|
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$384.09 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,094.76
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$422.50
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$384.09
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$291.09
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$261.98 |
| Rate for Payer: Aetna American Axle |
$189.21
|
| Rate for Payer: Aetna Commercial |
$247.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.21
|
| Rate for Payer: BCBS Complete |
$116.44
|
| Rate for Payer: BCBS Trust/PPO |
$87.60
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cofinity Commercial |
$203.76
|
| Rate for Payer: Cofinity Commercial |
$250.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Healthscope Commercial |
$261.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.43
|
| Rate for Payer: PHP Commercial |
$247.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.76
|
| Rate for Payer: Priority Health SBD |
$183.39
|
| Rate for Payer: UMR Bronson Commercial |
$107.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.32
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$131.82
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna American Axle |
$85.68
|
| Rate for Payer: Aetna American Axle |
$177.20
|
| Rate for Payer: Aetna American Axle |
$53.80
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Commercial |
$231.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cofinity Commercial |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Cofinity Commercial |
$92.27
|
| Rate for Payer: Cofinity Commercial |
$190.83
|
| Rate for Payer: Cofinity Commercial |
$234.45
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Healthscope Commercial |
$245.36
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.05
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$231.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.27
|
| Rate for Payer: Priority Health SBD |
$171.75
|
| Rate for Payer: Priority Health SBD |
$83.05
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: UMR Bronson Commercial |
$119.95
|
| Rate for Payer: UMR Bronson Commercial |
$58.00
|
| Rate for Payer: UMR Bronson Commercial |
$36.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.08
|
|
|
COVID VAC 2023-24 (12 YRS AND UP) (RAXTOZIN)(PF) 30 MCG/0.3 ML IM SUSP
|
Facility
|
IP
|
$44.70
|
|
|
Service Code
|
HCPCS 91320
|
| Hospital Charge Code |
205323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$40.23 |
| Rate for Payer: Aetna American Axle |
$29.06
|
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.06
|
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Cofinity Commercial |
$38.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.76
|
| Rate for Payer: Healthscope Commercial |
$40.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.00
|
| Rate for Payer: PHP Commercial |
$38.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.29
|
| Rate for Payer: Priority Health SBD |
$28.16
|
| Rate for Payer: UMR Bronson Commercial |
$19.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.52
|
|
|
COVID VAC 2023-24 (5-11 YR) (RAXTOZIN)(PF) 10 MCG/0.3 ML IM SUSP (EUA)
|
Facility
|
IP
|
$254.22
|
|
|
Service Code
|
HCPCS 91319
|
| Hospital Charge Code |
205325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.86 |
| Max. Negotiated Rate |
$228.80 |
| Rate for Payer: Aetna American Axle |
$165.24
|
| Rate for Payer: Aetna Commercial |
$216.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.24
|
| Rate for Payer: Cash Price |
$203.38
|
| Rate for Payer: Cofinity Commercial |
$177.95
|
| Rate for Payer: Cofinity Commercial |
$218.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.38
|
| Rate for Payer: Healthscope Commercial |
$228.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.09
|
| Rate for Payer: PHP Commercial |
$216.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.95
|
| Rate for Payer: Priority Health SBD |
$160.16
|
| Rate for Payer: UMR Bronson Commercial |
$111.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.66
|
|
|
COVID VAC 2023-24 (6 MO-4 YR)(RAXTOZIN)(PF) 3 MCG/0.3 ML IM SUSP (EUA)
|
Facility
|
IP
|
$569.56
|
|
|
Service Code
|
HCPCS 91318
|
| Hospital Charge Code |
205324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$250.61 |
| Max. Negotiated Rate |
$512.60 |
| Rate for Payer: Aetna American Axle |
$370.21
|
| Rate for Payer: Aetna Commercial |
$484.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.21
|
| Rate for Payer: Cash Price |
$455.65
|
| Rate for Payer: Cofinity Commercial |
$398.69
|
| Rate for Payer: Cofinity Commercial |
$489.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.65
|
| Rate for Payer: Healthscope Commercial |
$512.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$484.13
|
| Rate for Payer: PHP Commercial |
$484.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.69
|
| Rate for Payer: Priority Health SBD |
$358.82
|
| Rate for Payer: UMR Bronson Commercial |
$250.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.17
|
|
|
CPT 0255T
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 0255T
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$312.20 |
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.20
|
| Rate for Payer: UMR Bronson Commercial |
$205.16
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$28,584.24
|
|
|
Service Code
|
MS-DRG 073
|
| Min. Negotiated Rate |
$11,563.00 |
| Max. Negotiated Rate |
$28,584.24 |
| Rate for Payer: Aetna Medicare |
$12,658.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,214.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,214.48
|
| Rate for Payer: BCBS MAPPO |
$12,171.58
|
| Rate for Payer: BCBS Trust/PPO |
$28,584.24
|
| Rate for Payer: BCN Medicare Advantage |
$12,171.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,171.58
|
| Rate for Payer: Mclaren Medicare |
$12,171.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,780.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,997.32
|
| Rate for Payer: PACE Medicare |
$11,563.00
|
| Rate for Payer: PACE SWMI |
$12,171.58
|
| Rate for Payer: PHP Medicare Advantage |
$12,171.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,711.43
|
| Rate for Payer: Priority Health Medicare |
$12,171.58
|
| Rate for Payer: Priority Health Narrow Network |
$17,369.14
|
| Rate for Payer: Railroad Medicare Medicare |
$12,171.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,079.30
|
| Rate for Payer: UHC Core |
$18,924.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,171.58
|
| Rate for Payer: UHC Exchange |
$15,045.27
|
| Rate for Payer: UHC Medicare Advantage |
$12,536.73
|
| Rate for Payer: VA VA |
$12,171.58
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$20,696.24
|
|
|
Service Code
|
MS-DRG 074
|
| Min. Negotiated Rate |
$7,999.28 |
| Max. Negotiated Rate |
$20,696.24 |
| Rate for Payer: Aetna Medicare |
$8,757.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,525.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,525.36
|
| Rate for Payer: BCBS MAPPO |
$8,420.29
|
| Rate for Payer: BCBS Trust/PPO |
$20,696.24
|
| Rate for Payer: BCN Medicare Advantage |
$8,420.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,420.29
|
| Rate for Payer: Mclaren Medicare |
$8,420.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,841.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,683.33
|
| Rate for Payer: PACE Medicare |
$7,999.28
|
| Rate for Payer: PACE SWMI |
$8,420.29
|
| Rate for Payer: PHP Medicare Advantage |
$8,420.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,725.89
|
| Rate for Payer: Priority Health Medicare |
$8,420.29
|
| Rate for Payer: Priority Health Narrow Network |
$11,780.71
|
| Rate for Payer: Railroad Medicare Medicare |
$8,420.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,653.65
|
| Rate for Payer: UHC Core |
$12,835.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,420.29
|
| Rate for Payer: UHC Exchange |
$10,204.53
|
| Rate for Payer: UHC Medicare Advantage |
$8,672.90
|
| Rate for Payer: VA VA |
$8,420.29
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$72,434.34
|
|
|
Service Code
|
MS-DRG 026
|
| Min. Negotiated Rate |
$22,105.60 |
| Max. Negotiated Rate |
$72,434.34 |
| Rate for Payer: Aetna Medicare |
$24,199.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,086.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,086.31
|
| Rate for Payer: BCBS MAPPO |
$23,269.05
|
| Rate for Payer: BCBS Trust/PPO |
$72,434.34
|
| Rate for Payer: BCN Medicare Advantage |
$23,269.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,269.05
|
| Rate for Payer: Mclaren Medicare |
$23,269.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,432.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,759.41
|
| Rate for Payer: PACE Medicare |
$22,105.60
|
| Rate for Payer: PACE SWMI |
$23,269.05
|
| Rate for Payer: PHP Medicare Advantage |
$23,269.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42,376.75
|
| Rate for Payer: Priority Health Medicare |
$23,269.05
|
| Rate for Payer: Priority Health Narrow Network |
$33,901.40
|
| Rate for Payer: Railroad Medicare Medicare |
$23,269.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,046.59
|
| Rate for Payer: UHC Core |
$36,937.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,269.05
|
| Rate for Payer: UHC Exchange |
$29,365.63
|
| Rate for Payer: UHC Medicare Advantage |
$23,967.12
|
| Rate for Payer: VA VA |
$23,269.05
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$97,226.61
|
|
|
Service Code
|
MS-DRG 025
|
| Min. Negotiated Rate |
$32,815.10 |
| Max. Negotiated Rate |
$97,226.61 |
| Rate for Payer: Aetna Medicare |
$35,923.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,177.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,177.76
|
| Rate for Payer: BCBS MAPPO |
$34,542.21
|
| Rate for Payer: BCBS Trust/PPO |
$97,226.61
|
| Rate for Payer: BCN Medicare Advantage |
$34,542.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,542.21
|
| Rate for Payer: Mclaren Medicare |
$34,542.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36,269.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,723.54
|
| Rate for Payer: PACE Medicare |
$32,815.10
|
| Rate for Payer: PACE SWMI |
$34,542.21
|
| Rate for Payer: PHP Medicare Advantage |
$34,542.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63,369.25
|
| Rate for Payer: Priority Health Medicare |
$34,542.21
|
| Rate for Payer: Priority Health Narrow Network |
$50,695.40
|
| Rate for Payer: Railroad Medicare Medicare |
$34,542.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67,361.66
|
| Rate for Payer: UHC Core |
$55,235.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$34,542.21
|
| Rate for Payer: UHC Exchange |
$43,912.70
|
| Rate for Payer: UHC Medicare Advantage |
$35,578.48
|
| Rate for Payer: VA VA |
$34,542.21
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$65,832.95
|
|
|
Service Code
|
MS-DRG 027
|
| Min. Negotiated Rate |
$18,297.33 |
| Max. Negotiated Rate |
$65,832.95 |
| Rate for Payer: Aetna Medicare |
$20,030.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,075.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,075.44
|
| Rate for Payer: BCBS MAPPO |
$19,260.35
|
| Rate for Payer: BCBS Trust/PPO |
$65,832.95
|
| Rate for Payer: BCN Medicare Advantage |
$19,260.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,260.35
|
| Rate for Payer: Mclaren Medicare |
$19,260.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,223.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,149.40
|
| Rate for Payer: PACE Medicare |
$18,297.33
|
| Rate for Payer: PACE SWMI |
$19,260.35
|
| Rate for Payer: PHP Medicare Advantage |
$19,260.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,911.92
|
| Rate for Payer: Priority Health Medicare |
$19,260.35
|
| Rate for Payer: Priority Health Narrow Network |
$27,929.54
|
| Rate for Payer: Railroad Medicare Medicare |
$19,260.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,111.46
|
| Rate for Payer: UHC Core |
$30,430.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,260.35
|
| Rate for Payer: UHC Exchange |
$24,192.76
|
| Rate for Payer: UHC Medicare Advantage |
$19,838.16
|
| Rate for Payer: VA VA |
$19,260.35
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$189,796.82
|
|
|
Service Code
|
MS-DRG 955
|
| Min. Negotiated Rate |
$45,071.46 |
| Max. Negotiated Rate |
$189,796.82 |
| Rate for Payer: Aetna Medicare |
$49,341.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59,304.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59,304.55
|
| Rate for Payer: BCBS MAPPO |
$47,443.64
|
| Rate for Payer: BCBS Trust/PPO |
$189,796.82
|
| Rate for Payer: BCN Medicare Advantage |
$47,443.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47,443.64
|
| Rate for Payer: Mclaren Medicare |
$47,443.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49,815.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54,560.19
|
| Rate for Payer: PACE Medicare |
$45,071.46
|
| Rate for Payer: PACE SWMI |
$47,443.64
|
| Rate for Payer: PHP Medicare Advantage |
$47,443.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87,393.88
|
| Rate for Payer: Priority Health Medicare |
$47,443.64
|
| Rate for Payer: Priority Health Narrow Network |
$69,915.10
|
| Rate for Payer: Railroad Medicare Medicare |
$47,443.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92,899.91
|
| Rate for Payer: UHC Core |
$76,176.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$47,443.64
|
| Rate for Payer: UHC Exchange |
$60,560.95
|
| Rate for Payer: UHC Medicare Advantage |
$48,866.95
|
| Rate for Payer: VA VA |
$47,443.64
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$113,208.66
|
|
|
Service Code
|
MS-DRG 023
|
| Min. Negotiated Rate |
$41,986.50 |
| Max. Negotiated Rate |
$113,208.66 |
| Rate for Payer: Aetna Medicare |
$45,964.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,245.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,245.40
|
| Rate for Payer: BCBS MAPPO |
$44,196.32
|
| Rate for Payer: BCBS Trust/PPO |
$113,208.66
|
| Rate for Payer: BCN Medicare Advantage |
$44,196.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,196.32
|
| Rate for Payer: Mclaren Medicare |
$44,196.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46,406.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,825.77
|
| Rate for Payer: PACE Medicare |
$41,986.50
|
| Rate for Payer: PACE SWMI |
$44,196.32
|
| Rate for Payer: PHP Medicare Advantage |
$44,196.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81,346.83
|
| Rate for Payer: Priority Health Medicare |
$44,196.32
|
| Rate for Payer: Priority Health Narrow Network |
$65,077.46
|
| Rate for Payer: Railroad Medicare Medicare |
$44,196.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86,471.88
|
| Rate for Payer: UHC Core |
$70,905.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$44,196.32
|
| Rate for Payer: UHC Exchange |
$56,370.55
|
| Rate for Payer: UHC Medicare Advantage |
$45,522.21
|
| Rate for Payer: VA VA |
$44,196.32
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$86,976.49
|
|
|
Service Code
|
MS-DRG 024
|
| Min. Negotiated Rate |
$28,223.52 |
| Max. Negotiated Rate |
$86,976.49 |
| Rate for Payer: Aetna Medicare |
$30,897.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,136.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,136.21
|
| Rate for Payer: BCBS MAPPO |
$29,708.97
|
| Rate for Payer: BCBS Trust/PPO |
$86,976.49
|
| Rate for Payer: BCN Medicare Advantage |
$29,708.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,708.97
|
| Rate for Payer: Mclaren Medicare |
$29,708.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,194.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,165.32
|
| Rate for Payer: PACE Medicare |
$28,223.52
|
| Rate for Payer: PACE SWMI |
$29,708.97
|
| Rate for Payer: PHP Medicare Advantage |
$29,708.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54,368.98
|
| Rate for Payer: Priority Health Medicare |
$29,708.97
|
| Rate for Payer: Priority Health Narrow Network |
$43,495.18
|
| Rate for Payer: Railroad Medicare Medicare |
$29,708.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57,794.36
|
| Rate for Payer: UHC Core |
$47,390.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$29,708.97
|
| Rate for Payer: UHC Exchange |
$37,675.83
|
| Rate for Payer: UHC Medicare Advantage |
$30,600.24
|
| Rate for Payer: VA VA |
$29,708.97
|
|
|
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT (EG, BIOLOGICAL COLLAGEN, THERMOPLASTIC GRAFT)
|
Facility
|
OP
|
$15,377.24
|
|
|
Service Code
|
CPT 36830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$641.13 |
| Max. Negotiated Rate |
$15,377.24 |
| Rate for Payer: Aetna Medicare |
$5,080.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$6,446.43
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,377.24
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$12,301.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$705.24
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,884.69
|
| Rate for Payer: UHC Exchange |
$641.13
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,377.65
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
192134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.52 |
| Max. Negotiated Rate |
$5,739.88 |
| Rate for Payer: Aetna American Axle |
$4,145.47
|
| Rate for Payer: Aetna Commercial |
$5,421.00
|
| Rate for Payer: Aetna Medicare |
$132.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,145.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$158.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$158.88
|
| Rate for Payer: BCBS Complete |
$73.01
|
| Rate for Payer: BCBS MAPPO |
$127.10
|
| Rate for Payer: BCBS Trust/PPO |
$410.74
|
| Rate for Payer: BCN Medicare Advantage |
$127.10
|
| Rate for Payer: Cash Price |
$5,102.12
|
| Rate for Payer: Cash Price |
$5,102.12
|
| Rate for Payer: Cofinity Commercial |
$5,484.78
|
| Rate for Payer: Cofinity Commercial |
$4,464.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,102.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.10
|
| Rate for Payer: Healthscope Commercial |
$5,739.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,464.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,783.24
|
| Rate for Payer: Mclaren Medicaid |
$69.52
|
| Rate for Payer: Mclaren Medicare |
$127.10
|
| Rate for Payer: Meridian Medicaid |
$73.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,421.00
|
| Rate for Payer: PACE Medicare |
$120.75
|
| Rate for Payer: PACE SWMI |
$127.10
|
| Rate for Payer: PHP Commercial |
$5,421.00
|
| Rate for Payer: PHP Medicare Advantage |
$127.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,464.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.58
|
| Rate for Payer: Priority Health Medicare |
$127.10
|
| Rate for Payer: Priority Health Narrow Network |
$298.06
|
| Rate for Payer: Priority Health SBD |
$4,017.92
|
| Rate for Payer: Railroad Medicare Medicare |
$127.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.10
|
| Rate for Payer: UHC Medicare Advantage |
$130.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,359.73
|
| Rate for Payer: VA VA |
$127.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,783.24
|
|
|
CRIZANLIZUMAB-TMCA 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,377.65
|
|
|
Service Code
|
HCPCS J0791
|
| Hospital Charge Code |
192134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,806.17 |
| Max. Negotiated Rate |
$5,739.88 |
| Rate for Payer: Aetna American Axle |
$4,145.47
|
| Rate for Payer: Aetna Commercial |
$5,421.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,145.47
|
| Rate for Payer: Cash Price |
$5,102.12
|
| Rate for Payer: Cofinity Commercial |
$4,464.36
|
| Rate for Payer: Cofinity Commercial |
$5,484.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,102.12
|
| Rate for Payer: Healthscope Commercial |
$5,739.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,464.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,783.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,421.00
|
| Rate for Payer: PHP Commercial |
$5,421.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,464.36
|
| Rate for Payer: Priority Health SBD |
$4,017.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,806.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,783.24
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$176.27
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
108145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.22 |
| Max. Negotiated Rate |
$158.64 |
| Rate for Payer: Aetna American Axle |
$114.58
|
| Rate for Payer: Aetna Commercial |
$149.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.58
|
| Rate for Payer: BCBS Complete |
$70.51
|
| Rate for Payer: Cash Price |
$141.02
|
| Rate for Payer: Cofinity Commercial |
$123.39
|
| Rate for Payer: Cofinity Commercial |
$151.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.02
|
| Rate for Payer: Healthscope Commercial |
$158.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.83
|
| Rate for Payer: PHP Commercial |
$149.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.39
|
| Rate for Payer: Priority Health SBD |
$111.05
|
| Rate for Payer: UMR Bronson Commercial |
$65.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.20
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$176.27
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
108145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.56 |
| Max. Negotiated Rate |
$158.64 |
| Rate for Payer: Aetna American Axle |
$114.58
|
| Rate for Payer: Aetna Commercial |
$149.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.58
|
| Rate for Payer: Cash Price |
$141.02
|
| Rate for Payer: Cofinity Commercial |
$123.39
|
| Rate for Payer: Cofinity Commercial |
$151.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.02
|
| Rate for Payer: Healthscope Commercial |
$158.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.83
|
| Rate for Payer: PHP Commercial |
$149.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.39
|
| Rate for Payer: Priority Health SBD |
$111.05
|
| Rate for Payer: UMR Bronson Commercial |
$77.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.20
|
|
|
CURETTAGE, POSTPARTUM
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 59160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$187.30 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,755.28
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.03
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$187.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$17.54
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna American Axle |
$11.40
|
| Rate for Payer: Aetna American Axle |
$17.88
|
| Rate for Payer: Aetna American Axle |
$11.03
|
| Rate for Payer: Aetna American Axle |
$14.18
|
| Rate for Payer: Aetna American Axle |
$17.50
|
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.03
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Complete |
$11.00
|
| Rate for Payer: BCBS Complete |
$10.77
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$4.66
|
| Rate for Payer: BCBS Trust/PPO |
$4.66
|
| Rate for Payer: BCBS Trust/PPO |
$4.66
|
| Rate for Payer: BCBS Trust/PPO |
$4.66
|
| Rate for Payer: BCBS Trust/PPO |
$4.66
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cofinity Commercial |
$14.59
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$18.85
|
| Rate for Payer: Cofinity Commercial |
$11.88
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: Healthscope Commercial |
$19.64
|
| Rate for Payer: Healthscope Commercial |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.38
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$14.42
|
| Rate for Payer: PHP Commercial |
$18.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.26
|
| Rate for Payer: Priority Health SBD |
$10.69
|
| Rate for Payer: Priority Health SBD |
$17.33
|
| Rate for Payer: Priority Health SBD |
$11.05
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: UMR Bronson Commercial |
$9.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.07
|
| Rate for Payer: UMR Bronson Commercial |
$6.49
|
| Rate for Payer: UMR Bronson Commercial |
$6.28
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.63
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.82
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$19.64 |
| Rate for Payer: Aetna American Axle |
$14.18
|
| Rate for Payer: Aetna American Axle |
$11.40
|
| Rate for Payer: Aetna American Axle |
$17.88
|
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.18
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$22.01
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.01
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Healthscope Commercial |
$19.64
|
| Rate for Payer: Healthscope Commercial |
$24.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.55
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$18.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.28
|
| Rate for Payer: Priority Health SBD |
$11.05
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: Priority Health SBD |
$17.33
|
| Rate for Payer: UMR Bronson Commercial |
$9.60
|
| Rate for Payer: UMR Bronson Commercial |
$12.10
|
| Rate for Payer: UMR Bronson Commercial |
$7.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.63
|
|
|
CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
NDC 7985420050
|
| Hospital Charge Code |
2008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna American Axle |
$93.60
|
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$123.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$129.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.40
|
| Rate for Payer: PHP Commercial |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.80
|
| Rate for Payer: Priority Health SBD |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$63.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.00
|
|
|
CYANOCOBALAMIN (VIT B-12) 100 MCG TABLET
|
Facility
|
IP
|
$75.60
|
|
|
Service Code
|
NDC 8068107100
|
| Hospital Charge Code |
2008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.26 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Aetna American Axle |
$49.14
|
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.14
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.48
|
| Rate for Payer: Healthscope Commercial |
$68.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.26
|
| Rate for Payer: PHP Commercial |
$64.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.92
|
| Rate for Payer: Priority Health SBD |
$47.63
|
| Rate for Payer: UMR Bronson Commercial |
$33.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.70
|
|
