|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION
|
Facility
|
OP
|
$18.99
|
|
|
Service Code
|
NDC 00536126812
|
| Hospital Charge Code |
23063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: Aetna American Axle |
$12.34
|
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.34
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$17.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.14
|
| Rate for Payer: PHP Commercial |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health SBD |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$7.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.24
|
|
|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION
|
Facility
|
IP
|
$17.99
|
|
|
Service Code
|
NDC 70000054601
|
| Hospital Charge Code |
23063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$16.19 |
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna Commercial |
$15.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$16.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.29
|
| Rate for Payer: PHP Commercial |
$15.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$7.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.49
|
|
|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION
|
Facility
|
IP
|
$18.99
|
|
|
Service Code
|
NDC 00536126812
|
| Hospital Charge Code |
23063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: PHP Commercial |
$16.14
|
| Rate for Payer: Aetna American Axle |
$12.34
|
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.34
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$17.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health SBD |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.24
|
|
|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION
|
Facility
|
OP
|
$17.99
|
|
|
Service Code
|
NDC 70000054601
|
| Hospital Charge Code |
23063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$16.19 |
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna Commercial |
$15.29
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: Cash Price |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$16.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.29
|
| Rate for Payer: PHP Commercial |
$15.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$6.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.49
|
|
|
CANDIDA ALBICANS SKIN TEST FDA STANDARD INTRADERMAL
|
Facility
|
IP
|
$977.25
|
|
|
Service Code
|
NDC 59584013801
|
| Hospital Charge Code |
115385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$429.99 |
| Max. Negotiated Rate |
$879.52 |
| Rate for Payer: Aetna American Axle |
$635.21
|
| Rate for Payer: Aetna Commercial |
$830.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.21
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cofinity Commercial |
$684.08
|
| Rate for Payer: Cofinity Commercial |
$840.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$684.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.80
|
| Rate for Payer: Healthscope Commercial |
$879.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$684.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.66
|
| Rate for Payer: PHP Commercial |
$830.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.21
|
| Rate for Payer: Priority Health SBD |
$615.67
|
| Rate for Payer: UMR Bronson Commercial |
$429.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.94
|
|
|
CANDIDA ALBICANS SKIN TEST FDA STANDARD INTRADERMAL
|
Facility
|
OP
|
$977.25
|
|
|
Service Code
|
NDC 59584013801
|
| Hospital Charge Code |
115385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.58 |
| Max. Negotiated Rate |
$879.52 |
| Rate for Payer: Aetna American Axle |
$635.21
|
| Rate for Payer: Aetna Commercial |
$830.66
|
| Rate for Payer: Aetna Medicare |
$488.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.21
|
| Rate for Payer: BCBS Complete |
$390.90
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cofinity Commercial |
$684.08
|
| Rate for Payer: Cofinity Commercial |
$840.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$684.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$781.80
|
| Rate for Payer: Healthscope Commercial |
$879.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$684.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$732.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$830.66
|
| Rate for Payer: PHP Commercial |
$830.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.21
|
| Rate for Payer: Priority Health SBD |
$615.67
|
| Rate for Payer: UMR Bronson Commercial |
$361.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$732.94
|
|
|
CANGRELOR 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,117.50
|
|
|
Service Code
|
HCPCS C9460
|
| Hospital Charge Code |
174562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,371.70 |
| Max. Negotiated Rate |
$2,805.75 |
| Rate for Payer: Aetna American Axle |
$2,026.38
|
| Rate for Payer: Aetna Commercial |
$2,649.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,026.38
|
| Rate for Payer: Cash Price |
$2,494.00
|
| Rate for Payer: Cofinity Commercial |
$2,182.25
|
| Rate for Payer: Cofinity Commercial |
$2,681.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,182.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,494.00
|
| Rate for Payer: Healthscope Commercial |
$2,805.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,182.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,338.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,649.88
|
| Rate for Payer: PHP Commercial |
$2,649.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,026.38
|
| Rate for Payer: Priority Health SBD |
$1,964.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,371.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,338.12
|
|
|
CANGRELOR 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,117.50
|
|
|
Service Code
|
HCPCS C9460
|
| Hospital Charge Code |
174562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$2,805.75 |
| Rate for Payer: Aetna American Axle |
$2,026.38
|
| Rate for Payer: Aetna Commercial |
$2,649.88
|
| Rate for Payer: Aetna Medicare |
$19.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,026.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.52
|
| Rate for Payer: BCBS Complete |
$10.59
|
| Rate for Payer: BCBS MAPPO |
$18.82
|
| Rate for Payer: BCBS Trust/PPO |
$48.14
|
| Rate for Payer: BCN Commercial |
$48.14
|
| Rate for Payer: BCN Medicare Advantage |
$18.82
|
| Rate for Payer: Cash Price |
$2,494.00
|
| Rate for Payer: Cash Price |
$2,494.00
|
| Rate for Payer: Cofinity Commercial |
$2,681.05
|
| Rate for Payer: Cofinity Commercial |
$2,182.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,182.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,494.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$2,805.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,182.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,338.12
|
| Rate for Payer: Mclaren Medicaid |
$10.09
|
| Rate for Payer: Mclaren Medicare |
$18.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.76
|
| Rate for Payer: Meridian Medicaid |
$10.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,649.88
|
| Rate for Payer: Nomi Health Commercial |
$56.46
|
| Rate for Payer: PACE Medicare |
$17.88
|
| Rate for Payer: PACE SWMI |
$18.82
|
| Rate for Payer: PHP Commercial |
$2,649.88
|
| Rate for Payer: PHP Medicare Advantage |
$18.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,026.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.17
|
| Rate for Payer: Priority Health Medicare |
$18.82
|
| Rate for Payer: Priority Health Narrow Network |
$43.34
|
| Rate for Payer: Priority Health SBD |
$1,964.02
|
| Rate for Payer: Railroad Medicare Medicare |
$18.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.82
|
| Rate for Payer: UHC Exchange |
$35.97
|
| Rate for Payer: UHC Medicare Advantage |
$18.82
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,153.48
|
| Rate for Payer: VA VA |
$18.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,338.12
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$6,049.50
|
|
|
Service Code
|
NDC 70127010001
|
| Hospital Charge Code |
188582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,661.78 |
| Max. Negotiated Rate |
$5,444.55 |
| Rate for Payer: Aetna American Axle |
$3,932.18
|
| Rate for Payer: Aetna Commercial |
$5,142.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,932.18
|
| Rate for Payer: Cash Price |
$4,839.60
|
| Rate for Payer: Cofinity Commercial |
$4,234.65
|
| Rate for Payer: Cofinity Commercial |
$5,202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,234.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,839.60
|
| Rate for Payer: Healthscope Commercial |
$5,444.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,234.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,537.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,142.08
|
| Rate for Payer: PHP Commercial |
$5,142.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,932.18
|
| Rate for Payer: Priority Health SBD |
$3,811.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,661.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,537.12
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$6,049.50
|
|
|
Service Code
|
NDC 70127010010
|
| Hospital Charge Code |
188582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,661.78 |
| Max. Negotiated Rate |
$5,444.55 |
| Rate for Payer: Aetna American Axle |
$3,932.18
|
| Rate for Payer: Aetna Commercial |
$5,142.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,932.18
|
| Rate for Payer: Cash Price |
$4,839.60
|
| Rate for Payer: Cofinity Commercial |
$4,234.65
|
| Rate for Payer: Cofinity Commercial |
$5,202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,234.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,839.60
|
| Rate for Payer: Healthscope Commercial |
$5,444.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,234.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,537.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,142.08
|
| Rate for Payer: PHP Commercial |
$5,142.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,932.18
|
| Rate for Payer: Priority Health SBD |
$3,811.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,661.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,537.12
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$6,049.50
|
|
|
Service Code
|
NDC 70127010001
|
| Hospital Charge Code |
188582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,238.32 |
| Max. Negotiated Rate |
$5,444.55 |
| Rate for Payer: Aetna American Axle |
$3,932.18
|
| Rate for Payer: Aetna Commercial |
$5,142.08
|
| Rate for Payer: Aetna Medicare |
$3,024.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,932.18
|
| Rate for Payer: BCBS Complete |
$2,419.80
|
| Rate for Payer: Cash Price |
$4,839.60
|
| Rate for Payer: Cofinity Commercial |
$4,234.65
|
| Rate for Payer: Cofinity Commercial |
$5,202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,234.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,839.60
|
| Rate for Payer: Healthscope Commercial |
$5,444.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,234.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,537.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,142.08
|
| Rate for Payer: PHP Commercial |
$5,142.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,932.18
|
| Rate for Payer: Priority Health SBD |
$3,811.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,238.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,537.12
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$6,049.50
|
|
|
Service Code
|
NDC 70127010010
|
| Hospital Charge Code |
188582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,238.32 |
| Max. Negotiated Rate |
$5,444.55 |
| Rate for Payer: Aetna American Axle |
$3,932.18
|
| Rate for Payer: Aetna Commercial |
$5,142.08
|
| Rate for Payer: Aetna Medicare |
$3,024.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,932.18
|
| Rate for Payer: BCBS Complete |
$2,419.80
|
| Rate for Payer: Cash Price |
$4,839.60
|
| Rate for Payer: Cofinity Commercial |
$4,234.65
|
| Rate for Payer: Cofinity Commercial |
$5,202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,234.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,839.60
|
| Rate for Payer: Healthscope Commercial |
$5,444.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,234.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,537.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,142.08
|
| Rate for Payer: PHP Commercial |
$5,142.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,932.18
|
| Rate for Payer: Priority Health SBD |
$3,811.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,238.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,537.12
|
|
|
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 |
$2,191.80 |
| 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: BCBS Trust/PPO |
$2,191.80
|
| Rate for Payer: BCN Commercial |
$2,191.80
|
| Rate for Payer: Cash Price |
$17,143.36
|
| 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
|
|
|
CAPLACIZUMAB-YHDP 11 MG INJECTION KIT
|
Facility
|
IP
|
$21,429.20
|
|
|
Service Code
|
HCPCS C9047
|
| Hospital Charge Code |
189691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,428.85 |
| 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 New Business (MI Preferred) |
$13,928.98
|
| 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 |
$9,428.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,071.90
|
|
|
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
|
|
|
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
|
|
|
CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 26525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$647.08 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$711.79
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$647.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
CAPSULODESIS, METACARPOPHALANGEAL JOINT; SINGLE DIGIT
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$707.71 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$778.48
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$707.71
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH BONE BLOCK
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 23460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,057.05 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,162.76
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,057.05
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESS TRANSFER
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 23462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,035.41 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,138.95
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,035.41
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG, BANKART PROCEDURE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 23455
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.48 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$5,393.16
|
| Rate for Payer: BCN Commercial |
$5,393.16
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,052.13
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$956.48
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, OPEN (EG, CAPSULODESIS, LIGAMENT REPAIR, TENDON TRANSFER OR GRAFT) (INCLUDES SYNOVECTOMY, CAPSULOTOMY AND OPEN REDUCTION) FOR CARPAL INSTABILITY
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 25320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.69 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,052.36
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$956.69
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.75 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.82
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$320.75
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
CAPSULOTOMY, MIDFOOT; EXTENSIVE, INCLUDING POSTERIOR TALOTIBIAL CAPSULOTOMY AND TENDON(S) LENGTHENING (EG, RESISTANT CLUBFOOT DEFORMITY)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 28262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,071.91 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$3,225.14
|
| Rate for Payer: BCN Commercial |
$3,225.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,179.10
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,071.91
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$522.22 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,710.08
|
| Rate for Payer: BCN Commercial |
$1,710.08
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$574.44
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$522.22
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
