|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.66
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
18302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$18.59 |
| Rate for Payer: Aetna American Axle |
$13.43
|
| Rate for Payer: Aetna American Axle |
$11.60
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$17.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.43
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.53
|
| Rate for Payer: Healthscope Commercial |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$18.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.56
|
| Rate for Payer: PHP Commercial |
$17.56
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.43
|
| Rate for Payer: Priority Health SBD |
$13.02
|
| Rate for Payer: Priority Health SBD |
$11.24
|
| Rate for Payer: UMR Bronson Commercial |
$7.85
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.50
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna American Axle |
$18.47
|
| Rate for Payer: Aetna American Axle |
$11.60
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$14.20
|
| Rate for Payer: Aetna Medicare |
$8.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: BCBS Complete |
$11.36
|
| Rate for Payer: BCBS Complete |
$7.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.96
|
| Rate for Payer: BCBS Trust/PPO |
$2.96
|
| Rate for Payer: BCN Commercial |
$2.96
|
| Rate for Payer: BCN Commercial |
$2.96
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.27
|
| Rate for Payer: Healthscope Commercial |
$16.06
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Priority Health SBD |
$11.24
|
| Rate for Payer: UMR Bronson Commercial |
$6.60
|
| Rate for Payer: UMR Bronson Commercial |
$10.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.31
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
301718
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna American Axle |
$18.47
|
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: UMR Bronson Commercial |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.31
|
|
|
PIPERACILLIN-TAZOBACTAM (ZOSYN) 13.5 GRAM /560 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
IP
|
$99.68
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.86 |
| Max. Negotiated Rate |
$89.71 |
| Rate for Payer: Aetna American Axle |
$64.79
|
| Rate for Payer: Aetna Commercial |
$84.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cofinity Commercial |
$69.78
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.74
|
| Rate for Payer: Healthscope Commercial |
$89.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.73
|
| Rate for Payer: PHP Commercial |
$84.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.79
|
| Rate for Payer: Priority Health SBD |
$62.80
|
| Rate for Payer: UMR Bronson Commercial |
$43.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.76
|
|
|
PIPERACILLIN-TAZOBACTAM (ZOSYN) 13.5 GRAM /560 ML CONTINUOUS INFUSION (IV PREMIX)
|
Facility
|
OP
|
$99.68
|
|
|
Service Code
|
HCPCS J2543
|
| Hospital Charge Code |
200103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$89.71 |
| Rate for Payer: Aetna American Axle |
$64.79
|
| Rate for Payer: Aetna Commercial |
$84.73
|
| Rate for Payer: Aetna Medicare |
$49.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: BCBS Complete |
$39.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.96
|
| Rate for Payer: BCN Commercial |
$2.96
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cofinity Commercial |
$69.78
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.74
|
| Rate for Payer: Healthscope Commercial |
$89.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.73
|
| Rate for Payer: PHP Commercial |
$84.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.79
|
| Rate for Payer: Priority Health SBD |
$62.80
|
| Rate for Payer: UMR Bronson Commercial |
$36.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.76
|
|
|
PLACEMENT OF AMNIOTIC MEMBRANE ON THE OCULAR SURFACE; SINGLE LAYER, SUTURED
|
Facility
|
OP
|
$11,612.55
|
|
|
Service Code
|
CPT 65779
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$110.41 |
| Max. Negotiated Rate |
$11,612.55 |
| Rate for Payer: Aetna Medicare |
$3,842.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,618.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,618.44
|
| Rate for Payer: BCBS Complete |
$2,079.41
|
| Rate for Payer: BCBS MAPPO |
$3,694.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,591.67
|
| Rate for Payer: BCN Commercial |
$2,591.67
|
| Rate for Payer: BCN Medicare Advantage |
$3,694.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,694.75
|
| Rate for Payer: Mclaren Medicaid |
$1,980.39
|
| Rate for Payer: Mclaren Medicare |
$3,694.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,879.49
|
| Rate for Payer: Meridian Medicaid |
$2,079.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,248.96
|
| Rate for Payer: Nomi Health Commercial |
$11,084.25
|
| Rate for Payer: PACE Medicare |
$3,510.01
|
| Rate for Payer: PACE SWMI |
$3,694.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,694.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,980.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,612.55
|
| Rate for Payer: Priority Health Medicare |
$3,694.75
|
| Rate for Payer: Priority Health Narrow Network |
$9,290.04
|
| Rate for Payer: Railroad Medicare Medicare |
$3,694.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.45
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,694.75
|
| Rate for Payer: UHC Exchange |
$110.41
|
| Rate for Payer: UHC Medicare Advantage |
$3,694.75
|
| Rate for Payer: UHCCP Medicaid |
$1,980.39
|
| Rate for Payer: VA VA |
$3,694.75
|
|
|
PLACEMENT OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; INTERNAL-EXTERNAL
|
Facility
|
OP
|
$10,867.50
|
|
|
Service Code
|
CPT 47534
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.64 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,593.76
|
| Rate for Payer: BCN Commercial |
$2,593.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.40
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$347.64
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,853.33
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEEDLE, RADIOACTIVE SEEDS), PERCUTANEOUS; EACH ADDITIONAL LESION, INCLUDING MAMMOGRAPHIC GUIDANCE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$822.58
|
|
|
Service Code
|
CPT 19282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$822.58 |
| Rate for Payer: BCBS Trust/PPO |
$822.58
|
| Rate for Payer: BCCCP Commercial |
$156.92
|
| Rate for Payer: BCN Commercial |
$822.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.63
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$46.94
|
|
|
PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEEDLE, RADIOACTIVE SEEDS), PERCUTANEOUS; FIRST LESION, INCLUDING MAMMOGRAPHIC GUIDANCE
|
Facility
|
OP
|
$4,989.41
|
|
|
Service Code
|
CPT 19281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$719.13
|
| Rate for Payer: BCCCP Commercial |
$225.33
|
| Rate for Payer: BCN Commercial |
$719.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Nomi Health Commercial |
$4,762.44
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.94
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$93.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), PERCUTANEOUS, INTRA-ABDOMINAL, INTRA-PELVIC (EXCEPT PROSTATE), AND/OR RETROPERITONEUM, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$4,213.47
|
|
|
Service Code
|
CPT 49411
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$4,213.47 |
| Rate for Payer: Aetna Medicare |
$1,394.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,675.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,675.74
|
| Rate for Payer: BCBS Complete |
$754.48
|
| Rate for Payer: BCBS MAPPO |
$1,340.59
|
| Rate for Payer: BCBS Trust/PPO |
$466.33
|
| Rate for Payer: BCN Commercial |
$466.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,340.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,340.59
|
| Rate for Payer: Mclaren Medicaid |
$718.56
|
| Rate for Payer: Mclaren Medicare |
$1,340.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,407.62
|
| Rate for Payer: Meridian Medicaid |
$754.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,541.68
|
| Rate for Payer: Nomi Health Commercial |
$4,021.77
|
| Rate for Payer: PACE Medicare |
$1,273.56
|
| Rate for Payer: PACE SWMI |
$1,340.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,340.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,213.47
|
| Rate for Payer: Priority Health Medicare |
$1,340.59
|
| Rate for Payer: Priority Health Narrow Network |
$3,370.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,340.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.16
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,340.59
|
| Rate for Payer: UHC Exchange |
$175.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,340.59
|
| Rate for Payer: UHCCP Medicaid |
$718.56
|
| Rate for Payer: VA VA |
$1,340.59
|
|
|
PLACEMENT OF NEPHROURETERAL CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, NEW ACCESS
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 50433
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$239.92 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,707.90
|
| Rate for Payer: BCN Commercial |
$1,707.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.91
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$239.92
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$8,445.02
|
|
|
Service Code
|
CPT 46020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,440.20 |
| Max. Negotiated Rate |
$8,445.02 |
| Rate for Payer: Aetna Medicare |
$2,794.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,358.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,358.68
|
| Rate for Payer: BCBS Complete |
$1,512.21
|
| Rate for Payer: BCBS MAPPO |
$2,686.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,731.25
|
| Rate for Payer: BCN Commercial |
$2,731.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,686.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,686.94
|
| Rate for Payer: Mclaren Medicaid |
$1,440.20
|
| Rate for Payer: Mclaren Medicare |
$2,686.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,821.29
|
| Rate for Payer: Meridian Medicaid |
$1,512.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,089.98
|
| Rate for Payer: Nomi Health Commercial |
$5,642.57
|
| Rate for Payer: PACE Medicare |
$2,552.59
|
| Rate for Payer: PACE SWMI |
$2,686.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,686.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,440.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,445.02
|
| Rate for Payer: Priority Health Medicare |
$2,686.94
|
| Rate for Payer: Priority Health Narrow Network |
$6,756.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2,686.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,563.47
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,686.94
|
| Rate for Payer: UHC Exchange |
$5,135.01
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.94
|
| Rate for Payer: UHCCP Medicaid |
$1,440.20
|
| Rate for Payer: VA VA |
$2,686.94
|
|
|
PLASMALYTE A 1 L/HEPARIN 30000UNIT IRRIGATION
|
Facility
|
OP
|
$35.43
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
500532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$31.89 |
| Rate for Payer: Aetna American Axle |
$23.03
|
| Rate for Payer: Aetna Commercial |
$30.12
|
| Rate for Payer: Aetna Medicare |
$17.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.03
|
| Rate for Payer: BCBS Complete |
$14.17
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.58
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$30.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.34
|
| Rate for Payer: Healthscope Commercial |
$31.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.12
|
| Rate for Payer: PHP Commercial |
$30.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.03
|
| Rate for Payer: Priority Health SBD |
$22.32
|
| Rate for Payer: UMR Bronson Commercial |
$13.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.57
|
|
|
PLASMALYTE A 1 L/HEPARIN 30000UNIT IRRIGATION
|
Facility
|
IP
|
$35.43
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
500532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$31.89 |
| Rate for Payer: Aetna American Axle |
$23.03
|
| Rate for Payer: Aetna Commercial |
$30.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.03
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$30.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.34
|
| Rate for Payer: Healthscope Commercial |
$31.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.12
|
| Rate for Payer: PHP Commercial |
$30.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.03
|
| Rate for Payer: Priority Health SBD |
$22.32
|
| Rate for Payer: UMR Bronson Commercial |
$15.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.57
|
|
|
PLASTIC OPERATION OF PENIS FOR STRAIGHTENING OF CHORDEE (EG, HYPOSPADIAS), WITH OR WITHOUT MOBILIZATION OF URETHRA
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 54300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$620.71 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,673.05
|
| Rate for Payer: BCN Commercial |
$2,673.05
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.78
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$620.71
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY, PARTIAL OR COMPLETE, UNILATERAL
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 40700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$967.32 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,703.90
|
| Rate for Payer: BCN Commercial |
$3,703.90
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,064.05
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$967.32
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
PLASTIC REPAIR OF INTROITUS
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 56800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$245.44 |
| 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 |
$1,660.74
|
| Rate for Payer: BCN Commercial |
$1,660.74
|
| 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) |
$269.98
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$245.44
|
| 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
|
|
|
PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY; PRIMARY OR SIMPLE
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 42500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$330.43 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,642.02
|
| Rate for Payer: BCN Commercial |
$1,642.02
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.47
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$330.43
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$673.24
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
103895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$296.23 |
| Max. Negotiated Rate |
$605.92 |
| Rate for Payer: Aetna American Axle |
$437.61
|
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.61
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$471.27
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$471.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$471.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.25
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.61
|
| Rate for Payer: Priority Health SBD |
$424.14
|
| Rate for Payer: UMR Bronson Commercial |
$296.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.93
|
|
|
PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
OP
|
$673.24
|
|
|
Service Code
|
HCPCS 90670
|
| Hospital Charge Code |
103895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$714.53 |
| Rate for Payer: Aetna American Axle |
$437.61
|
| Rate for Payer: Aetna American Axle |
$451.28
|
| Rate for Payer: Aetna Commercial |
$572.25
|
| Rate for Payer: Aetna Commercial |
$590.14
|
| Rate for Payer: Aetna Medicare |
$347.14
|
| Rate for Payer: Aetna Medicare |
$336.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.61
|
| Rate for Payer: BCBS Complete |
$269.30
|
| Rate for Payer: BCBS Complete |
$277.71
|
| Rate for Payer: BCBS Trust/PPO |
$714.53
|
| Rate for Payer: BCBS Trust/PPO |
$714.53
|
| Rate for Payer: BCN Commercial |
$714.53
|
| Rate for Payer: BCN Commercial |
$714.53
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cash Price |
$555.42
|
| Rate for Payer: Cash Price |
$555.42
|
| Rate for Payer: Cash Price |
$538.59
|
| Rate for Payer: Cofinity Commercial |
$486.00
|
| Rate for Payer: Cofinity Commercial |
$471.27
|
| Rate for Payer: Cofinity Commercial |
$578.99
|
| Rate for Payer: Cofinity Commercial |
$597.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$471.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$486.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$555.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.59
|
| Rate for Payer: Healthscope Commercial |
$624.85
|
| Rate for Payer: Healthscope Commercial |
$605.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$471.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$486.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$520.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$590.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.25
|
| Rate for Payer: PHP Commercial |
$572.25
|
| Rate for Payer: PHP Commercial |
$590.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$451.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.99
|
| Rate for Payer: Priority Health Narrow Network |
$206.39
|
| Rate for Payer: Priority Health Narrow Network |
$206.39
|
| Rate for Payer: Priority Health SBD |
$424.14
|
| Rate for Payer: Priority Health SBD |
$437.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.41
|
| Rate for Payer: UHC Exchange |
$223.41
|
| Rate for Payer: UHC Exchange |
$223.41
|
| Rate for Payer: UMR Bronson Commercial |
$249.10
|
| Rate for Payer: UMR Bronson Commercial |
$256.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$520.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.93
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
IP
|
$777.63
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$342.16 |
| Max. Negotiated Rate |
$699.87 |
| Rate for Payer: Aetna American Axle |
$505.46
|
| Rate for Payer: Aetna American Axle |
$521.29
|
| Rate for Payer: Aetna Commercial |
$660.99
|
| Rate for Payer: Aetna Commercial |
$681.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.29
|
| Rate for Payer: Cash Price |
$622.10
|
| Rate for Payer: Cash Price |
$641.59
|
| Rate for Payer: Cofinity Commercial |
$689.71
|
| Rate for Payer: Cofinity Commercial |
$561.39
|
| Rate for Payer: Cofinity Commercial |
$544.34
|
| Rate for Payer: Cofinity Commercial |
$668.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$561.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.59
|
| Rate for Payer: Healthscope Commercial |
$699.87
|
| Rate for Payer: Healthscope Commercial |
$721.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$561.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.99
|
| Rate for Payer: PHP Commercial |
$681.69
|
| Rate for Payer: PHP Commercial |
$660.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.29
|
| Rate for Payer: Priority Health SBD |
$489.91
|
| Rate for Payer: Priority Health SBD |
$505.25
|
| Rate for Payer: UMR Bronson Commercial |
$342.16
|
| Rate for Payer: UMR Bronson Commercial |
$352.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.49
|
|
|
PNEUMOCOCCAL 20-VALENT CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE
|
Facility
|
OP
|
$777.63
|
|
|
Service Code
|
HCPCS 90677
|
| Hospital Charge Code |
197781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$238.43 |
| Max. Negotiated Rate |
$1,361.78 |
| Rate for Payer: Aetna American Axle |
$505.46
|
| Rate for Payer: Aetna American Axle |
$521.29
|
| Rate for Payer: Aetna Commercial |
$681.69
|
| Rate for Payer: Aetna Commercial |
$660.99
|
| Rate for Payer: Aetna Medicare |
$401.00
|
| Rate for Payer: Aetna Medicare |
$388.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.29
|
| Rate for Payer: BCBS Complete |
$311.05
|
| Rate for Payer: BCBS Complete |
$320.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,361.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,361.78
|
| Rate for Payer: BCN Commercial |
$1,361.78
|
| Rate for Payer: BCN Commercial |
$1,361.78
|
| Rate for Payer: Cash Price |
$641.59
|
| Rate for Payer: Cash Price |
$622.10
|
| Rate for Payer: Cash Price |
$641.59
|
| Rate for Payer: Cash Price |
$622.10
|
| Rate for Payer: Cofinity Commercial |
$668.76
|
| Rate for Payer: Cofinity Commercial |
$689.71
|
| Rate for Payer: Cofinity Commercial |
$561.39
|
| Rate for Payer: Cofinity Commercial |
$544.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$544.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$561.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.10
|
| Rate for Payer: Healthscope Commercial |
$721.79
|
| Rate for Payer: Healthscope Commercial |
$699.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$544.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$561.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$601.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.99
|
| Rate for Payer: PHP Commercial |
$681.69
|
| Rate for Payer: PHP Commercial |
$660.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$238.43
|
| Rate for Payer: Priority Health Narrow Network |
$238.43
|
| Rate for Payer: Priority Health SBD |
$489.91
|
| Rate for Payer: Priority Health SBD |
$505.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.10
|
| Rate for Payer: UHC Exchange |
$258.10
|
| Rate for Payer: UHC Exchange |
$258.10
|
| Rate for Payer: UMR Bronson Commercial |
$287.72
|
| Rate for Payer: UMR Bronson Commercial |
$296.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$601.49
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$83,565.24
|
|
|
Service Code
|
HCPCS J9309
|
| Hospital Charge Code |
190691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36,768.71 |
| Max. Negotiated Rate |
$75,208.72 |
| Rate for Payer: Aetna American Axle |
$54,317.41
|
| Rate for Payer: Aetna Commercial |
$71,030.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54,317.41
|
| Rate for Payer: Cash Price |
$66,852.19
|
| Rate for Payer: Cofinity Commercial |
$58,495.67
|
| Rate for Payer: Cofinity Commercial |
$71,866.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$58,495.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66,852.19
|
| Rate for Payer: Healthscope Commercial |
$75,208.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58,495.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62,673.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71,030.45
|
| Rate for Payer: PHP Commercial |
$71,030.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54,317.41
|
| Rate for Payer: Priority Health SBD |
$52,646.10
|
| Rate for Payer: UMR Bronson Commercial |
$36,768.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62,673.93
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 140 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$83,565.24
|
|
|
Service Code
|
HCPCS J9309
|
| Hospital Charge Code |
190691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$75,208.72 |
| Rate for Payer: Aetna American Axle |
$54,317.41
|
| Rate for Payer: Aetna Commercial |
$71,030.45
|
| Rate for Payer: Aetna Medicare |
$138.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54,317.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.15
|
| Rate for Payer: BCBS Complete |
$74.81
|
| Rate for Payer: BCBS MAPPO |
$132.92
|
| Rate for Payer: BCBS Trust/PPO |
$358.38
|
| Rate for Payer: BCN Commercial |
$358.38
|
| Rate for Payer: BCN Medicare Advantage |
$132.92
|
| Rate for Payer: Cash Price |
$66,852.19
|
| Rate for Payer: Cash Price |
$66,852.19
|
| Rate for Payer: Cofinity Commercial |
$71,866.11
|
| Rate for Payer: Cofinity Commercial |
$58,495.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$58,495.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66,852.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$75,208.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58,495.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62,673.93
|
| Rate for Payer: Mclaren Medicaid |
$71.25
|
| Rate for Payer: Mclaren Medicare |
$132.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.57
|
| Rate for Payer: Meridian Medicaid |
$74.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71,030.45
|
| Rate for Payer: Nomi Health Commercial |
$398.76
|
| Rate for Payer: PACE Medicare |
$126.27
|
| Rate for Payer: PACE SWMI |
$132.92
|
| Rate for Payer: PHP Commercial |
$71,030.45
|
| Rate for Payer: PHP Medicare Advantage |
$132.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54,317.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.50
|
| Rate for Payer: Priority Health Medicare |
$132.92
|
| Rate for Payer: Priority Health Narrow Network |
$298.80
|
| Rate for Payer: Priority Health SBD |
$52,646.10
|
| Rate for Payer: Railroad Medicare Medicare |
$132.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.92
|
| Rate for Payer: UHC Exchange |
$254.02
|
| Rate for Payer: UHC Medicare Advantage |
$132.92
|
| Rate for Payer: UHCCP Medicaid |
$71.25
|
| Rate for Payer: UMR Bronson Commercial |
$30,919.14
|
| Rate for Payer: VA VA |
$132.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62,673.93
|
|
|
POLATUZUMAB VEDOTIN-PIIQ 30 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17,906.89
|
|
|
Service Code
|
HCPCS J9309
|
| Hospital Charge Code |
195050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$16,116.20 |
| Rate for Payer: UHC Exchange |
$254.02
|
| Rate for Payer: UHC Medicare Advantage |
$132.92
|
| Rate for Payer: UHCCP Medicaid |
$71.25
|
| Rate for Payer: UMR Bronson Commercial |
$6,625.55
|
| Rate for Payer: VA VA |
$132.92
|
| Rate for Payer: Aetna American Axle |
$11,639.48
|
| Rate for Payer: Aetna Commercial |
$15,220.86
|
| Rate for Payer: Aetna Medicare |
$138.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,639.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.15
|
| Rate for Payer: BCBS Complete |
$74.81
|
| Rate for Payer: BCBS MAPPO |
$132.92
|
| Rate for Payer: BCBS Trust/PPO |
$358.38
|
| Rate for Payer: BCN Commercial |
$358.38
|
| Rate for Payer: BCN Medicare Advantage |
$132.92
|
| Rate for Payer: Cash Price |
$14,325.51
|
| Rate for Payer: Cash Price |
$14,325.51
|
| Rate for Payer: Cofinity Commercial |
$15,399.93
|
| Rate for Payer: Cofinity Commercial |
$12,534.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,534.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,325.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$16,116.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,534.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,430.17
|
| Rate for Payer: Mclaren Medicaid |
$71.25
|
| Rate for Payer: Mclaren Medicare |
$132.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.57
|
| Rate for Payer: Meridian Medicaid |
$74.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,220.86
|
| Rate for Payer: Nomi Health Commercial |
$398.76
|
| Rate for Payer: PACE Medicare |
$126.27
|
| Rate for Payer: PACE SWMI |
$132.92
|
| Rate for Payer: PHP Commercial |
$15,220.86
|
| Rate for Payer: PHP Medicare Advantage |
$132.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,639.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.50
|
| Rate for Payer: Priority Health Medicare |
$132.92
|
| Rate for Payer: Priority Health Narrow Network |
$298.80
|
| Rate for Payer: Priority Health SBD |
$11,281.34
|
| Rate for Payer: Railroad Medicare Medicare |
$132.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,430.17
|
|
