|
TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOUT CERCLAGE AND/OR LOCKING SCREWS
|
Facility
|
OP
|
$36,827.89
|
|
|
Service Code
|
CPT 24516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$852.33 |
| Max. Negotiated Rate |
$36,827.89 |
| Rate for Payer: Aetna Medicare |
$12,166.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,623.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,623.31
|
| Rate for Payer: BCBS Complete |
$6,719.70
|
| Rate for Payer: BCBS MAPPO |
$11,698.65
|
| Rate for Payer: BCBS Trust/PPO |
$7,393.38
|
| Rate for Payer: BCN Medicare Advantage |
$11,698.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,698.65
|
| Rate for Payer: Mclaren Medicaid |
$6,399.16
|
| Rate for Payer: Mclaren Medicare |
$11,698.65
|
| Rate for Payer: Meridian Medicaid |
$6,719.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,283.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,453.45
|
| Rate for Payer: PACE Medicare |
$11,113.72
|
| Rate for Payer: PACE SWMI |
$11,698.65
|
| Rate for Payer: PHP Medicare Advantage |
$11,698.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,399.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,827.89
|
| Rate for Payer: Priority Health Medicare |
$11,698.65
|
| Rate for Payer: Priority Health Narrow Network |
$29,462.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11,698.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$937.56
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,698.65
|
| Rate for Payer: UHC Exchange |
$852.33
|
| Rate for Payer: UHC Medicare Advantage |
$12,049.61
|
| Rate for Payer: VA VA |
$11,698.65
|
|
|
TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 59812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,425.00
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.78
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$306.16
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 59820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.40 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,223.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.94
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$385.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 59821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$376.56 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$3,244.08
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.22
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$376.56
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY SINGLE OR MULTIPLE PINNING, IN SITU
|
Facility
|
OP
|
$8,596.00
|
|
|
Service Code
|
CPT 27176
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$914.87 |
| Max. Negotiated Rate |
$8,596.00 |
| Rate for Payer: BCBS Trust/PPO |
$3,185.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.36
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Exchange |
$914.87
|
|
|
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
|
Facility
|
OP
|
$1,757.43
|
|
|
Service Code
|
CPT 12020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$185.33 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Medicare |
$580.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.82
|
| Rate for Payer: BCBS Complete |
$320.66
|
| Rate for Payer: BCBS MAPPO |
$558.26
|
| Rate for Payer: BCBS Trust/PPO |
$621.27
|
| Rate for Payer: BCN Medicare Advantage |
$558.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.26
|
| Rate for Payer: Mclaren Medicaid |
$305.37
|
| Rate for Payer: Mclaren Medicare |
$558.26
|
| Rate for Payer: Meridian Medicaid |
$320.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.00
|
| Rate for Payer: PACE Medicare |
$530.35
|
| Rate for Payer: PACE SWMI |
$558.26
|
| Rate for Payer: PHP Medicare Advantage |
$558.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$558.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.86
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.26
|
| Rate for Payer: UHC Exchange |
$185.33
|
| Rate for Payer: UHC Medicare Advantage |
$575.01
|
| Rate for Payer: VA VA |
$558.26
|
|
|
TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE
|
Facility
|
OP
|
$36,827.89
|
|
|
Service Code
|
CPT 27759
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$986.58 |
| Max. Negotiated Rate |
$36,827.89 |
| Rate for Payer: Aetna Medicare |
$12,166.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,623.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,623.31
|
| Rate for Payer: BCBS Complete |
$6,719.70
|
| Rate for Payer: BCBS MAPPO |
$11,698.65
|
| Rate for Payer: BCBS Trust/PPO |
$7,499.43
|
| Rate for Payer: BCN Medicare Advantage |
$11,698.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,698.65
|
| Rate for Payer: Mclaren Medicaid |
$6,399.16
|
| Rate for Payer: Mclaren Medicare |
$11,698.65
|
| Rate for Payer: Meridian Medicaid |
$6,719.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,283.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,453.45
|
| Rate for Payer: PACE Medicare |
$11,113.72
|
| Rate for Payer: PACE SWMI |
$11,698.65
|
| Rate for Payer: PHP Medicare Advantage |
$11,698.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,399.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,827.89
|
| Rate for Payer: Priority Health Medicare |
$11,698.65
|
| Rate for Payer: Priority Health Narrow Network |
$29,462.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11,698.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,085.24
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,698.65
|
| Rate for Payer: UHC Exchange |
$986.58
|
| Rate for Payer: UHC Medicare Advantage |
$12,049.61
|
| Rate for Payer: VA VA |
$11,698.65
|
|
|
TREMELIMUMAB-ACTL 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$175,110.00
|
|
|
Service Code
|
HCPCS J9347
|
| Hospital Charge Code |
201908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.44 |
| Max. Negotiated Rate |
$157,599.00 |
| Rate for Payer: Aetna American Axle |
$113,821.50
|
| Rate for Payer: Aetna Commercial |
$148,843.50
|
| Rate for Payer: Aetna Medicare |
$141.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113,821.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.12
|
| Rate for Payer: BCBS Complete |
$78.17
|
| Rate for Payer: BCBS MAPPO |
$136.09
|
| Rate for Payer: BCBS Trust/PPO |
$439.79
|
| Rate for Payer: BCN Medicare Advantage |
$136.09
|
| Rate for Payer: Cash Price |
$140,088.00
|
| Rate for Payer: Cash Price |
$140,088.00
|
| Rate for Payer: Cofinity Commercial |
$150,594.60
|
| Rate for Payer: Cofinity Commercial |
$122,577.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140,088.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.09
|
| Rate for Payer: Healthscope Commercial |
$157,599.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122,577.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131,332.50
|
| Rate for Payer: Mclaren Medicaid |
$74.44
|
| Rate for Payer: Mclaren Medicare |
$136.09
|
| Rate for Payer: Meridian Medicaid |
$78.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$142.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148,843.50
|
| Rate for Payer: PACE Medicare |
$129.29
|
| Rate for Payer: PACE SWMI |
$136.09
|
| Rate for Payer: PHP Commercial |
$148,843.50
|
| Rate for Payer: PHP Medicare Advantage |
$136.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122,577.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$400.32
|
| Rate for Payer: Priority Health Medicare |
$136.09
|
| Rate for Payer: Priority Health Narrow Network |
$320.26
|
| Rate for Payer: Priority Health SBD |
$110,319.30
|
| Rate for Payer: Railroad Medicare Medicare |
$136.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.09
|
| Rate for Payer: UHC Medicare Advantage |
$140.18
|
| Rate for Payer: UMR Bronson Commercial |
$64,790.70
|
| Rate for Payer: VA VA |
$136.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131,332.50
|
|
|
TREPROSTINIL SODIUM 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,654.78
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
32931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$728.10 |
| Max. Negotiated Rate |
$1,489.30 |
| Rate for Payer: Aetna American Axle |
$1,075.61
|
| Rate for Payer: Aetna American Axle |
$1,195.13
|
| Rate for Payer: Aetna Commercial |
$1,562.86
|
| Rate for Payer: Aetna Commercial |
$1,406.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,195.13
|
| Rate for Payer: Cash Price |
$1,323.82
|
| Rate for Payer: Cash Price |
$1,470.93
|
| Rate for Payer: Cofinity Commercial |
$1,423.11
|
| Rate for Payer: Cofinity Commercial |
$1,158.35
|
| Rate for Payer: Cofinity Commercial |
$1,287.06
|
| Rate for Payer: Cofinity Commercial |
$1,581.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,470.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,323.82
|
| Rate for Payer: Healthscope Commercial |
$1,489.30
|
| Rate for Payer: Healthscope Commercial |
$1,654.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,287.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,158.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,241.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,379.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,562.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,406.56
|
| Rate for Payer: PHP Commercial |
$1,406.56
|
| Rate for Payer: PHP Commercial |
$1,562.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,287.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,158.35
|
| Rate for Payer: Priority Health SBD |
$1,042.51
|
| Rate for Payer: Priority Health SBD |
$1,158.36
|
| Rate for Payer: UMR Bronson Commercial |
$728.10
|
| Rate for Payer: UMR Bronson Commercial |
$809.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,241.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,379.00
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20,691.48
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
32933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,104.25 |
| Max. Negotiated Rate |
$18,622.33 |
| Rate for Payer: Aetna American Axle |
$13,449.46
|
| Rate for Payer: Aetna Commercial |
$17,587.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,449.46
|
| Rate for Payer: Cash Price |
$16,553.18
|
| Rate for Payer: Cofinity Commercial |
$17,794.67
|
| Rate for Payer: Cofinity Commercial |
$14,484.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,553.18
|
| Rate for Payer: Healthscope Commercial |
$18,622.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,484.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,518.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17,587.76
|
| Rate for Payer: PHP Commercial |
$17,587.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,484.04
|
| Rate for Payer: Priority Health SBD |
$13,035.63
|
| Rate for Payer: UMR Bronson Commercial |
$9,104.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,518.61
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$9,254.07
|
|
|
Service Code
|
NDC 0555-0808-02
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,071.79 |
| Max. Negotiated Rate |
$8,328.66 |
| Rate for Payer: Aetna American Axle |
$6,015.15
|
| Rate for Payer: Aetna Commercial |
$7,865.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,015.15
|
| Rate for Payer: Cash Price |
$7,403.26
|
| Rate for Payer: Cofinity Commercial |
$6,477.85
|
| Rate for Payer: Cofinity Commercial |
$7,958.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,403.26
|
| Rate for Payer: Healthscope Commercial |
$8,328.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,477.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,940.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,865.96
|
| Rate for Payer: PHP Commercial |
$7,865.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,477.85
|
| Rate for Payer: Priority Health SBD |
$5,830.06
|
| Rate for Payer: UMR Bronson Commercial |
$4,071.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,940.55
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$3,593.81
|
|
|
Service Code
|
NDC 68462-792-01
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,581.28 |
| Max. Negotiated Rate |
$3,234.43 |
| Rate for Payer: Aetna American Axle |
$2,335.98
|
| Rate for Payer: Aetna Commercial |
$3,054.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,335.98
|
| Rate for Payer: Cash Price |
$2,875.05
|
| Rate for Payer: Cofinity Commercial |
$2,515.67
|
| Rate for Payer: Cofinity Commercial |
$3,090.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,875.05
|
| Rate for Payer: Healthscope Commercial |
$3,234.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,515.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,695.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,054.74
|
| Rate for Payer: PHP Commercial |
$3,054.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,515.67
|
| Rate for Payer: Priority Health SBD |
$2,264.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,581.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,695.36
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$2,841.60
|
|
|
Service Code
|
NDC 68084-075-21
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,250.30 |
| Max. Negotiated Rate |
$2,557.44 |
| Rate for Payer: Aetna American Axle |
$1,847.04
|
| Rate for Payer: Aetna Commercial |
$2,415.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,847.04
|
| Rate for Payer: Cash Price |
$2,273.28
|
| Rate for Payer: Cofinity Commercial |
$1,989.12
|
| Rate for Payer: Cofinity Commercial |
$2,443.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,273.28
|
| Rate for Payer: Healthscope Commercial |
$2,557.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,989.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,131.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,415.36
|
| Rate for Payer: PHP Commercial |
$2,415.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,989.12
|
| Rate for Payer: Priority Health SBD |
$1,790.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,250.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,131.20
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$9,453.13
|
|
|
Service Code
|
NDC 10370-268-01
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,159.38 |
| Max. Negotiated Rate |
$8,507.82 |
| Rate for Payer: Aetna American Axle |
$6,144.53
|
| Rate for Payer: Aetna Commercial |
$8,035.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,144.53
|
| Rate for Payer: Cash Price |
$7,562.50
|
| Rate for Payer: Cofinity Commercial |
$6,617.19
|
| Rate for Payer: Cofinity Commercial |
$8,129.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,562.50
|
| Rate for Payer: Healthscope Commercial |
$8,507.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,617.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,089.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,035.16
|
| Rate for Payer: PHP Commercial |
$8,035.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,617.19
|
| Rate for Payer: Priority Health SBD |
$5,955.47
|
| Rate for Payer: UMR Bronson Commercial |
$4,159.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,089.85
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$94.72
|
|
|
Service Code
|
NDC 68084-075-11
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$85.25 |
| Rate for Payer: Aetna American Axle |
$61.57
|
| Rate for Payer: Aetna Commercial |
$80.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.57
|
| Rate for Payer: Cash Price |
$75.78
|
| Rate for Payer: Cofinity Commercial |
$66.30
|
| Rate for Payer: Cofinity Commercial |
$81.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.78
|
| Rate for Payer: Healthscope Commercial |
$85.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.51
|
| Rate for Payer: PHP Commercial |
$80.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health SBD |
$59.67
|
| Rate for Payer: UMR Bronson Commercial |
$41.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.04
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$14.25
|
|
|
Service Code
|
NDC 67877-317-15
|
| Hospital Charge Code |
8112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Aetna American Axle |
$9.26
|
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.26
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$12.26
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.40
|
| Rate for Payer: Healthscope Commercial |
$12.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.11
|
| Rate for Payer: PHP Commercial |
$12.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.98
|
| Rate for Payer: Priority Health SBD |
$8.98
|
| Rate for Payer: UMR Bronson Commercial |
$6.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.69
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$26.60
|
|
|
Service Code
|
NDC 45802-063-36
|
| Hospital Charge Code |
8112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Aetna American Axle |
$17.29
|
| Rate for Payer: Aetna Commercial |
$22.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.29
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$22.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.28
|
| Rate for Payer: Healthscope Commercial |
$23.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.61
|
| Rate for Payer: PHP Commercial |
$22.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.62
|
| Rate for Payer: Priority Health SBD |
$16.76
|
| Rate for Payer: UMR Bronson Commercial |
$11.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.95
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$60.39
|
|
|
Service Code
|
NDC 45802-063-05
|
| Hospital Charge Code |
8112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$54.35 |
| Rate for Payer: Aetna American Axle |
$39.25
|
| Rate for Payer: Aetna Commercial |
$51.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.25
|
| Rate for Payer: Cash Price |
$48.31
|
| Rate for Payer: Cofinity Commercial |
$51.94
|
| Rate for Payer: Cofinity Commercial |
$42.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.31
|
| Rate for Payer: Healthscope Commercial |
$54.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.33
|
| Rate for Payer: PHP Commercial |
$51.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health SBD |
$38.05
|
| Rate for Payer: UMR Bronson Commercial |
$26.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.29
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$13.30
|
|
|
Service Code
|
NDC 0713-0226-15
|
| Hospital Charge Code |
8112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$11.97 |
| Rate for Payer: Aetna American Axle |
$8.64
|
| Rate for Payer: Aetna Commercial |
$11.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.64
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Cofinity Commercial |
$11.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.64
|
| Rate for Payer: Healthscope Commercial |
$11.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.30
|
| Rate for Payer: PHP Commercial |
$11.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.31
|
| Rate for Payer: Priority Health SBD |
$8.38
|
| Rate for Payer: UMR Bronson Commercial |
$5.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.98
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$18.36
|
|
|
Service Code
|
NDC 0168-0003-80
|
| Hospital Charge Code |
8112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna American Axle |
$11.93
|
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.93
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.61
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health SBD |
$11.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.77
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
NDC 0168-0003-15
|
| Hospital Charge Code |
8112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Aetna American Axle |
$5.97
|
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.97
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.80
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| Rate for Payer: Priority Health SBD |
$5.78
|
| Rate for Payer: UMR Bronson Commercial |
$4.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.88
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$15.06
|
|
|
Service Code
|
NDC 45802-063-35
|
| Hospital Charge Code |
8112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna American Axle |
$9.79
|
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.79
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.80
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UMR Bronson Commercial |
$6.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT
|
Facility
|
IP
|
$84.22
|
|
|
Service Code
|
NDC 45802-054-05
|
| Hospital Charge Code |
8117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$75.80 |
| Rate for Payer: Aetna American Axle |
$54.74
|
| Rate for Payer: Aetna Commercial |
$71.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.74
|
| Rate for Payer: Cash Price |
$67.38
|
| Rate for Payer: Cofinity Commercial |
$58.95
|
| Rate for Payer: Cofinity Commercial |
$72.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.38
|
| Rate for Payer: Healthscope Commercial |
$75.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.59
|
| Rate for Payer: PHP Commercial |
$71.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.95
|
| Rate for Payer: Priority Health SBD |
$53.06
|
| Rate for Payer: UMR Bronson Commercial |
$37.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.16
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT
|
Facility
|
IP
|
$12.90
|
|
|
Service Code
|
NDC 0713-0229-15
|
| Hospital Charge Code |
8117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Aetna American Axle |
$8.38
|
| Rate for Payer: Aetna Commercial |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.38
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$11.09
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$11.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.96
|
| Rate for Payer: PHP Commercial |
$10.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.03
|
| Rate for Payer: Priority Health SBD |
$8.13
|
| Rate for Payer: UMR Bronson Commercial |
$5.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.68
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT
|
Facility
|
IP
|
$21.20
|
|
|
Service Code
|
NDC 45802-054-35
|
| Hospital Charge Code |
8117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna American Axle |
$13.78
|
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.02
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.84
|
| Rate for Payer: Priority Health SBD |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.90
|
|
