|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,348.80
|
| Rate for Payer: BCN Commercial |
$3,348.80
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA OR FACET) FOR INTRINSIC BONY LESION, SINGLE VERTEBRAL SEGMENT; LUMBAR
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 22102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,985.59
|
| Rate for Payer: BCN Commercial |
$4,985.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONY LESION, WITHOUT DECOMPRESSION OF SPINAL CORD OR NERVE ROOT(S), SINGLE VERTEBRAL SEGMENT; LUMBAR
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 22114
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,360.93
|
| Rate for Payer: BCN Commercial |
$4,360.93
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 56700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,952.61
|
| Rate for Payer: BCN Commercial |
$2,952.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$13,753.59
|
|
|
Service Code
|
APR-DRG 8444
|
| Min. Negotiated Rate |
$13,098.66 |
| Max. Negotiated Rate |
$13,753.59 |
| Rate for Payer: BCBS Complete |
$13,753.59
|
| Rate for Payer: Mclaren Medicaid |
$13,098.66
|
| Rate for Payer: Meridian Medicaid |
$13,753.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,098.66
|
| Rate for Payer: UHC Medicaid |
$13,098.66
|
| Rate for Payer: UHCCP Medicaid |
$13,098.66
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$6,106.52
|
|
|
Service Code
|
APR-DRG 8442
|
| Min. Negotiated Rate |
$5,815.73 |
| Max. Negotiated Rate |
$6,106.52 |
| Rate for Payer: BCBS Complete |
$6,106.52
|
| Rate for Payer: Mclaren Medicaid |
$5,815.73
|
| Rate for Payer: Meridian Medicaid |
$6,106.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,815.73
|
| Rate for Payer: UHC Medicaid |
$5,815.73
|
| Rate for Payer: UHCCP Medicaid |
$5,815.73
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$3,374.69
|
|
|
Service Code
|
APR-DRG 8441
|
| Min. Negotiated Rate |
$3,213.99 |
| Max. Negotiated Rate |
$3,374.69 |
| Rate for Payer: BCBS Complete |
$3,374.69
|
| Rate for Payer: Mclaren Medicaid |
$3,213.99
|
| Rate for Payer: Meridian Medicaid |
$3,374.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,213.99
|
| Rate for Payer: UHC Medicaid |
$3,213.99
|
| Rate for Payer: UHCCP Medicaid |
$3,213.99
|
|
|
PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$8,503.61
|
|
|
Service Code
|
APR-DRG 8443
|
| Min. Negotiated Rate |
$8,098.67 |
| Max. Negotiated Rate |
$8,503.61 |
| Rate for Payer: BCBS Complete |
$8,503.61
|
| Rate for Payer: Mclaren Medicaid |
$8,098.67
|
| Rate for Payer: Meridian Medicaid |
$8,503.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,098.67
|
| Rate for Payer: UHC Medicaid |
$8,098.67
|
| Rate for Payer: UHCCP Medicaid |
$8,098.67
|
|
|
PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
|
Facility
|
OP
|
$19,480.40
|
|
|
Service Code
|
CPT 60210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.44 |
| Max. Negotiated Rate |
$19,480.40 |
| Rate for Payer: Aetna Medicare |
$6,264.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,635.71
|
| Rate for Payer: BCN Commercial |
$4,635.71
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Mclaren Medicaid |
$6,023.79
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$6,324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Nomi Health Commercial |
$18,071.37
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,480.40
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health Tiered Network |
$15,584.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
|
PATELLECTOMY OR HEMIPATELLECTOMY
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,866.80 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,866.80
|
| Rate for Payer: BCN Commercial |
$2,866.80
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC
|
Facility
|
IP
|
$27,527.86
|
|
|
Service Code
|
MSDRG 543
|
| Min. Negotiated Rate |
$8,730.32 |
| Max. Negotiated Rate |
$27,527.86 |
| Rate for Payer: Aetna Medicare |
$9,557.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,487.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,487.26
|
| Rate for Payer: BCBS MAPPO |
$9,189.81
|
| Rate for Payer: BCBS Trust/PPO |
$27,527.86
|
| Rate for Payer: BCN Commercial |
$27,527.86
|
| Rate for Payer: BCN Medicare Advantage |
$9,189.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,189.81
|
| Rate for Payer: Mclaren Medicare |
$9,189.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,649.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,568.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,108.79
|
| Rate for Payer: Nomi Health Commercial |
$13,261.20
|
| Rate for Payer: PACE Medicare |
$8,730.32
|
| Rate for Payer: PACE SWMI |
$9,189.81
|
| Rate for Payer: PHP Medicare Advantage |
$9,189.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,573.56
|
| Rate for Payer: Priority Health Medicare |
$9,189.81
|
| Rate for Payer: Priority Health Tiered Network |
$13,258.85
|
| Rate for Payer: Railroad Medicare Medicare |
$9,189.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,756.40
|
| Rate for Payer: UHC Core |
$14,018.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,189.81
|
| Rate for Payer: UHC Exchange |
$11,448.84
|
| Rate for Payer: VA VA |
$9,189.81
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$52,560.43
|
|
|
Service Code
|
MSDRG 542
|
| Min. Negotiated Rate |
$14,597.39 |
| Max. Negotiated Rate |
$52,560.43 |
| Rate for Payer: Aetna Medicare |
$15,980.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,207.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,207.09
|
| Rate for Payer: BCBS MAPPO |
$15,365.67
|
| Rate for Payer: BCBS Trust/PPO |
$52,560.43
|
| Rate for Payer: BCN Commercial |
$52,560.43
|
| Rate for Payer: BCN Medicare Advantage |
$15,365.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,365.67
|
| Rate for Payer: Mclaren Medicare |
$15,365.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,133.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,670.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,902.24
|
| Rate for Payer: Nomi Health Commercial |
$22,787.85
|
| Rate for Payer: PACE Medicare |
$14,597.39
|
| Rate for Payer: PACE SWMI |
$15,365.67
|
| Rate for Payer: PHP Medicare Advantage |
$15,365.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,479.76
|
| Rate for Payer: Priority Health Medicare |
$15,365.67
|
| Rate for Payer: Priority Health Tiered Network |
$22,783.80
|
| Rate for Payer: Railroad Medicare Medicare |
$15,365.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,793.95
|
| Rate for Payer: UHC Core |
$24,089.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,365.67
|
| Rate for Payer: UHC Exchange |
$19,673.51
|
| Rate for Payer: VA VA |
$15,365.67
|
|
|
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$20,450.99
|
|
|
Service Code
|
MSDRG 544
|
| Min. Negotiated Rate |
$6,558.28 |
| Max. Negotiated Rate |
$20,450.99 |
| Rate for Payer: Aetna Medicare |
$7,179.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,629.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,629.31
|
| Rate for Payer: BCBS MAPPO |
$6,903.45
|
| Rate for Payer: BCBS Trust/PPO |
$20,450.99
|
| Rate for Payer: BCN Commercial |
$20,450.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,903.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,903.45
|
| Rate for Payer: Mclaren Medicare |
$6,903.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,248.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,938.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,593.80
|
| Rate for Payer: Nomi Health Commercial |
$9,734.34
|
| Rate for Payer: PACE Medicare |
$6,558.28
|
| Rate for Payer: PACE SWMI |
$6,903.45
|
| Rate for Payer: PHP Medicare Advantage |
$6,903.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,165.77
|
| Rate for Payer: Priority Health Medicare |
$6,903.45
|
| Rate for Payer: Priority Health Tiered Network |
$9,732.61
|
| Rate for Payer: Railroad Medicare Medicare |
$6,903.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,299.98
|
| Rate for Payer: UHC Core |
$10,290.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,903.45
|
| Rate for Payer: UHC Exchange |
$8,403.98
|
| Rate for Payer: VA VA |
$6,903.45
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$633.42
|
|
|
Service Code
|
NDC 53436008404
|
| Hospital Charge Code |
176467
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.70 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna American Axle |
$411.72
|
| Rate for Payer: Aetna Commercial |
$538.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.72
|
| Rate for Payer: Cash Price |
$506.74
|
| Rate for Payer: Cofinity Advantage |
$443.39
|
| Rate for Payer: Cofinity Commercial |
$544.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.74
|
| Rate for Payer: Healthscope Commercial |
$570.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$443.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$475.06
|
| Rate for Payer: PHP Commercial |
$538.41
|
| Rate for Payer: Priority Health SBD |
$399.05
|
| Rate for Payer: UMR Bronson Commercial |
$278.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.06
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$3,555.00
|
|
|
Service Code
|
NDC 53436008430
|
| Hospital Charge Code |
176467
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,315.35 |
| Max. Negotiated Rate |
$3,199.50 |
| Rate for Payer: Aetna American Axle |
$2,310.75
|
| Rate for Payer: Aetna Commercial |
$3,021.75
|
| Rate for Payer: Aetna Medicare |
$1,777.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,310.75
|
| Rate for Payer: BCBS Complete |
$1,422.00
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cofinity Advantage |
$2,488.50
|
| Rate for Payer: Cofinity Commercial |
$3,057.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.00
|
| Rate for Payer: Healthscope Commercial |
$3,199.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,488.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,666.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,844.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,021.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,666.25
|
| Rate for Payer: PHP Commercial |
$3,021.75
|
| Rate for Payer: Priority Health SBD |
$2,239.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,310.75
|
| Rate for Payer: UHC Core |
$1,852.15
|
| Rate for Payer: UHC Exchange |
$1,397.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,315.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,666.25
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$118.50
|
|
|
Service Code
|
NDC 53436008401
|
| Hospital Charge Code |
176467
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$106.65 |
| Rate for Payer: Aetna American Axle |
$77.03
|
| Rate for Payer: Aetna Commercial |
$100.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.03
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cofinity Advantage |
$82.95
|
| Rate for Payer: Cofinity Commercial |
$101.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.80
|
| Rate for Payer: Healthscope Commercial |
$106.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.88
|
| Rate for Payer: PHP Commercial |
$100.72
|
| Rate for Payer: Priority Health SBD |
$74.66
|
| Rate for Payer: UMR Bronson Commercial |
$52.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.88
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$118.50
|
|
|
Service Code
|
NDC 53436008401
|
| Hospital Charge Code |
176467
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.84 |
| Max. Negotiated Rate |
$106.65 |
| Rate for Payer: Aetna American Axle |
$77.03
|
| Rate for Payer: Aetna Commercial |
$100.72
|
| Rate for Payer: Aetna Medicare |
$59.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.03
|
| Rate for Payer: BCBS Complete |
$47.40
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cofinity Advantage |
$82.95
|
| Rate for Payer: Cofinity Commercial |
$101.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.80
|
| Rate for Payer: Healthscope Commercial |
$106.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.88
|
| Rate for Payer: PHP Commercial |
$100.72
|
| Rate for Payer: Priority Health SBD |
$74.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.03
|
| Rate for Payer: UHC Core |
$61.74
|
| Rate for Payer: UHC Exchange |
$46.57
|
| Rate for Payer: UMR Bronson Commercial |
$43.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.88
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$3,555.00
|
|
|
Service Code
|
NDC 53436008430
|
| Hospital Charge Code |
176467
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,564.20 |
| Max. Negotiated Rate |
$3,199.50 |
| Rate for Payer: Aetna American Axle |
$2,310.75
|
| Rate for Payer: Aetna Commercial |
$3,021.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,310.75
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cofinity Advantage |
$2,488.50
|
| Rate for Payer: Cofinity Commercial |
$3,057.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.00
|
| Rate for Payer: Healthscope Commercial |
$3,199.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,488.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,666.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,021.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,666.25
|
| Rate for Payer: PHP Commercial |
$3,021.75
|
| Rate for Payer: Priority Health SBD |
$2,239.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,564.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,666.25
|
|
|
PATIROMER CALCIUM SORBITEX 8.4 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$633.42
|
|
|
Service Code
|
NDC 53436008404
|
| Hospital Charge Code |
176467
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.37 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna American Axle |
$411.72
|
| Rate for Payer: Aetna Commercial |
$538.41
|
| Rate for Payer: Aetna Medicare |
$316.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.72
|
| Rate for Payer: BCBS Complete |
$253.37
|
| Rate for Payer: Cash Price |
$506.74
|
| Rate for Payer: Cofinity Advantage |
$443.39
|
| Rate for Payer: Cofinity Commercial |
$544.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.74
|
| Rate for Payer: Healthscope Commercial |
$570.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$443.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$506.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$475.06
|
| Rate for Payer: PHP Commercial |
$538.41
|
| Rate for Payer: Priority Health SBD |
$399.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.72
|
| Rate for Payer: UHC Core |
$330.01
|
| Rate for Payer: UHC Exchange |
$248.93
|
| Rate for Payer: UMR Bronson Commercial |
$234.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.06
|
|
|
PATISIRAN (LIPID COMPLEX) 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25,441.00
|
|
|
Service Code
|
HCPCS J0222
|
| Hospital Charge Code |
188116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.77 |
| Max. Negotiated Rate |
$22,896.90 |
| Rate for Payer: Aetna American Axle |
$16,536.65
|
| Rate for Payer: Aetna Commercial |
$21,624.85
|
| Rate for Payer: Aetna Medicare |
$104.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,536.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.12
|
| Rate for Payer: BCBS Complete |
$55.41
|
| Rate for Payer: BCBS MAPPO |
$100.90
|
| Rate for Payer: BCBS Trust/PPO |
$324.15
|
| Rate for Payer: BCN Commercial |
$324.15
|
| Rate for Payer: BCN Medicare Advantage |
$100.90
|
| Rate for Payer: Cash Price |
$20,352.80
|
| Rate for Payer: Cash Price |
$20,352.80
|
| Rate for Payer: Cofinity Advantage |
$17,808.70
|
| Rate for Payer: Cofinity Commercial |
$21,879.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,352.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.90
|
| Rate for Payer: Healthscope Commercial |
$22,896.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,808.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,080.75
|
| Rate for Payer: Mclaren Medicaid |
$100.90
|
| Rate for Payer: Mclaren Medicare |
$100.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.94
|
| Rate for Payer: Meridian Medicaid |
$105.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,624.85
|
| Rate for Payer: Nomi Health Commercial |
$302.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19,080.75
|
| Rate for Payer: PACE Medicare |
$95.86
|
| Rate for Payer: PACE SWMI |
$100.90
|
| Rate for Payer: PHP Commercial |
$21,624.85
|
| Rate for Payer: PHP Medicare Advantage |
$100.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$315.31
|
| Rate for Payer: Priority Health Medicare |
$100.90
|
| Rate for Payer: Priority Health SBD |
$16,027.83
|
| Rate for Payer: Priority Health Tiered Network |
$252.25
|
| Rate for Payer: Railroad Medicare Medicare |
$100.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.95
|
| Rate for Payer: UHC Core |
$164.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$100.90
|
| Rate for Payer: UHC Exchange |
$164.95
|
| Rate for Payer: UHC Medicaid |
$52.77
|
| Rate for Payer: UHCCP Medicaid |
$52.77
|
| Rate for Payer: UMR Bronson Commercial |
$9,413.17
|
| Rate for Payer: VA VA |
$100.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,080.75
|
|
|
PATISIRAN (LIPID COMPLEX) 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25,441.00
|
|
|
Service Code
|
HCPCS J0222
|
| Hospital Charge Code |
188116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,194.04 |
| Max. Negotiated Rate |
$22,896.90 |
| Rate for Payer: Aetna American Axle |
$16,536.65
|
| Rate for Payer: Aetna Commercial |
$21,624.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,536.65
|
| Rate for Payer: Cash Price |
$20,352.80
|
| Rate for Payer: Cofinity Advantage |
$17,808.70
|
| Rate for Payer: Cofinity Commercial |
$21,879.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,352.80
|
| Rate for Payer: Healthscope Commercial |
$22,896.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,808.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,080.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,624.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19,080.75
|
| Rate for Payer: PHP Commercial |
$21,624.85
|
| Rate for Payer: Priority Health SBD |
$16,027.83
|
| Rate for Payer: UMR Bronson Commercial |
$11,194.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,080.75
|
|
|
PEDIATRIC CHEWABLE MULTIVITAMIN WITH MINERALS TABLET WRAPPER
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 96295012826
|
| Hospital Charge Code |
301519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.46
|
| Rate for Payer: UHC Core |
$42.85
|
| Rate for Payer: UHC Exchange |
$32.32
|
| Rate for Payer: UMR Bronson Commercial |
$30.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
PEDIATRIC CHEWABLE MULTIVITAMIN WITH MINERALS TABLET WRAPPER
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 96295012826
|
| Hospital Charge Code |
301519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$36.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
PEDIATRIC COMPLEAT CUSTOM
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 43900014240
|
| Hospital Charge Code |
180159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna American Axle |
$3.90
|
| Rate for Payer: Aetna Commercial |
$5.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.90
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Advantage |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: PHP Commercial |
$5.10
|
| Rate for Payer: Priority Health SBD |
$3.78
|
| Rate for Payer: UMR Bronson Commercial |
$2.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.50
|
|
|
PEDIATRIC COMPLEAT CUSTOM
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 43900014240
|
| Hospital Charge Code |
180159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna American Axle |
$3.90
|
| Rate for Payer: Aetna Commercial |
$5.10
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.90
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Advantage |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: PHP Commercial |
$5.10
|
| Rate for Payer: Priority Health SBD |
$3.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.90
|
| Rate for Payer: UHC Core |
$3.13
|
| Rate for Payer: UHC Exchange |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$2.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.50
|
|
