|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
OP
|
$153.76
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.89 |
| Max. Negotiated Rate |
$138.38 |
| Rate for Payer: Aetna American Axle |
$99.94
|
| Rate for Payer: Aetna Commercial |
$130.70
|
| Rate for Payer: Aetna Medicare |
$76.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.94
|
| Rate for Payer: BCBS Complete |
$61.50
|
| Rate for Payer: Cash Price |
$123.01
|
| Rate for Payer: Cofinity Commercial |
$107.63
|
| Rate for Payer: Cofinity Commercial |
$132.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.01
|
| Rate for Payer: Healthscope Commercial |
$138.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.70
|
| Rate for Payer: PHP Commercial |
$130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.94
|
| Rate for Payer: Priority Health SBD |
$96.87
|
| Rate for Payer: UMR Bronson Commercial |
$56.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.32
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP
|
Facility
|
IP
|
$153.76
|
|
|
Service Code
|
NDC 24208063562
|
| Hospital Charge Code |
28810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.65 |
| Max. Negotiated Rate |
$138.38 |
| Rate for Payer: Aetna American Axle |
$99.94
|
| Rate for Payer: Aetna Commercial |
$130.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.94
|
| Rate for Payer: Cash Price |
$123.01
|
| Rate for Payer: Cofinity Commercial |
$107.63
|
| Rate for Payer: Cofinity Commercial |
$132.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.01
|
| Rate for Payer: Healthscope Commercial |
$138.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.70
|
| Rate for Payer: PHP Commercial |
$130.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.94
|
| Rate for Payer: Priority Health SBD |
$96.87
|
| Rate for Payer: UMR Bronson Commercial |
$67.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.32
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
OP
|
$278.99
|
|
|
Service Code
|
NDC 61314064610
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.23 |
| Max. Negotiated Rate |
$251.09 |
| Rate for Payer: Aetna American Axle |
$181.34
|
| Rate for Payer: Aetna Commercial |
$237.14
|
| Rate for Payer: Aetna Medicare |
$139.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.34
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: Cash Price |
$223.19
|
| Rate for Payer: Cofinity Commercial |
$195.29
|
| Rate for Payer: Cofinity Commercial |
$239.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.19
|
| Rate for Payer: Healthscope Commercial |
$251.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.14
|
| Rate for Payer: PHP Commercial |
$237.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.34
|
| Rate for Payer: Priority Health SBD |
$175.76
|
| Rate for Payer: UMR Bronson Commercial |
$103.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.24
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
IP
|
$278.99
|
|
|
Service Code
|
NDC 61314064610
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.76 |
| Max. Negotiated Rate |
$251.09 |
| Rate for Payer: Aetna American Axle |
$181.34
|
| Rate for Payer: Aetna Commercial |
$237.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.34
|
| Rate for Payer: Cash Price |
$223.19
|
| Rate for Payer: Cofinity Commercial |
$195.29
|
| Rate for Payer: Cofinity Commercial |
$239.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.19
|
| Rate for Payer: Healthscope Commercial |
$251.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.14
|
| Rate for Payer: PHP Commercial |
$237.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.34
|
| Rate for Payer: Priority Health SBD |
$175.76
|
| Rate for Payer: UMR Bronson Commercial |
$122.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.24
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
OP
|
$189.84
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.24 |
| Max. Negotiated Rate |
$170.86 |
| Rate for Payer: Aetna American Axle |
$123.40
|
| Rate for Payer: Aetna Commercial |
$161.36
|
| Rate for Payer: Aetna Medicare |
$94.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.40
|
| Rate for Payer: BCBS Complete |
$75.94
|
| Rate for Payer: Cash Price |
$151.87
|
| Rate for Payer: Cofinity Commercial |
$132.89
|
| Rate for Payer: Cofinity Commercial |
$163.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.87
|
| Rate for Payer: Healthscope Commercial |
$170.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.36
|
| Rate for Payer: PHP Commercial |
$161.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.40
|
| Rate for Payer: Priority Health SBD |
$119.60
|
| Rate for Payer: UMR Bronson Commercial |
$70.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.38
|
|
|
NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION
|
Facility
|
IP
|
$189.84
|
|
|
Service Code
|
NDC 24208063110
|
| Hospital Charge Code |
34814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.53 |
| Max. Negotiated Rate |
$170.86 |
| Rate for Payer: Aetna American Axle |
$123.40
|
| Rate for Payer: Aetna Commercial |
$161.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.40
|
| Rate for Payer: Cash Price |
$151.87
|
| Rate for Payer: Cofinity Commercial |
$132.89
|
| Rate for Payer: Cofinity Commercial |
$163.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.87
|
| Rate for Payer: Healthscope Commercial |
$170.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.36
|
| Rate for Payer: PHP Commercial |
$161.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.40
|
| Rate for Payer: Priority Health SBD |
$119.60
|
| Rate for Payer: UMR Bronson Commercial |
$83.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.38
|
|
|
NEONATAL PARENTERAL NUTRITION (2 IN 1) CUSTOM
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
NDC 00090000235
|
| Hospital Charge Code |
158489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna American Axle |
$234.00
|
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna Medicare |
$180.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.00
|
| Rate for Payer: BCBS Complete |
$144.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$309.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.00
|
| Rate for Payer: PHP Commercial |
$306.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.00
|
| Rate for Payer: Priority Health SBD |
$226.80
|
| Rate for Payer: UMR Bronson Commercial |
$133.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.00
|
|
|
NEONATAL PARENTERAL NUTRITION (2 IN 1) CUSTOM
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
NDC 00090000235
|
| Hospital Charge Code |
158489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna American Axle |
$234.00
|
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$309.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.00
|
| Rate for Payer: PHP Commercial |
$306.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.00
|
| Rate for Payer: Priority Health SBD |
$226.80
|
| Rate for Payer: UMR Bronson Commercial |
$158.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.00
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.97
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
167219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna American Axle |
$11.78
|
| Rate for Payer: Aetna American Axle |
$11.98
|
| Rate for Payer: Aetna American Axle |
$14.35
|
| Rate for Payer: Aetna American Axle |
$13.77
|
| Rate for Payer: Aetna American Axle |
$10.73
|
| Rate for Payer: Aetna American Axle |
$17.37
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Commercial |
$18.77
|
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: Aetna Medicare |
$13.36
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna Medicare |
$11.04
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: Aetna Medicare |
$8.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.77
|
| Rate for Payer: BCBS Complete |
$8.48
|
| Rate for Payer: BCBS Complete |
$6.60
|
| Rate for Payer: BCBS Complete |
$8.83
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: BCBS Complete |
$10.69
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Cofinity Commercial |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: PHP Commercial |
$22.71
|
| Rate for Payer: PHP Commercial |
$18.77
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$15.40
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$16.83
|
| Rate for Payer: Priority Health SBD |
$13.35
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: Priority Health SBD |
$13.91
|
| Rate for Payer: Priority Health SBD |
$10.40
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| Rate for Payer: UMR Bronson Commercial |
$6.70
|
| Rate for Payer: UMR Bronson Commercial |
$7.84
|
| Rate for Payer: UMR Bronson Commercial |
$6.82
|
| Rate for Payer: UMR Bronson Commercial |
$6.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.89
|
| Rate for Payer: UMR Bronson Commercial |
$8.17
|
| Rate for Payer: UMR Bronson Commercial |
$9.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.38
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.51
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
167219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna American Axle |
$10.73
|
| Rate for Payer: Aetna American Axle |
$17.37
|
| Rate for Payer: Aetna American Axle |
$14.35
|
| Rate for Payer: Aetna American Axle |
$11.98
|
| Rate for Payer: Aetna American Axle |
$11.78
|
| Rate for Payer: Aetna American Axle |
$13.77
|
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Commercial |
$18.77
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.37
|
| Rate for Payer: Cash Price |
$16.95
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Cofinity Commercial |
$14.83
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$12.68
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$18.99
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Healthscope Commercial |
$19.07
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.71
|
| Rate for Payer: PHP Commercial |
$18.77
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: PHP Commercial |
$18.01
|
| Rate for Payer: PHP Commercial |
$14.03
|
| Rate for Payer: PHP Commercial |
$15.40
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$22.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.35
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: Priority Health SBD |
$11.42
|
| Rate for Payer: Priority Health SBD |
$10.40
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$16.83
|
| Rate for Payer: Priority Health SBD |
$13.91
|
| Rate for Payer: Priority Health SBD |
$13.35
|
| Rate for Payer: UMR Bronson Commercial |
$9.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.87
|
| Rate for Payer: UMR Bronson Commercial |
$9.72
|
| Rate for Payer: UMR Bronson Commercial |
$11.76
|
| Rate for Payer: UMR Bronson Commercial |
$7.26
|
| Rate for Payer: UMR Bronson Commercial |
$8.11
|
| Rate for Payer: UMR Bronson Commercial |
$7.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.38
|
|
|
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; UP TO 4 CM LENGTH
|
Facility
|
OP
|
$17,581.19
|
|
|
Service Code
|
CPT 64890
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,347.73 |
| Max. Negotiated Rate |
$17,581.19 |
| Rate for Payer: Aetna Medicare |
$6,495.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,807.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,807.20
|
| Rate for Payer: BCBS Complete |
$3,515.11
|
| Rate for Payer: BCBS MAPPO |
$6,245.76
|
| Rate for Payer: BCN Medicare Advantage |
$6,245.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,245.76
|
| Rate for Payer: Mclaren Medicaid |
$3,347.73
|
| Rate for Payer: Mclaren Medicare |
$6,245.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,558.05
|
| Rate for Payer: Meridian Medicaid |
$3,515.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,182.62
|
| Rate for Payer: PACE Medicare |
$5,933.47
|
| Rate for Payer: PACE SWMI |
$6,245.76
|
| Rate for Payer: PHP Medicare Advantage |
$6,245.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,347.73
|
| Rate for Payer: Priority Health Medicare |
$6,245.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6,245.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,581.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,245.76
|
| Rate for Payer: UHC Exchange |
$11,936.27
|
| Rate for Payer: UHC Medicare Advantage |
$6,245.76
|
| Rate for Payer: UHCCP Medicaid |
$3,347.73
|
| Rate for Payer: VA VA |
$6,245.76
|
|
|
NERVE PEDICLE TRANSFER; FIRST STAGE
|
Facility
|
OP
|
$17,581.19
|
|
|
Service Code
|
CPT 64905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,347.73 |
| Max. Negotiated Rate |
$17,581.19 |
| Rate for Payer: Aetna Medicare |
$6,495.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,807.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,807.20
|
| Rate for Payer: BCBS Complete |
$3,515.11
|
| Rate for Payer: BCBS MAPPO |
$6,245.76
|
| Rate for Payer: BCN Medicare Advantage |
$6,245.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,245.76
|
| Rate for Payer: Mclaren Medicaid |
$3,347.73
|
| Rate for Payer: Mclaren Medicare |
$6,245.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,558.05
|
| Rate for Payer: Meridian Medicaid |
$3,515.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,182.62
|
| Rate for Payer: PACE Medicare |
$5,933.47
|
| Rate for Payer: PACE SWMI |
$6,245.76
|
| Rate for Payer: PHP Medicare Advantage |
$6,245.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,347.73
|
| Rate for Payer: Priority Health Medicare |
$6,245.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6,245.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,581.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,245.76
|
| Rate for Payer: UHC Exchange |
$11,936.27
|
| Rate for Payer: UHC Medicare Advantage |
$6,245.76
|
| Rate for Payer: UHCCP Medicaid |
$3,347.73
|
| Rate for Payer: VA VA |
$6,245.76
|
|
|
NERVE REPAIR; WITH NERVE ALLOGRAFT, EACH NERVE, FIRST STRAND (CABLE)
|
Facility
|
OP
|
$17,581.19
|
|
|
Service Code
|
CPT 64912
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,347.73 |
| Max. Negotiated Rate |
$17,581.19 |
| Rate for Payer: Aetna Medicare |
$6,495.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,807.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,807.20
|
| Rate for Payer: BCBS Complete |
$3,515.11
|
| Rate for Payer: BCBS MAPPO |
$6,245.76
|
| Rate for Payer: BCN Medicare Advantage |
$6,245.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,245.76
|
| Rate for Payer: Mclaren Medicaid |
$3,347.73
|
| Rate for Payer: Mclaren Medicare |
$6,245.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,558.05
|
| Rate for Payer: Meridian Medicaid |
$3,515.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,182.62
|
| Rate for Payer: PACE Medicare |
$5,933.47
|
| Rate for Payer: PACE SWMI |
$6,245.76
|
| Rate for Payer: PHP Medicare Advantage |
$6,245.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,347.73
|
| Rate for Payer: Priority Health Medicare |
$6,245.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6,245.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,581.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,245.76
|
| Rate for Payer: UHC Exchange |
$11,936.27
|
| Rate for Payer: UHC Medicare Advantage |
$6,245.76
|
| Rate for Payer: UHCCP Medicaid |
$3,347.73
|
| Rate for Payer: VA VA |
$6,245.76
|
|
|
NERVE REPAIR; WITH SYNTHETIC CONDUIT OR VEIN ALLOGRAFT (EG, NERVE TUBE), EACH NERVE
|
Facility
|
OP
|
$17,581.19
|
|
|
Service Code
|
CPT 64910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,347.73 |
| Max. Negotiated Rate |
$17,581.19 |
| Rate for Payer: Aetna Medicare |
$6,495.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,807.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,807.20
|
| Rate for Payer: BCBS Complete |
$3,515.11
|
| Rate for Payer: BCBS MAPPO |
$6,245.76
|
| Rate for Payer: BCN Medicare Advantage |
$6,245.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,245.76
|
| Rate for Payer: Mclaren Medicaid |
$3,347.73
|
| Rate for Payer: Mclaren Medicare |
$6,245.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,558.05
|
| Rate for Payer: Meridian Medicaid |
$3,515.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,182.62
|
| Rate for Payer: PACE Medicare |
$5,933.47
|
| Rate for Payer: PACE SWMI |
$6,245.76
|
| Rate for Payer: PHP Medicare Advantage |
$6,245.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,347.73
|
| Rate for Payer: Priority Health Medicare |
$6,245.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6,245.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,581.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,245.76
|
| Rate for Payer: UHC Exchange |
$11,936.27
|
| Rate for Payer: UHC Medicare Advantage |
$6,245.76
|
| Rate for Payer: UHCCP Medicaid |
$3,347.73
|
| Rate for Payer: VA VA |
$6,245.76
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (SPECIFY)
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64716
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEUROPLASTY; DIGITAL, 1 OR BOTH, SAME DIGIT
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64702
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; OTHER THAN SPECIFIED
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64708
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; SCIATIC NERVE
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64712
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEUROPLASTY; NERVE OF HAND OR FOOT
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 64704
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
|
NEVIRAPINE 200 MG TABLET
|
Facility
|
IP
|
$145.23
|
|
|
Service Code
|
NDC 31722050560
|
| Hospital Charge Code |
17403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$130.71 |
| Rate for Payer: Aetna American Axle |
$94.40
|
| Rate for Payer: Aetna Commercial |
$123.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.40
|
| Rate for Payer: Cash Price |
$116.18
|
| Rate for Payer: Cofinity Commercial |
$101.66
|
| Rate for Payer: Cofinity Commercial |
$124.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.18
|
| Rate for Payer: Healthscope Commercial |
$130.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.45
|
| Rate for Payer: PHP Commercial |
$123.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.40
|
| Rate for Payer: Priority Health SBD |
$91.49
|
| Rate for Payer: UMR Bronson Commercial |
$63.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.92
|
|
|
NEVIRAPINE 200 MG TABLET
|
Facility
|
OP
|
$145.23
|
|
|
Service Code
|
NDC 31722050560
|
| Hospital Charge Code |
17403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.74 |
| Max. Negotiated Rate |
$130.71 |
| Rate for Payer: Aetna American Axle |
$94.40
|
| Rate for Payer: Aetna Commercial |
$123.45
|
| Rate for Payer: Aetna Medicare |
$72.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.40
|
| Rate for Payer: BCBS Complete |
$58.09
|
| Rate for Payer: Cash Price |
$116.18
|
| Rate for Payer: Cofinity Commercial |
$101.66
|
| Rate for Payer: Cofinity Commercial |
$124.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.18
|
| Rate for Payer: Healthscope Commercial |
$130.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.45
|
| Rate for Payer: PHP Commercial |
$123.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.40
|
| Rate for Payer: Priority Health SBD |
$91.49
|
| Rate for Payer: UMR Bronson Commercial |
$53.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.92
|
|
|
NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$676.23
|
|
|
Service Code
|
NDC 65862005724
|
| Hospital Charge Code |
24119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.21 |
| Max. Negotiated Rate |
$608.61 |
| Rate for Payer: Aetna American Axle |
$439.55
|
| Rate for Payer: Aetna Commercial |
$574.80
|
| Rate for Payer: Aetna Medicare |
$338.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.55
|
| Rate for Payer: BCBS Complete |
$270.49
|
| Rate for Payer: Cash Price |
$540.98
|
| Rate for Payer: Cofinity Commercial |
$473.36
|
| Rate for Payer: Cofinity Commercial |
$581.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$473.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.98
|
| Rate for Payer: Healthscope Commercial |
$608.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.80
|
| Rate for Payer: PHP Commercial |
$574.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.55
|
| Rate for Payer: Priority Health SBD |
$426.02
|
| Rate for Payer: UMR Bronson Commercial |
$250.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.17
|
|
