|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); DISTAL PHALANX OF FINGER
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 26236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$429.80 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.17
|
| Rate for Payer: BCN Commercial |
$1,399.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.78
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$429.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY), BONE (EG, OSTEOMYELITIS); FIBULA
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 27641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$631.76 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,452.10
|
| Rate for Payer: BCN Commercial |
$2,452.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$694.94
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$631.76
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), HUMERUS
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 24140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$682.41 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,452.10
|
| Rate for Payer: BCN Commercial |
$2,452.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.65
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$682.41
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); METACARPAL
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$486.10 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.71
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$486.10
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), OLECRANON PROCESS
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 24147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.41 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,372.99
|
| Rate for Payer: BCN Commercial |
$2,372.99
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$669.25
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$608.41
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); PROXIMAL OR MIDDLE PHALANX OF FINGER
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 26235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$479.47 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.32
|
| Rate for Payer: BCN Commercial |
$1,444.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.42
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$479.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY), BONE (EG, OSTEOMYELITIS); TIBIA
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 27640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$805.24 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,580.49
|
| Rate for Payer: BCN Commercial |
$2,580.49
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.76
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$805.24
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); RADIUS
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 25151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,703.94 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,531.18
|
| Rate for Payer: BCN Commercial |
$2,531.18
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,948.57
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$6,075.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); ULNA
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 25150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$550.90 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.99
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$550.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); PHALANX OF TOE
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.91 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$398.41
|
| Rate for Payer: BCN Commercial |
$398.41
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.00
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$320.91
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TALUS OR CALCANEUS
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$477.29 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,390.24
|
| Rate for Payer: BCN Commercial |
$3,390.24
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.02
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$477.29
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$422.70 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,771.97
|
| Rate for Payer: BCN Commercial |
$2,771.97
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.97
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$422.70
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA OR FACET) FOR INTRINSIC BONY LESION, SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 22103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.41 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$515.50
|
| Rate for Payer: BCN Commercial |
$515.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.55
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$131.41
|
|
|
PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA OR FACET) FOR INTRINSIC BONY LESION, SINGLE VERTEBRAL SEGMENT; THORACIC
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 22101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$858.51 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,277.38
|
| Rate for Payer: BCN Commercial |
$2,277.38
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$944.36
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$858.51
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 56700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$195.76 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,444.02
|
| Rate for Payer: BCN Commercial |
$2,444.02
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.34
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$195.76
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 60210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$688.56 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,837.21
|
| Rate for Payer: BCN Commercial |
$3,837.21
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$757.42
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$688.56
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
PATELLECTOMY OR HEMIPATELLECTOMY
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$635.57 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,372.99
|
| Rate for Payer: BCN Commercial |
$2,372.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.13
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$635.57
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
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 Commercial |
$2,488.50
|
| Rate for Payer: Cofinity Commercial |
$3,057.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,488.50
|
| 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: PHP Commercial |
$3,021.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,310.75
|
| Rate for Payer: Priority Health SBD |
$2,239.65
|
| 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
|
$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 Commercial |
$443.39
|
| Rate for Payer: Cofinity Commercial |
$544.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$443.39
|
| 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: PHP Commercial |
$538.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.72
|
| 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
|
$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 |
$77.02
|
| Rate for Payer: Aetna Commercial |
$100.72
|
| Rate for Payer: Aetna Medicare |
$59.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.02
|
| Rate for Payer: BCBS Complete |
$47.40
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cofinity Commercial |
$101.91
|
| Rate for Payer: Cofinity Commercial |
$82.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.95
|
| 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: PHP Commercial |
$100.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.02
|
| Rate for Payer: Priority Health SBD |
$74.66
|
| 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 Commercial |
$2,488.50
|
| Rate for Payer: Cofinity Commercial |
$3,057.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,488.50
|
| 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: PHP Commercial |
$3,021.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,310.75
|
| 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 Commercial |
$443.39
|
| Rate for Payer: Cofinity Commercial |
$544.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$443.39
|
| 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: PHP Commercial |
$538.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.72
|
| Rate for Payer: Priority Health SBD |
$399.05
|
| Rate for Payer: UMR Bronson Commercial |
$234.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.06
|
|
|
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 |
$77.02
|
| Rate for Payer: Aetna Commercial |
$100.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.02
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cofinity Commercial |
$101.91
|
| Rate for Payer: Cofinity Commercial |
$82.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.95
|
| 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: PHP Commercial |
$100.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.02
|
| 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
|
|
|
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 |
$52.97 |
| 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 |
$102.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,536.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.54
|
| Rate for Payer: BCBS Complete |
$55.62
|
| Rate for Payer: BCBS MAPPO |
$98.83
|
| Rate for Payer: BCBS Trust/PPO |
$266.60
|
| Rate for Payer: BCN Commercial |
$266.60
|
| Rate for Payer: BCN Medicare Advantage |
$98.83
|
| Rate for Payer: Cash Price |
$20,352.80
|
| Rate for Payer: Cash Price |
$20,352.80
|
| Rate for Payer: Cofinity Commercial |
$21,879.26
|
| Rate for Payer: Cofinity Commercial |
$17,808.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,808.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,352.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.83
|
| 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 |
$52.97
|
| Rate for Payer: Mclaren Medicare |
$98.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.77
|
| Rate for Payer: Meridian Medicaid |
$55.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,624.85
|
| Rate for Payer: Nomi Health Commercial |
$296.49
|
| Rate for Payer: PACE Medicare |
$93.89
|
| Rate for Payer: PACE SWMI |
$98.83
|
| Rate for Payer: PHP Commercial |
$21,624.85
|
| Rate for Payer: PHP Medicare Advantage |
$98.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,536.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.58
|
| Rate for Payer: Priority Health Medicare |
$98.83
|
| Rate for Payer: Priority Health Narrow Network |
$227.66
|
| Rate for Payer: Priority Health SBD |
$16,027.83
|
| Rate for Payer: Railroad Medicare Medicare |
$98.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.83
|
| Rate for Payer: UHC Exchange |
$188.87
|
| Rate for Payer: UHC Medicare Advantage |
$98.83
|
| Rate for Payer: UHCCP Medicaid |
$52.97
|
| Rate for Payer: UMR Bronson Commercial |
$9,413.17
|
| Rate for Payer: VA VA |
$98.83
|
| 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 Commercial |
$17,808.70
|
| Rate for Payer: Cofinity Commercial |
$21,879.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,808.70
|
| 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: PHP Commercial |
$21,624.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,536.65
|
| 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
|
|
