|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK
|
Facility
|
OP
|
$678.18
|
|
|
Service Code
|
CPT G0105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$645.84 |
| Max. Negotiated Rate |
$678.18 |
| Rate for Payer: BCBS Complete |
$678.18
|
| Rate for Payer: Mclaren Medicaid |
$645.84
|
| Rate for Payer: Meridian Medicaid |
$678.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.84
|
| Rate for Payer: UHCCP Medicaid |
$645.84
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK
|
Facility
|
OP
|
$678.18
|
|
|
Service Code
|
CPT G0121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$645.84 |
| Max. Negotiated Rate |
$678.18 |
| Rate for Payer: BCBS Complete |
$678.18
|
| Rate for Payer: Mclaren Medicaid |
$645.84
|
| Rate for Payer: Meridian Medicaid |
$678.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.84
|
| Rate for Payer: UHCCP Medicaid |
$645.84
|
|
|
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$678.18
|
|
|
Service Code
|
CPT G0104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$645.84 |
| Max. Negotiated Rate |
$678.18 |
| Rate for Payer: BCBS Complete |
$678.18
|
| Rate for Payer: Mclaren Medicaid |
$645.84
|
| Rate for Payer: Meridian Medicaid |
$678.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.84
|
| Rate for Payer: UHCCP Medicaid |
$645.84
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$226.27
|
|
|
Service Code
|
CPT 57456
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$226.27 |
| Rate for Payer: BCBS Complete |
$226.27
|
| Rate for Payer: BCCCP Commercial |
$146.69
|
| Rate for Payer: Mclaren Medicaid |
$215.48
|
| Rate for Payer: Meridian Medicaid |
$226.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.48
|
| Rate for Payer: UHCCP Medicaid |
$215.48
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S) OF THE CERVIX
|
Facility
|
OP
|
$2,365.09
|
|
|
Service Code
|
CPT 57460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$295.08 |
| Max. Negotiated Rate |
$2,365.09 |
| Rate for Payer: BCBS Complete |
$2,365.09
|
| Rate for Payer: BCCCP Commercial |
$295.08
|
| Rate for Payer: Mclaren Medicaid |
$2,252.32
|
| Rate for Payer: Meridian Medicaid |
$2,365.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,252.32
|
| Rate for Payer: UHCCP Medicaid |
$2,252.32
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATION OF THE CERVIX
|
Facility
|
OP
|
$2,365.09
|
|
|
Service Code
|
CPT 57461
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$331.06 |
| Max. Negotiated Rate |
$2,365.09 |
| Rate for Payer: BCBS Complete |
$2,365.09
|
| Rate for Payer: BCCCP Commercial |
$331.06
|
| Rate for Payer: Mclaren Medicaid |
$2,252.32
|
| Rate for Payer: Meridian Medicaid |
$2,365.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,252.32
|
| Rate for Payer: UHCCP Medicaid |
$2,252.32
|
|
|
COLPOSCOPY OF THE VULVA; WITH BIOPSY(S)
|
Facility
|
OP
|
$226.27
|
|
|
Service Code
|
CPT 56821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$215.48 |
| Max. Negotiated Rate |
$226.27 |
| Rate for Payer: BCBS Complete |
$226.27
|
| Rate for Payer: Mclaren Medicaid |
$215.48
|
| Rate for Payer: Meridian Medicaid |
$226.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.48
|
| Rate for Payer: UHCCP Medicaid |
$215.48
|
|
|
COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID
|
Facility
|
IP
|
$204.34
|
|
|
Service Code
|
NDC 00574030216
|
| Hospital Charge Code |
119062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.82 |
| Max. Negotiated Rate |
$183.91 |
| Rate for Payer: Aetna Commercial |
$173.69
|
| Rate for Payer: BCBS Trust/PPO |
$166.80
|
| Rate for Payer: BCN Commercial |
$157.91
|
| Rate for Payer: Cash Price |
$163.47
|
| Rate for Payer: Cofinity Commercial |
$175.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.47
|
| Rate for Payer: Healthscope Commercial |
$183.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.69
|
| Rate for Payer: Nomi Health Commercial |
$167.56
|
| Rate for Payer: PHP Commercial |
$173.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.82
|
| Rate for Payer: Priority Health HMO/PPO |
$177.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.82
|
| Rate for Payer: UHC Core |
$170.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.26
|
|
|
COMPOUNDING VEHICLE SUGAR-FREE NO.9 ORAL LIQUID
|
Facility
|
OP
|
$204.34
|
|
|
Service Code
|
NDC 00574030216
|
| Hospital Charge Code |
119062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.53 |
| Max. Negotiated Rate |
$183.91 |
| Rate for Payer: Aetna Commercial |
$173.69
|
| Rate for Payer: Aetna Medicare |
$53.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.86
|
| Rate for Payer: BCBS Complete |
$81.74
|
| Rate for Payer: BCBS MAPPO |
$51.08
|
| Rate for Payer: BCBS Trust/PPO |
$167.99
|
| Rate for Payer: BCN Commercial |
$158.87
|
| Rate for Payer: BCN Medicare Advantage |
$51.08
|
| Rate for Payer: Cash Price |
$163.47
|
| Rate for Payer: Cofinity Commercial |
$175.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.08
|
| Rate for Payer: Healthscope Commercial |
$183.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.69
|
| Rate for Payer: Nomi Health Commercial |
$167.56
|
| Rate for Payer: PACE Senior Care Partners |
$48.53
|
| Rate for Payer: PACE SWMI |
$51.08
|
| Rate for Payer: PHP Commercial |
$173.69
|
| Rate for Payer: PHP Medicare Advantage |
$51.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.82
|
| Rate for Payer: Priority Health HMO/PPO |
$177.78
|
| Rate for Payer: Priority Health Medicare |
$51.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.91
|
| Rate for Payer: Railroad Medicare Medicare |
$51.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.82
|
| Rate for Payer: UHC Core |
$170.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.08
|
| Rate for Payer: UHC Exchange |
$51.08
|
| Rate for Payer: UHC Medicare Advantage |
$51.08
|
| Rate for Payer: VA VA |
$51.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.26
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
|
Facility
|
OP
|
$2,365.09
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$293.81 |
| Max. Negotiated Rate |
$2,365.09 |
| Rate for Payer: BCBS Complete |
$2,365.09
|
| Rate for Payer: BCCCP Commercial |
$293.81
|
| Rate for Payer: Mclaren Medicaid |
$2,252.32
|
| Rate for Payer: Meridian Medicaid |
$2,365.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,252.32
|
| Rate for Payer: UHCCP Medicaid |
$2,252.32
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
IP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,658.25 |
| Max. Negotiated Rate |
$2,296.04 |
| Rate for Payer: Aetna Commercial |
$2,168.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,082.50
|
| Rate for Payer: BCN Commercial |
$1,971.53
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,193.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Healthscope Commercial |
$2,296.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,913.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: PHP Commercial |
$2,168.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,219.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,709.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,245.01
|
| Rate for Payer: UHC Core |
$2,130.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,913.36
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
OP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$605.90 |
| Max. Negotiated Rate |
$2,296.04 |
| Rate for Payer: Aetna Commercial |
$2,168.48
|
| Rate for Payer: Aetna Medicare |
$663.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.23
|
| Rate for Payer: BCBS Complete |
$1,020.46
|
| Rate for Payer: BCBS MAPPO |
$637.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,097.30
|
| Rate for Payer: BCN Commercial |
$1,983.52
|
| Rate for Payer: BCN Medicare Advantage |
$637.79
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,193.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.79
|
| Rate for Payer: Healthscope Commercial |
$2,296.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,913.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: PACE Senior Care Partners |
$605.90
|
| Rate for Payer: PACE SWMI |
$637.79
|
| Rate for Payer: PHP Commercial |
$2,168.48
|
| Rate for Payer: PHP Medicare Advantage |
$637.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,219.50
|
| Rate for Payer: Priority Health Medicare |
$644.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,709.27
|
| Rate for Payer: Railroad Medicare Medicare |
$637.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,245.01
|
| Rate for Payer: UHC Core |
$2,130.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.79
|
| Rate for Payer: UHC Exchange |
$637.79
|
| Rate for Payer: UHC Medicare Advantage |
$637.79
|
| Rate for Payer: VA VA |
$637.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,913.36
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
OP
|
$1,572.69
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$373.51 |
| Max. Negotiated Rate |
$1,415.42 |
| Rate for Payer: Aetna Commercial |
$1,336.79
|
| Rate for Payer: Aetna Medicare |
$408.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$491.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$491.47
|
| Rate for Payer: BCBS Complete |
$629.08
|
| Rate for Payer: BCBS MAPPO |
$393.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,292.91
|
| Rate for Payer: BCN Commercial |
$1,222.77
|
| Rate for Payer: BCN Medicare Advantage |
$393.17
|
| Rate for Payer: Cash Price |
$1,258.15
|
| Rate for Payer: Cofinity Commercial |
$1,352.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.17
|
| Rate for Payer: Healthscope Commercial |
$1,415.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,179.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.79
|
| Rate for Payer: Nomi Health Commercial |
$1,289.61
|
| Rate for Payer: PACE Senior Care Partners |
$373.51
|
| Rate for Payer: PACE SWMI |
$393.17
|
| Rate for Payer: PHP Commercial |
$1,336.79
|
| Rate for Payer: PHP Medicare Advantage |
$393.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,368.24
|
| Rate for Payer: Priority Health Medicare |
$397.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,053.70
|
| Rate for Payer: Railroad Medicare Medicare |
$393.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,383.97
|
| Rate for Payer: UHC Core |
$1,313.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.17
|
| Rate for Payer: UHC Exchange |
$393.17
|
| Rate for Payer: UHC Medicare Advantage |
$393.17
|
| Rate for Payer: VA VA |
$393.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,179.52
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,572.69
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,022.25 |
| Max. Negotiated Rate |
$1,415.42 |
| Rate for Payer: Aetna Commercial |
$1,336.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,283.79
|
| Rate for Payer: BCN Commercial |
$1,215.37
|
| Rate for Payer: Cash Price |
$1,258.15
|
| Rate for Payer: Cofinity Commercial |
$1,352.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.15
|
| Rate for Payer: Healthscope Commercial |
$1,415.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,179.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.79
|
| Rate for Payer: Nomi Health Commercial |
$1,289.61
|
| Rate for Payer: PHP Commercial |
$1,336.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,368.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,053.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,383.97
|
| Rate for Payer: UHC Core |
$1,313.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,179.52
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
IP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,658.25 |
| Max. Negotiated Rate |
$2,296.04 |
| Rate for Payer: Aetna Commercial |
$2,168.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,082.50
|
| Rate for Payer: BCN Commercial |
$1,971.53
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,193.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Healthscope Commercial |
$2,296.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,913.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: PHP Commercial |
$2,168.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,219.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,709.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,245.01
|
| Rate for Payer: UHC Core |
$2,130.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,913.36
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
OP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$605.90 |
| Max. Negotiated Rate |
$2,296.04 |
| Rate for Payer: Aetna Commercial |
$2,168.48
|
| Rate for Payer: Aetna Medicare |
$663.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$797.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$797.23
|
| Rate for Payer: BCBS Complete |
$1,020.46
|
| Rate for Payer: BCBS MAPPO |
$637.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,097.30
|
| Rate for Payer: BCN Commercial |
$1,983.52
|
| Rate for Payer: BCN Medicare Advantage |
$637.79
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$2,193.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.79
|
| Rate for Payer: Healthscope Commercial |
$2,296.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,913.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: Nomi Health Commercial |
$2,091.94
|
| Rate for Payer: PACE Senior Care Partners |
$605.90
|
| Rate for Payer: PACE SWMI |
$637.79
|
| Rate for Payer: PHP Commercial |
$2,168.48
|
| Rate for Payer: PHP Medicare Advantage |
$637.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,219.50
|
| Rate for Payer: Priority Health Medicare |
$644.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,709.27
|
| Rate for Payer: Railroad Medicare Medicare |
$637.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,245.01
|
| Rate for Payer: UHC Core |
$2,130.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.79
|
| Rate for Payer: UHC Exchange |
$637.79
|
| Rate for Payer: UHC Medicare Advantage |
$637.79
|
| Rate for Payer: VA VA |
$637.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,913.36
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DOUBLE OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$5,313.85
|
|
|
Service Code
|
CPT 28299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,060.48 |
| Max. Negotiated Rate |
$5,313.85 |
| Rate for Payer: BCBS Complete |
$5,313.85
|
| Rate for Payer: Mclaren Medicaid |
$5,060.48
|
| Rate for Payer: Meridian Medicaid |
$5,313.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,060.48
|
| Rate for Payer: UHCCP Medicaid |
$5,060.48
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH PROXIMAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 28295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH RESECTION OF PROXIMAL PHALANX BASE, WHEN PERFORMED, ANY METHOD
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 28292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
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 |
$85.68 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: BCBS Trust/PPO |
$107.60
|
| Rate for Payer: BCN Commercial |
$101.87
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Nomi Health Commercial |
$108.09
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health HMO/PPO |
$114.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.00
|
| Rate for Payer: UHC Core |
$110.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$131.82
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Medicare |
$34.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.19
|
| Rate for Payer: BCBS Complete |
$52.73
|
| Rate for Payer: BCBS MAPPO |
$32.96
|
| Rate for Payer: BCBS Trust/PPO |
$108.37
|
| Rate for Payer: BCN Commercial |
$102.49
|
| Rate for Payer: BCN Medicare Advantage |
$32.96
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.96
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Nomi Health Commercial |
$108.09
|
| Rate for Payer: PACE Senior Care Partners |
$31.31
|
| Rate for Payer: PACE SWMI |
$32.96
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: PHP Medicare Advantage |
$32.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health HMO/PPO |
$114.68
|
| Rate for Payer: Priority Health Medicare |
$33.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.32
|
| Rate for Payer: Railroad Medicare Medicare |
$32.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.00
|
| Rate for Payer: UHC Core |
$110.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.96
|
| Rate for Payer: UHC Exchange |
$32.96
|
| Rate for Payer: UHC Medicare Advantage |
$32.96
|
| Rate for Payer: VA VA |
$32.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.86
|
|
|
CPT 0255T
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 0255T
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Medicare |
$227.50
|
| Rate for Payer: BCBS Complete |
$182.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$12.82
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$11.54 |
| Rate for Payer: Aetna Commercial |
$10.90
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: BCBS Trust/PPO |
$10.46
|
| Rate for Payer: BCBS Trust/PPO |
$14.32
|
| Rate for Payer: BCN Commercial |
$9.91
|
| Rate for Payer: BCN Commercial |
$13.55
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Healthscope Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$10.51
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: PHP Commercial |
$10.90
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.33
|
| Rate for Payer: Priority Health HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health HMO/PPO |
$11.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$10.70
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
|
|
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 |
$4.17 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Commercial |
$10.90
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Aetna Medicare |
$3.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.01
|
| Rate for Payer: BCBS Complete |
$5.13
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS MAPPO |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCBS Trust/PPO |
$10.54
|
| Rate for Payer: BCN Commercial |
$13.64
|
| Rate for Payer: BCN Commercial |
$9.97
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: BCN Medicare Advantage |
$3.20
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.90
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: Nomi Health Commercial |
$10.51
|
| Rate for Payer: PACE Senior Care Partners |
$4.17
|
| Rate for Payer: PACE Senior Care Partners |
$3.04
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PACE SWMI |
$3.20
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$10.90
|
| Rate for Payer: PHP Medicare Advantage |
$3.20
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.33
|
| Rate for Payer: Priority Health HMO/PPO |
$11.15
|
| Rate for Payer: Priority Health HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Medicare |
$3.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: UHC Core |
$10.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.20
|
| Rate for Payer: UHC Exchange |
$3.20
|
| Rate for Payer: UHC Exchange |
$4.38
|
| Rate for Payer: UHC Medicare Advantage |
$3.20
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: VA VA |
$3.20
|
| Rate for Payer: VA VA |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
|
