|
CAPLACIZUMAB-YHDP 11 MG INJECTION KIT
|
Facility
|
OP
|
$21,429.20
|
|
|
Service Code
|
HCPCS C9047
|
| Hospital Charge Code |
189691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,928.80 |
| Max. Negotiated Rate |
$19,286.28 |
| Rate for Payer: Aetna American Axle |
$13,928.98
|
| Rate for Payer: Aetna Commercial |
$18,214.82
|
| Rate for Payer: Aetna Medicare |
$10,714.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,928.98
|
| Rate for Payer: BCBS Complete |
$8,571.68
|
| Rate for Payer: Cash Price |
$17,143.36
|
| Rate for Payer: Cofinity Commercial |
$15,000.44
|
| Rate for Payer: Cofinity Commercial |
$18,429.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,000.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,143.36
|
| Rate for Payer: Healthscope Commercial |
$19,286.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,000.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,071.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,214.82
|
| Rate for Payer: PHP Commercial |
$18,214.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,928.98
|
| Rate for Payer: Priority Health SBD |
$13,500.40
|
| Rate for Payer: UMR Bronson Commercial |
$7,928.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,071.90
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM
|
Facility
|
OP
|
$15.12
|
|
|
Service Code
|
NDC 00536252525
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: Aetna American Axle |
$9.83
|
| Rate for Payer: Aetna Commercial |
$12.85
|
| Rate for Payer: Aetna Medicare |
$7.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.83
|
| Rate for Payer: BCBS Complete |
$6.05
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$13.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.10
|
| Rate for Payer: Healthscope Commercial |
$13.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.85
|
| Rate for Payer: PHP Commercial |
$12.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.83
|
| Rate for Payer: Priority Health SBD |
$9.53
|
| Rate for Payer: UMR Bronson Commercial |
$5.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.34
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$15.12
|
|
|
Service Code
|
NDC 00536252525
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: Aetna American Axle |
$9.83
|
| Rate for Payer: Aetna Commercial |
$12.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.83
|
| Rate for Payer: Cash Price |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$13.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.10
|
| Rate for Payer: Healthscope Commercial |
$13.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.85
|
| Rate for Payer: PHP Commercial |
$12.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.83
|
| Rate for Payer: Priority Health SBD |
$9.53
|
| Rate for Payer: UMR Bronson Commercial |
$6.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.34
|
|
|
CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT
|
Facility
|
OP
|
$4,393.64
|
|
|
Service Code
|
CPT 26525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,982.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
CAPSULODESIS, METACARPOPHALANGEAL JOINT; SINGLE DIGIT
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH BONE BLOCK
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 23460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESS TRANSFER
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 23462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG, BANKART PROCEDURE)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 23455
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, OPEN (EG, CAPSULODESIS, LIGAMENT REPAIR, TENDON TRANSFER OR GRAFT) (INCLUDES SYNOVECTOMY, CAPSULOTOMY AND OPEN REDUCTION) FOR CARPAL INSTABILITY
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 25320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
CAPSULOTOMY, MIDFOOT; EXTENSIVE, INCLUDING POSTERIOR TALOTIBIAL CAPSULOTOMY AND TENDON(S) LENGTHENING (EG, RESISTANT CLUBFOOT DEFORMITY)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
CAPSULOTOMY, MIDFOOT; WITH TENDON LENGTHENING
|
Facility
|
OP
|
$4,393.64
|
|
|
Service Code
|
CPT 28261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,982.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
CAPSULOTOMY, WRIST (EG, CONTRACTURE)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 25085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
CAPTOPRIL 12.5 MG TABLET
|
Facility
|
IP
|
$579.84
|
|
|
Service Code
|
NDC 51079086320
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.13 |
| Max. Negotiated Rate |
$521.86 |
| Rate for Payer: Aetna American Axle |
$376.90
|
| Rate for Payer: Aetna Commercial |
$492.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.90
|
| Rate for Payer: Cash Price |
$463.87
|
| Rate for Payer: Cofinity Commercial |
$405.89
|
| Rate for Payer: Cofinity Commercial |
$498.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$405.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.87
|
| Rate for Payer: Healthscope Commercial |
$521.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$405.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.86
|
| Rate for Payer: PHP Commercial |
$492.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.90
|
| Rate for Payer: Priority Health SBD |
$365.30
|
| Rate for Payer: UMR Bronson Commercial |
$255.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.88
|
|
|
CAPTOPRIL 12.5 MG TABLET
|
Facility
|
IP
|
$533.76
|
|
|
Service Code
|
NDC 00904710561
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.85 |
| Max. Negotiated Rate |
$480.38 |
| Rate for Payer: Aetna American Axle |
$346.94
|
| Rate for Payer: Aetna Commercial |
$453.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.94
|
| Rate for Payer: Cash Price |
$427.01
|
| Rate for Payer: Cofinity Commercial |
$373.63
|
| Rate for Payer: Cofinity Commercial |
$459.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$373.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.01
|
| Rate for Payer: Healthscope Commercial |
$480.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.70
|
| Rate for Payer: PHP Commercial |
$453.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.94
|
| Rate for Payer: Priority Health SBD |
$336.27
|
| Rate for Payer: UMR Bronson Commercial |
$234.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.32
|
|
|
CAPTOPRIL 12.5 MG TABLET
|
Facility
|
IP
|
$5.80
|
|
|
Service Code
|
NDC 51079086301
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna American Axle |
$3.77
|
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.77
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$4.06
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health SBD |
$3.65
|
| Rate for Payer: UMR Bronson Commercial |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
CAPTOPRIL 12.5 MG TABLET
|
Facility
|
OP
|
$5.80
|
|
|
Service Code
|
NDC 51079086301
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna American Axle |
$3.77
|
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna Medicare |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.77
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$4.06
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health SBD |
$3.65
|
| Rate for Payer: UMR Bronson Commercial |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
CAPTOPRIL 12.5 MG TABLET
|
Facility
|
OP
|
$533.76
|
|
|
Service Code
|
NDC 00904710561
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.49 |
| Max. Negotiated Rate |
$480.38 |
| Rate for Payer: Aetna American Axle |
$346.94
|
| Rate for Payer: Aetna Commercial |
$453.70
|
| Rate for Payer: Aetna Medicare |
$266.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.94
|
| Rate for Payer: BCBS Complete |
$213.50
|
| Rate for Payer: Cash Price |
$427.01
|
| Rate for Payer: Cofinity Commercial |
$373.63
|
| Rate for Payer: Cofinity Commercial |
$459.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$373.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.01
|
| Rate for Payer: Healthscope Commercial |
$480.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.70
|
| Rate for Payer: PHP Commercial |
$453.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.94
|
| Rate for Payer: Priority Health SBD |
$336.27
|
| Rate for Payer: UMR Bronson Commercial |
$197.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.32
|
|
|
CAPTOPRIL 12.5 MG TABLET
|
Facility
|
OP
|
$579.84
|
|
|
Service Code
|
NDC 51079086320
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.54 |
| Max. Negotiated Rate |
$521.86 |
| Rate for Payer: Aetna American Axle |
$376.90
|
| Rate for Payer: Aetna Commercial |
$492.86
|
| Rate for Payer: Aetna Medicare |
$289.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.90
|
| Rate for Payer: BCBS Complete |
$231.94
|
| Rate for Payer: Cash Price |
$463.87
|
| Rate for Payer: Cofinity Commercial |
$405.89
|
| Rate for Payer: Cofinity Commercial |
$498.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$405.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.87
|
| Rate for Payer: Healthscope Commercial |
$521.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$405.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.86
|
| Rate for Payer: PHP Commercial |
$492.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.90
|
| Rate for Payer: Priority Health SBD |
$365.30
|
| Rate for Payer: UMR Bronson Commercial |
$214.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.88
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$598.56
|
|
|
Service Code
|
NDC 00904710661
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.37 |
| Max. Negotiated Rate |
$538.70 |
| Rate for Payer: Aetna American Axle |
$389.06
|
| Rate for Payer: Aetna Commercial |
$508.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.06
|
| Rate for Payer: Cash Price |
$478.85
|
| Rate for Payer: Cofinity Commercial |
$418.99
|
| Rate for Payer: Cofinity Commercial |
$514.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$418.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.85
|
| Rate for Payer: Healthscope Commercial |
$538.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$418.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.78
|
| Rate for Payer: PHP Commercial |
$508.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.06
|
| Rate for Payer: Priority Health SBD |
$377.09
|
| Rate for Payer: UMR Bronson Commercial |
$263.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.92
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$5.96
|
|
|
Service Code
|
NDC 51079086401
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna American Axle |
$3.87
|
| Rate for Payer: Aetna Commercial |
$5.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.87
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cofinity Commercial |
$4.17
|
| Rate for Payer: Cofinity Commercial |
$5.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.07
|
| Rate for Payer: PHP Commercial |
$5.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.87
|
| Rate for Payer: Priority Health SBD |
$3.75
|
| Rate for Payer: UMR Bronson Commercial |
$2.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.47
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$281.28
|
|
|
Service Code
|
NDC 27241016101
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.07 |
| Max. Negotiated Rate |
$253.15 |
| Rate for Payer: Aetna American Axle |
$182.83
|
| Rate for Payer: Aetna Commercial |
$239.09
|
| Rate for Payer: Aetna Medicare |
$140.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.83
|
| Rate for Payer: BCBS Complete |
$112.51
|
| Rate for Payer: Cash Price |
$225.02
|
| Rate for Payer: Cofinity Commercial |
$196.90
|
| Rate for Payer: Cofinity Commercial |
$241.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.02
|
| Rate for Payer: Healthscope Commercial |
$253.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.09
|
| Rate for Payer: PHP Commercial |
$239.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.83
|
| Rate for Payer: Priority Health SBD |
$177.21
|
| Rate for Payer: UMR Bronson Commercial |
$104.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.96
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$5.96
|
|
|
Service Code
|
NDC 51079086401
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna American Axle |
$3.87
|
| Rate for Payer: Aetna Commercial |
$5.07
|
| Rate for Payer: Aetna Medicare |
$2.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.87
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cofinity Commercial |
$4.17
|
| Rate for Payer: Cofinity Commercial |
$5.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.07
|
| Rate for Payer: PHP Commercial |
$5.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.87
|
| Rate for Payer: Priority Health SBD |
$3.75
|
| Rate for Payer: UMR Bronson Commercial |
$2.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.47
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$598.56
|
|
|
Service Code
|
NDC 00904710661
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.47 |
| Max. Negotiated Rate |
$538.70 |
| Rate for Payer: Aetna American Axle |
$389.06
|
| Rate for Payer: Aetna Commercial |
$508.78
|
| Rate for Payer: Aetna Medicare |
$299.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.06
|
| Rate for Payer: BCBS Complete |
$239.42
|
| Rate for Payer: Cash Price |
$478.85
|
| Rate for Payer: Cofinity Commercial |
$418.99
|
| Rate for Payer: Cofinity Commercial |
$514.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$418.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.85
|
| Rate for Payer: Healthscope Commercial |
$538.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$418.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.78
|
| Rate for Payer: PHP Commercial |
$508.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.06
|
| Rate for Payer: Priority Health SBD |
$377.09
|
| Rate for Payer: UMR Bronson Commercial |
$221.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.92
|
|
