40
|
| Rate for Payer: Aetna American Axle |
$49.55
|
| Rate for Payer: Aetna Commercial |
$68.08
|
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Commercial |
$97.29
|
| Rate for Payer: Aetna Medicare |
$40.05
|
| Rate for Payer: Aetna Medicare |
$38.12
|
| Rate for Payer: Aetna Medicare |
$57.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.40
|
| Rate for Payer: BCBS Complete |
$45.78
|
| Rate for Payer: BCBS Complete |
$30.49
|
| Rate for Payer: BCBS Complete |
$32.04
|
| 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 |
$65.56
|
| Rate for Payer: Cofinity Commercial |
$80.12
|
| Rate for Payer: Cofinity Commercial |
$98.44
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Cofinity Commercial |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$53.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.08
|
| Rate for Payer: Healthscope Commercial |
$103.01
|
| Rate for Payer: Healthscope Commercial |
$68.61
|
| Rate for Payer: Healthscope Commercial |
$72.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.12
|
| 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 |
$57.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.08
|
| 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 |
$97.29
|
| Rate for Payer: PHP Commercial |
$64.80
|
| Rate for Payer: PHP Commercial |
$68.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.40
|
| Rate for Payer: Priority Health SBD |
$48.02
|
| Rate for Payer: Priority Health SBD |
$72.11
|
| Rate for Payer: Priority Health SBD |
$50.46
|
| 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
|
$10,050.52
|
|
|
Service Code
|
CPT 14301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,913.77 |
| Max. Negotiated Rate |
$10,050.52 |
| Rate for Payer: Aetna Medicare |
$3,713.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,050.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$6,823.53
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 14061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 14060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
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
|
$5,021.81
|
|
|
Service Code
|
CPT 14041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 14040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 14021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 14020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 14001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 14000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
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 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17,913.44
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
165224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.60 |
| 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 |
$43.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,643.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.70
|
| Rate for Payer: BCBS Complete |
$23.73
|
| Rate for Payer: BCBS MAPPO |
$42.16
|
| Rate for Payer: BCN Medicare Advantage |
$42.16
|
| Rate for Payer: Cash Price |
$14,330.75
|
| 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: Health Alliance Plan Medicare Advantage |
$42.16
|
| 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 |
$22.60
|
| Rate for Payer: Mclaren Medicare |
$42.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.27
|
| Rate for Payer: Meridian Medicaid |
$23.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,226.42
|
| Rate for Payer: PACE Medicare |
$40.05
|
| Rate for Payer: PACE SWMI |
$42.16
|
| Rate for Payer: PHP Commercial |
$15,226.42
|
| Rate for Payer: PHP Medicare Advantage |
$42.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,643.74
|
| Rate for Payer: Priority Health Medicare |
$42.16
|
| Rate for Payer: Priority Health SBD |
$11,285.47
|
| Rate for Payer: Railroad Medicare Medicare |
$42.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.16
|
| Rate for Payer: UHC Exchange |
$80.57
|
| Rate for Payer: UHC Medicare Advantage |
$42.16
|
| Rate for Payer: UHCCP Medicaid |
$22.60
|
| Rate for Payer: UMR Bronson Commercial |
$6,627.97
|
| Rate for Payer: VA VA |
$42.16
|
| 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 |
$22.60 |
| 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 |
$43.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,629.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.70
|
| Rate for Payer: BCBS Complete |
$23.73
|
| Rate for Payer: BCBS MAPPO |
$42.16
|
| Rate for Payer: BCN Medicare Advantage |
$42.16
|
| Rate for Payer: Cash Price |
$22,929.18
|
| Rate for Payer: Cash Price |
$22,929.18
|
| Rate for Payer: Cofinity Commercial |
$20,063.03
|
| Rate for Payer: Cofinity Commercial |
$24,648.86
|
| 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 |
$42.16
|
| 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 |
$22.60
|
| Rate for Payer: Mclaren Medicare |
$42.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.27
|
| Rate for Payer: Meridian Medicaid |
$23.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,362.25
|
| Rate for Payer: PACE Medicare |
$40.05
|
| Rate for Payer: PACE SWMI |
$42.16
|
| Rate for Payer: PHP Commercial |
$24,362.25
|
| Rate for Payer: PHP Medicare Advantage |
$42.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,629.96
|
| Rate for Payer: Priority Health Medicare |
$42.16
|
| Rate for Payer: Priority Health SBD |
$18,056.73
|
| Rate for Payer: Railroad Medicare Medicare |
$42.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.16
|
| Rate for Payer: UHC Exchange |
$80.57
|
| Rate for Payer: UHC Medicare Advantage |
$42.16
|
| Rate for Payer: UHCCP Medicaid |
$22.60
|
| Rate for Payer: UMR Bronson Commercial |
$10,604.74
|
| Rate for Payer: VA VA |
$42.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,496.10
|
|
|
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 35 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15,018.28
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
35775
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.36 |
| 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 |
$239.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,761.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$287.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$287.69
|
| Rate for Payer: BCBS Complete |
$129.53
|
| Rate for Payer: BCBS MAPPO |
$230.15
|
| Rate for Payer: BCN Medicare Advantage |
$230.15
|
| 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 |
$230.15
|
| 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 |
$123.36
|
| Rate for Payer: Mclaren Medicare |
$230.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.66
|
| Rate for Payer: Meridian Medicaid |
$129.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$264.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,765.54
|
| Rate for Payer: PACE Medicare |
$218.64
|
| Rate for Payer: PACE SWMI |
$230.15
|
| Rate for Payer: PHP Commercial |
$12,765.54
|
| Rate for Payer: PHP Medicare Advantage |
$230.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,761.88
|
| Rate for Payer: Priority Health Medicare |
$230.15
|
| Rate for Payer: Priority Health SBD |
$9,461.52
|
| Rate for Payer: Railroad Medicare Medicare |
$230.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.15
|
| Rate for Payer: UHC Exchange |
$439.84
|
| Rate for Payer: UHC Medicare Advantage |
$230.15
|
| Rate for Payer: UHCCP Medicaid |
$123.36
|
| Rate for Payer: UMR Bronson Commercial |
$5,556.76
|
| Rate for Payer: VA VA |
$230.15
|
| 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 |
$123.36 |
| 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 |
$239.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$287.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$287.69
|
| Rate for Payer: BCBS Complete |
$129.53
|
| Rate for Payer: BCBS MAPPO |
$230.15
|
| Rate for Payer: BCN Medicare Advantage |
$230.15
|
| 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 |
$230.15
|
| 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 |
$1,980.43
|
| Rate for Payer: Mclaren Medicaid |
$123.36
|
| Rate for Payer: Mclaren Medicare |
$230.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.66
|
| Rate for Payer: Meridian Medicaid |
$129.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$264.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,244.49
|
| Rate for Payer: PACE Medicare |
$218.64
|
| Rate for Payer: PACE SWMI |
$230.15
|
| Rate for Payer: PHP Commercial |
$2,244.49
|
| Rate for Payer: PHP Medicare Advantage |
$230.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,716.38
|
| Rate for Payer: Priority Health Medicare |
$230.15
|
| Rate for Payer: Priority Health SBD |
$1,663.57
|
| Rate for Payer: Railroad Medicare Medicare |
$230.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.15
|
| Rate for Payer: UHC Exchange |
$439.84
|
| Rate for Payer: UHC Medicare Advantage |
$230.15
|
| Rate for Payer: UHCCP Medicaid |
$123.36
|
| Rate for Payer: UMR Bronson Commercial |
$977.01
|
| Rate for Payer: VA VA |
$230.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,980.43
|
|
|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,640.58
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
38494
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,161.86 |
| 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 New Business (MI Preferred) |
$1,716.38
|
| Rate for Payer: Cash Price |
$2,112.46
|
| Rate for Payer: Cofinity Commercial |
$1,848.41
|
| Rate for Payer: Cofinity Commercial |
$2,270.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,848.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,112.46
|
| 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 |
$1,980.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,244.49
|
| Rate for Payer: PHP Commercial |
$2,244.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,716.38
|
| Rate for Payer: Priority Health SBD |
$1,663.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,161.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,980.43
|
|
|
ALBENDAZOLE 200 MG TABLET
|
Facility
|
OP
|
$205.61
|
|
|
Service Code
|
NDC 72205005108
|
| Hospital Charge Code |
8979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$185.05 |
| Rate for Payer: Aetna American Axle |
$133.65
|
| Rate for Payer: Aetna Commercial |
$174.77
|
| Rate for Payer: Aetna Medicare |
$102.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.65
|
| Rate for Payer: BCBS Complete |
$82.24
|
| Rate for Payer: Cash Price |
$164.49
|
| Rate for Payer: Cofinity Commercial |
$143.93
|
| Rate for Payer: Cofinity Commercial |
$176.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.49
|
| Rate for Payer: Healthscope Commercial |
$185.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.77
|
| Rate for Payer: PHP Commercial |
$174.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.65
|
| Rate for Payer: Priority Health SBD |
$129.53
|
| Rate for Payer: UMR Bronson Commercial |
$76.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.21
|
|
