|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$108.10
|
|
|
Service Code
|
NDC 68382080501
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.56 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna American Axle |
$70.27
|
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.27
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Advantage |
$75.67
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: Priority Health SBD |
$68.10
|
| Rate for Payer: UMR Bronson Commercial |
$47.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 24605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,437.49
|
| Rate for Payer: BCN Commercial |
$1,437.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOUT CERCLAGE AND/OR LOCKING SCREWS
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 24516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$9,367.90
|
| Rate for Payer: BCN Commercial |
$9,367.90
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 59812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,072.64
|
| Rate for Payer: BCN Commercial |
$3,072.64
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
TREATMENT OF INTERTROCHANTERIC, PERITROCHANTERIC, OR SUBTROCHANTERIC FEMORAL FRACTURE; WITH INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$5,417.18
|
| Rate for Payer: BCN Commercial |
$5,417.18
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 59820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,817.70
|
| Rate for Payer: BCN Commercial |
$2,817.70
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 59821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$4,110.46
|
| Rate for Payer: BCN Commercial |
$4,110.46
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY SINGLE OR MULTIPLE PINNING, IN SITU
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 27176
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$4,035.80
|
| Rate for Payer: BCN Commercial |
$4,035.80
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLOGICAL), BY ABDUCTION, SPLINT OR TRACTION; WITH MANIPULATION, REQUIRING ANESTHESIA
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 27257
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,308.65
|
| Rate for Payer: BCN Commercial |
$1,308.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE
|
Facility
|
OP
|
$2,381.49
|
|
|
Service Code
|
CPT 12020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$787.19
|
| Rate for Payer: BCN Commercial |
$787.19
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
TREATMENT OF TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS); WITH MANIPULATION, EACH
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 28455
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$265.07 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$265.07
|
| Rate for Payer: BCN Commercial |
$265.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) BY INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 27759
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$9,502.28
|
| Rate for Payer: BCN Commercial |
$9,502.28
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
TREMELIMUMAB-ACTL 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$190,473.82
|
|
|
Service Code
|
HCPCS J9347
|
| Hospital Charge Code |
201908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$171,426.44 |
| Rate for Payer: Aetna American Axle |
$123,807.98
|
| Rate for Payer: Aetna Commercial |
$161,902.75
|
| Rate for Payer: Aetna Medicare |
$148.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123,807.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.04
|
| Rate for Payer: BCBS Complete |
$78.66
|
| Rate for Payer: BCBS MAPPO |
$143.23
|
| Rate for Payer: BCBS Trust/PPO |
$463.74
|
| Rate for Payer: BCN Commercial |
$463.74
|
| Rate for Payer: BCN Medicare Advantage |
$143.23
|
| Rate for Payer: Cash Price |
$152,379.06
|
| Rate for Payer: Cash Price |
$152,379.06
|
| Rate for Payer: Cofinity Advantage |
$133,331.67
|
| Rate for Payer: Cofinity Commercial |
$163,807.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152,379.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.23
|
| Rate for Payer: Healthscope Commercial |
$171,426.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133,331.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142,855.36
|
| Rate for Payer: Mclaren Medicaid |
$143.23
|
| Rate for Payer: Mclaren Medicare |
$143.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.39
|
| Rate for Payer: Meridian Medicaid |
$150.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$157.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161,902.75
|
| Rate for Payer: Nomi Health Commercial |
$429.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142,855.36
|
| Rate for Payer: PACE Medicare |
$136.07
|
| Rate for Payer: PACE SWMI |
$143.23
|
| Rate for Payer: PHP Commercial |
$161,902.75
|
| Rate for Payer: PHP Medicare Advantage |
$143.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$444.39
|
| Rate for Payer: Priority Health Medicare |
$143.23
|
| Rate for Payer: Priority Health SBD |
$119,998.51
|
| Rate for Payer: Priority Health Tiered Network |
$355.51
|
| Rate for Payer: Railroad Medicare Medicare |
$143.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.98
|
| Rate for Payer: UHC Core |
$235.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$143.23
|
| Rate for Payer: UHC Exchange |
$235.98
|
| Rate for Payer: UHC Medicaid |
$74.91
|
| Rate for Payer: UHCCP Medicaid |
$74.91
|
| Rate for Payer: UMR Bronson Commercial |
$70,475.31
|
| Rate for Payer: VA VA |
$143.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142,855.36
|
|
|
TREPROSTINIL SODIUM 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,783.56
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
32931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$1,605.20 |
| Rate for Payer: Aetna American Axle |
$1,159.31
|
| Rate for Payer: Aetna American Axle |
$1,075.61
|
| Rate for Payer: Aetna Commercial |
$1,406.56
|
| Rate for Payer: Aetna Commercial |
$1,516.03
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,159.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.99
|
| Rate for Payer: BCBS Complete |
$30.31
|
| Rate for Payer: BCBS Complete |
$30.31
|
| Rate for Payer: BCBS MAPPO |
$55.19
|
| Rate for Payer: BCBS MAPPO |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$176.63
|
| Rate for Payer: BCBS Trust/PPO |
$176.63
|
| Rate for Payer: BCN Commercial |
$176.63
|
| Rate for Payer: BCN Commercial |
$176.63
|
| Rate for Payer: BCN Medicare Advantage |
$55.19
|
| Rate for Payer: BCN Medicare Advantage |
$55.19
|
| Rate for Payer: Cash Price |
$1,323.82
|
| Rate for Payer: Cash Price |
$1,426.85
|
| Rate for Payer: Cash Price |
$1,426.85
|
| Rate for Payer: Cash Price |
$1,323.82
|
| Rate for Payer: Cofinity Advantage |
$1,248.49
|
| Rate for Payer: Cofinity Advantage |
$1,158.35
|
| Rate for Payer: Cofinity Commercial |
$1,423.11
|
| Rate for Payer: Cofinity Commercial |
$1,533.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,323.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,426.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.19
|
| Rate for Payer: Healthscope Commercial |
$1,489.30
|
| Rate for Payer: Healthscope Commercial |
$1,605.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,248.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,158.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,241.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,337.67
|
| Rate for Payer: Mclaren Medicaid |
$55.19
|
| Rate for Payer: Mclaren Medicaid |
$55.19
|
| Rate for Payer: Mclaren Medicare |
$55.19
|
| Rate for Payer: Mclaren Medicare |
$55.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.95
|
| Rate for Payer: Meridian Medicaid |
$57.95
|
| Rate for Payer: Meridian Medicaid |
$57.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,406.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,516.03
|
| Rate for Payer: Nomi Health Commercial |
$165.57
|
| Rate for Payer: Nomi Health Commercial |
$165.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,337.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,241.09
|
| Rate for Payer: PACE Medicare |
$52.43
|
| Rate for Payer: PACE Medicare |
$52.43
|
| Rate for Payer: PACE SWMI |
$55.19
|
| Rate for Payer: PACE SWMI |
$55.19
|
| Rate for Payer: PHP Commercial |
$1,406.56
|
| Rate for Payer: PHP Commercial |
$1,516.03
|
| Rate for Payer: PHP Medicare Advantage |
$55.19
|
| Rate for Payer: PHP Medicare Advantage |
$55.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$172.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$172.53
|
| Rate for Payer: Priority Health Medicare |
$55.19
|
| Rate for Payer: Priority Health Medicare |
$55.19
|
| Rate for Payer: Priority Health SBD |
$1,042.51
|
| Rate for Payer: Priority Health SBD |
$1,123.64
|
| Rate for Payer: Priority Health Tiered Network |
$138.02
|
| Rate for Payer: Priority Health Tiered Network |
$138.02
|
| Rate for Payer: Railroad Medicare Medicare |
$55.19
|
| Rate for Payer: Railroad Medicare Medicare |
$55.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.89
|
| Rate for Payer: UHC Core |
$89.89
|
| Rate for Payer: UHC Core |
$89.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$55.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$55.19
|
| Rate for Payer: UHC Exchange |
$89.89
|
| Rate for Payer: UHC Exchange |
$89.89
|
| Rate for Payer: UHC Medicaid |
$28.86
|
| Rate for Payer: UHC Medicaid |
$28.86
|
| Rate for Payer: UHCCP Medicaid |
$28.86
|
| Rate for Payer: UHCCP Medicaid |
$28.86
|
| Rate for Payer: UMR Bronson Commercial |
$612.27
|
| Rate for Payer: UMR Bronson Commercial |
$659.92
|
| Rate for Payer: VA VA |
$55.19
|
| Rate for Payer: VA VA |
$55.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,337.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,241.09
|
|
|
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 |
$1,159.31
|
| Rate for Payer: Aetna Commercial |
$1,406.56
|
| Rate for Payer: Aetna Commercial |
$1,516.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,159.31
|
| Rate for Payer: Cash Price |
$1,323.82
|
| Rate for Payer: Cash Price |
$1,426.85
|
| Rate for Payer: Cofinity Advantage |
$1,248.49
|
| Rate for Payer: Cofinity Advantage |
$1,158.35
|
| Rate for Payer: Cofinity Commercial |
$1,533.86
|
| Rate for Payer: Cofinity Commercial |
$1,423.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,323.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,426.85
|
| Rate for Payer: Healthscope Commercial |
$1,489.30
|
| Rate for Payer: Healthscope Commercial |
$1,605.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,248.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,158.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,241.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,337.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,406.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,516.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,241.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,337.67
|
| Rate for Payer: PHP Commercial |
$1,406.56
|
| Rate for Payer: PHP Commercial |
$1,516.03
|
| Rate for Payer: Priority Health SBD |
$1,123.64
|
| Rate for Payer: Priority Health SBD |
$1,042.51
|
| Rate for Payer: UMR Bronson Commercial |
$728.10
|
| Rate for Payer: UMR Bronson Commercial |
$784.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,241.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,337.67
|
|
|
TREPROSTINIL SODIUM 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20,691.48
|
|
|
Service Code
|
HCPCS J3285
|
| Hospital Charge Code |
32933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.86 |
| 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 Medicare |
$57.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,449.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.99
|
| Rate for Payer: BCBS Complete |
$30.31
|
| Rate for Payer: BCBS MAPPO |
$55.19
|
| Rate for Payer: BCBS Trust/PPO |
$176.63
|
| Rate for Payer: BCN Commercial |
$176.63
|
| Rate for Payer: BCN Medicare Advantage |
$55.19
|
| Rate for Payer: Cash Price |
$16,553.18
|
| Rate for Payer: Cash Price |
$16,553.18
|
| Rate for Payer: Cofinity Advantage |
$14,484.04
|
| Rate for Payer: Cofinity Commercial |
$17,794.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,553.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.19
|
| 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: Mclaren Medicaid |
$55.19
|
| Rate for Payer: Mclaren Medicare |
$55.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.95
|
| Rate for Payer: Meridian Medicaid |
$57.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,587.76
|
| Rate for Payer: Nomi Health Commercial |
$165.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,518.61
|
| Rate for Payer: PACE Medicare |
$52.43
|
| Rate for Payer: PACE SWMI |
$55.19
|
| Rate for Payer: PHP Commercial |
$17,587.76
|
| Rate for Payer: PHP Medicare Advantage |
$55.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$172.53
|
| Rate for Payer: Priority Health Medicare |
$55.19
|
| Rate for Payer: Priority Health SBD |
$13,035.63
|
| Rate for Payer: Priority Health Tiered Network |
$138.02
|
| Rate for Payer: Railroad Medicare Medicare |
$55.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.89
|
| Rate for Payer: UHC Core |
$89.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$55.19
|
| Rate for Payer: UHC Exchange |
$89.89
|
| Rate for Payer: UHC Medicaid |
$28.86
|
| Rate for Payer: UHCCP Medicaid |
$28.86
|
| Rate for Payer: UMR Bronson Commercial |
$7,655.85
|
| Rate for Payer: VA VA |
$55.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,518.61
|
|
|
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 Advantage |
$14,484.04
|
| Rate for Payer: Cofinity Commercial |
$17,794.67
|
| 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 Commercial |
$17,587.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,518.61
|
| Rate for Payer: PHP Commercial |
$17,587.76
|
| 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 00555080802
|
| 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 Advantage |
$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 Commercial |
$7,865.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,940.55
|
| Rate for Payer: PHP Commercial |
$7,865.96
|
| 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
|
$9,254.07
|
|
|
Service Code
|
NDC 10370026801
|
| 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 Advantage |
$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 Commercial |
$7,865.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,940.55
|
| Rate for Payer: PHP Commercial |
$7,865.96
|
| 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
|
$3,091.58
|
|
|
Service Code
|
NDC 68084007521
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,360.30 |
| Max. Negotiated Rate |
$2,782.42 |
| Rate for Payer: Aetna American Axle |
$2,009.53
|
| Rate for Payer: Aetna Commercial |
$2,627.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,009.53
|
| Rate for Payer: Cash Price |
$2,473.26
|
| Rate for Payer: Cofinity Advantage |
$2,164.11
|
| Rate for Payer: Cofinity Commercial |
$2,658.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,473.26
|
| Rate for Payer: Healthscope Commercial |
$2,782.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,164.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,318.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,627.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,318.68
|
| Rate for Payer: PHP Commercial |
$2,627.84
|
| Rate for Payer: Priority Health SBD |
$1,947.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,360.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,318.68
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
OP
|
$103.06
|
|
|
Service Code
|
NDC 68084007511
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$92.75 |
| Rate for Payer: Aetna American Axle |
$66.99
|
| Rate for Payer: Aetna Commercial |
$87.60
|
| Rate for Payer: Aetna Medicare |
$51.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.99
|
| Rate for Payer: BCBS Complete |
$41.22
|
| Rate for Payer: Cash Price |
$82.45
|
| Rate for Payer: Cofinity Advantage |
$72.14
|
| Rate for Payer: Cofinity Commercial |
$88.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.45
|
| Rate for Payer: Healthscope Commercial |
$92.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.30
|
| Rate for Payer: PHP Commercial |
$87.60
|
| Rate for Payer: Priority Health SBD |
$64.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.99
|
| Rate for Payer: UHC Core |
$53.69
|
| Rate for Payer: UHC Exchange |
$40.50
|
| Rate for Payer: UMR Bronson Commercial |
$38.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.30
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
OP
|
$3,091.58
|
|
|
Service Code
|
NDC 68084007521
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,143.88 |
| Max. Negotiated Rate |
$2,782.42 |
| Rate for Payer: Aetna American Axle |
$2,009.53
|
| Rate for Payer: Aetna Commercial |
$2,627.84
|
| Rate for Payer: Aetna Medicare |
$1,545.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,009.53
|
| Rate for Payer: BCBS Complete |
$1,236.63
|
| Rate for Payer: Cash Price |
$2,473.26
|
| Rate for Payer: Cofinity Advantage |
$2,164.11
|
| Rate for Payer: Cofinity Commercial |
$2,658.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,473.26
|
| Rate for Payer: Healthscope Commercial |
$2,782.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,164.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,318.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,473.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,627.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,318.68
|
| Rate for Payer: PHP Commercial |
$2,627.84
|
| Rate for Payer: Priority Health SBD |
$1,947.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,009.53
|
| Rate for Payer: UHC Core |
$1,610.71
|
| Rate for Payer: UHC Exchange |
$1,214.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,143.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,318.68
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
OP
|
$3,989.34
|
|
|
Service Code
|
NDC 68462079201
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,476.06 |
| Max. Negotiated Rate |
$3,590.41 |
| Rate for Payer: Aetna American Axle |
$2,593.07
|
| Rate for Payer: Aetna Commercial |
$3,390.94
|
| Rate for Payer: Aetna Medicare |
$1,994.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,593.07
|
| Rate for Payer: BCBS Complete |
$1,595.74
|
| Rate for Payer: Cash Price |
$3,191.47
|
| Rate for Payer: Cofinity Advantage |
$2,792.54
|
| Rate for Payer: Cofinity Commercial |
$3,430.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,191.47
|
| Rate for Payer: Healthscope Commercial |
$3,590.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,792.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,992.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,191.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,390.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,992.01
|
| Rate for Payer: PHP Commercial |
$3,390.94
|
| Rate for Payer: Priority Health SBD |
$2,513.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,593.07
|
| Rate for Payer: UHC Core |
$2,078.45
|
| Rate for Payer: UHC Exchange |
$1,567.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,476.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,992.01
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
OP
|
$9,254.07
|
|
|
Service Code
|
NDC 00555080802
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,424.01 |
| 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 Medicare |
$4,627.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,015.15
|
| Rate for Payer: BCBS Complete |
$3,701.63
|
| Rate for Payer: Cash Price |
$7,403.26
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$7,403.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,865.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,940.55
|
| Rate for Payer: PHP Commercial |
$7,865.96
|
| Rate for Payer: Priority Health SBD |
$5,830.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,015.15
|
| Rate for Payer: UHC Core |
$4,821.37
|
| Rate for Payer: UHC Exchange |
$3,636.85
|
| Rate for Payer: UMR Bronson Commercial |
$3,424.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,940.55
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$103.06
|
|
|
Service Code
|
NDC 68084007511
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$92.75 |
| Rate for Payer: Aetna American Axle |
$66.99
|
| Rate for Payer: Aetna Commercial |
$87.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.99
|
| Rate for Payer: Cash Price |
$82.45
|
| Rate for Payer: Cofinity Advantage |
$72.14
|
| Rate for Payer: Cofinity Commercial |
$88.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.45
|
| Rate for Payer: Healthscope Commercial |
$92.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.30
|
| Rate for Payer: PHP Commercial |
$87.60
|
| Rate for Payer: Priority Health SBD |
$64.93
|
| Rate for Payer: UMR Bronson Commercial |
$45.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.30
|
|
