|
GUAR GUM ORAL POWDER FOR PEDIATRIC FEEDS
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 4390097647
|
| Hospital Charge Code |
150949
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.82
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
GUAR GUM ORAL POWDER PACKET
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 4390097647
|
| Hospital Charge Code |
30538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.82
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN
|
Facility
|
IP
|
$49.19
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
11931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$44.27 |
| Rate for Payer: Aetna American Axle |
$31.97
|
| Rate for Payer: Aetna Commercial |
$41.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.97
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$34.43
|
| Rate for Payer: Cofinity Commercial |
$42.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.35
|
| Rate for Payer: Healthscope Commercial |
$44.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.81
|
| Rate for Payer: PHP Commercial |
$41.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.43
|
| Rate for Payer: Priority Health SBD |
$30.99
|
| Rate for Payer: UMR Bronson Commercial |
$21.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.89
|
|
|
HAIR REMOVAL
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 00170
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: UMR Bronson Commercial |
$36.80
|
|
|
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT; WITH IMPLANT
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 28291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$475.45 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,942.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.00
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$475.45
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT; WITHOUT IMPLANT
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$457.76 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$503.54
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$457.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
NDC 51079-734-01
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: Aetna American Axle |
$2.35
|
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.08
|
| Rate for Payer: PHP Commercial |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.53
|
| Rate for Payer: Priority Health SBD |
$2.28
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
NDC 0904-7241-61
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.25
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: UMR Bronson Commercial |
$125.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 0378-0257-01
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.37 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna American Axle |
$211.80
|
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.80
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.97
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.10
|
| Rate for Payer: Priority Health SBD |
$205.29
|
| Rate for Payer: UMR Bronson Commercial |
$143.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$361.95
|
|
|
Service Code
|
NDC 51079-734-20
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.26 |
| Max. Negotiated Rate |
$325.76 |
| Rate for Payer: Aetna American Axle |
$235.27
|
| Rate for Payer: Aetna Commercial |
$307.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.27
|
| Rate for Payer: Cash Price |
$289.56
|
| Rate for Payer: Cofinity Commercial |
$253.36
|
| Rate for Payer: Cofinity Commercial |
$311.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.56
|
| Rate for Payer: Healthscope Commercial |
$325.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.66
|
| Rate for Payer: PHP Commercial |
$307.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.36
|
| Rate for Payer: Priority Health SBD |
$228.03
|
| Rate for Payer: UMR Bronson Commercial |
$159.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.46
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 60687-161-11
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna American Axle |
$2.57
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.37
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health SBD |
$2.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$346.75
|
|
|
Service Code
|
NDC 68382-079-01
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.57 |
| Max. Negotiated Rate |
$312.08 |
| Rate for Payer: Aetna American Axle |
$225.39
|
| Rate for Payer: Aetna Commercial |
$294.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.39
|
| Rate for Payer: Cash Price |
$277.40
|
| Rate for Payer: Cofinity Commercial |
$242.72
|
| Rate for Payer: Cofinity Commercial |
$298.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.40
|
| Rate for Payer: Healthscope Commercial |
$312.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.74
|
| Rate for Payer: PHP Commercial |
$294.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.72
|
| Rate for Payer: Priority Health SBD |
$218.45
|
| Rate for Payer: UMR Bronson Commercial |
$152.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.06
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
NDC 51079-736-01
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health SBD |
$1.71
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.04
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$395.04
|
|
|
Service Code
|
NDC 60687-161-01
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.82 |
| Max. Negotiated Rate |
$355.54 |
| Rate for Payer: Aetna American Axle |
$256.78
|
| Rate for Payer: Aetna Commercial |
$335.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.78
|
| Rate for Payer: Cash Price |
$316.03
|
| Rate for Payer: Cofinity Commercial |
$276.53
|
| Rate for Payer: Cofinity Commercial |
$339.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.03
|
| Rate for Payer: Healthscope Commercial |
$355.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.78
|
| Rate for Payer: PHP Commercial |
$335.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.53
|
| Rate for Payer: Priority Health SBD |
$248.88
|
| Rate for Payer: UMR Bronson Commercial |
$173.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.28
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$271.20
|
|
|
Service Code
|
NDC 51079-736-20
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.33 |
| Max. Negotiated Rate |
$244.08 |
| Rate for Payer: Aetna American Axle |
$176.28
|
| Rate for Payer: Aetna Commercial |
$230.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.28
|
| Rate for Payer: Cash Price |
$216.96
|
| Rate for Payer: Cofinity Commercial |
$189.84
|
| Rate for Payer: Cofinity Commercial |
$233.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.96
|
| Rate for Payer: Healthscope Commercial |
$244.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.52
|
| Rate for Payer: PHP Commercial |
$230.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.84
|
| Rate for Payer: Priority Health SBD |
$170.86
|
| Rate for Payer: UMR Bronson Commercial |
$119.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.40
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$365.76
|
|
|
Service Code
|
NDC 0378-0327-01
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.93 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna American Axle |
$237.74
|
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: Cash Price |
$292.61
|
| Rate for Payer: Cofinity Commercial |
$256.03
|
| Rate for Payer: Cofinity Commercial |
$314.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.61
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.90
|
| Rate for Payer: PHP Commercial |
$310.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.03
|
| Rate for Payer: Priority Health SBD |
$230.43
|
| Rate for Payer: UMR Bronson Commercial |
$160.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.32
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$232.65
|
|
|
Service Code
|
NDC 0781-1396-13
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.37 |
| Max. Negotiated Rate |
$209.38 |
| Rate for Payer: Aetna American Axle |
$151.22
|
| Rate for Payer: Aetna Commercial |
$197.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.22
|
| Rate for Payer: Cash Price |
$186.12
|
| Rate for Payer: Cofinity Commercial |
$200.08
|
| Rate for Payer: Cofinity Commercial |
$162.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.12
|
| Rate for Payer: Healthscope Commercial |
$209.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.75
|
| Rate for Payer: PHP Commercial |
$197.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.86
|
| Rate for Payer: Priority Health SBD |
$146.57
|
| Rate for Payer: UMR Bronson Commercial |
$102.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.49
|
|
|
HALOPERIDOL (BULK) POWDER
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
NDC 38779-0330-3
|
| Hospital Charge Code |
17126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna American Axle |
$81.90
|
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Cofinity Commercial |
$88.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.10
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| Rate for Payer: UMR Bronson Commercial |
$55.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
|
|
HALOPERIDOL (BULK) POWDER
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
NDC 51552-0519-2
|
| Hospital Charge Code |
17126
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$98.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: UMR Bronson Commercial |
$61.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$81.40
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$73.26 |
| Rate for Payer: Aetna American Axle |
$52.91
|
| Rate for Payer: Aetna Commercial |
$69.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.91
|
| Rate for Payer: Cash Price |
$65.12
|
| Rate for Payer: Cofinity Commercial |
$56.98
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.12
|
| Rate for Payer: Healthscope Commercial |
$73.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.19
|
| Rate for Payer: PHP Commercial |
$69.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.98
|
| Rate for Payer: Priority Health SBD |
$51.28
|
| Rate for Payer: UMR Bronson Commercial |
$35.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.05
|
|
|
HALOPERIDOL DECANOATE 50 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$81.40
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$73.26 |
| Rate for Payer: Aetna American Axle |
$52.91
|
| Rate for Payer: Aetna Commercial |
$69.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.91
|
| Rate for Payer: BCBS Complete |
$32.56
|
| Rate for Payer: BCBS Trust/PPO |
$28.35
|
| Rate for Payer: Cash Price |
$65.12
|
| Rate for Payer: Cash Price |
$65.12
|
| Rate for Payer: Cofinity Commercial |
$56.98
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.12
|
| Rate for Payer: Healthscope Commercial |
$73.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.19
|
| Rate for Payer: PHP Commercial |
$69.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.98
|
| Rate for Payer: Priority Health SBD |
$51.28
|
| Rate for Payer: UMR Bronson Commercial |
$30.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.05
|
|
|
HALOPERIDOL LACTATE 2 MG/ML ORAL CONCENTRATE
|
Facility
|
IP
|
$425.82
|
|
|
Service Code
|
NDC 54838-501-40
|
| Hospital Charge Code |
3585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.36 |
| Max. Negotiated Rate |
$383.24 |
| Rate for Payer: Aetna American Axle |
$276.78
|
| Rate for Payer: Aetna Commercial |
$361.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.78
|
| Rate for Payer: Cash Price |
$340.66
|
| Rate for Payer: Cofinity Commercial |
$298.07
|
| Rate for Payer: Cofinity Commercial |
$366.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.66
|
| Rate for Payer: Healthscope Commercial |
$383.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.95
|
| Rate for Payer: PHP Commercial |
$361.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.07
|
| Rate for Payer: Priority Health SBD |
$268.27
|
| Rate for Payer: UMR Bronson Commercial |
$187.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.36
|
|
|
HALOPERIDOL LACTATE 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$237.95
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
3584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.70 |
| Max. Negotiated Rate |
$214.16 |
| Rate for Payer: Aetna American Axle |
$154.67
|
| Rate for Payer: Aetna American Axle |
$6.84
|
| Rate for Payer: Aetna American Axle |
$10.27
|
| Rate for Payer: Aetna American Axle |
$9.85
|
| Rate for Payer: Aetna American Axle |
$55.70
|
| Rate for Payer: Aetna American Axle |
$15.13
|
| Rate for Payer: Aetna American Axle |
$8.37
|
| Rate for Payer: Aetna Commercial |
$72.84
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna Commercial |
$202.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.67
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cash Price |
$68.55
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$190.36
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Cofinity Commercial |
$7.37
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Cofinity Commercial |
$16.29
|
| Rate for Payer: Cofinity Commercial |
$73.69
|
| Rate for Payer: Cofinity Commercial |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$204.64
|
| Rate for Payer: Cofinity Commercial |
$166.56
|
| Rate for Payer: Cofinity Commercial |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$214.16
|
| Rate for Payer: Healthscope Commercial |
$77.12
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Healthscope Commercial |
$9.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.84
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: PHP Commercial |
$72.84
|
| Rate for Payer: PHP Commercial |
$8.95
|
| Rate for Payer: PHP Commercial |
$202.26
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health SBD |
$9.95
|
| Rate for Payer: Priority Health SBD |
$53.98
|
| Rate for Payer: Priority Health SBD |
$14.66
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$8.11
|
| Rate for Payer: Priority Health SBD |
$149.91
|
| Rate for Payer: Priority Health SBD |
$6.63
|
| Rate for Payer: UMR Bronson Commercial |
$6.95
|
| Rate for Payer: UMR Bronson Commercial |
$5.67
|
| Rate for Payer: UMR Bronson Commercial |
$4.63
|
| Rate for Payer: UMR Bronson Commercial |
$37.70
|
| Rate for Payer: UMR Bronson Commercial |
$6.67
|
| Rate for Payer: UMR Bronson Commercial |
$10.24
|
| Rate for Payer: UMR Bronson Commercial |
$104.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.27
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$26,493.50
|
|
|
Service Code
|
MS-DRG 513
|
| Min. Negotiated Rate |
$12,353.65 |
| Max. Negotiated Rate |
$26,493.50 |
| Rate for Payer: Aetna Medicare |
$13,523.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,254.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,254.80
|
| Rate for Payer: BCBS MAPPO |
$13,003.84
|
| Rate for Payer: BCBS Trust/PPO |
$26,493.50
|
| Rate for Payer: BCN Medicare Advantage |
$13,003.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,003.84
|
| Rate for Payer: Mclaren Medicare |
$13,003.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,654.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,954.42
|
| Rate for Payer: PACE Medicare |
$12,353.65
|
| Rate for Payer: PACE SWMI |
$13,003.84
|
| Rate for Payer: PHP Medicare Advantage |
$13,003.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,261.22
|
| Rate for Payer: Priority Health Medicare |
$13,003.84
|
| Rate for Payer: Priority Health Narrow Network |
$18,608.98
|
| Rate for Payer: Railroad Medicare Medicare |
$13,003.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,726.73
|
| Rate for Payer: UHC Core |
$20,275.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,003.84
|
| Rate for Payer: UHC Exchange |
$16,119.22
|
| Rate for Payer: UHC Medicare Advantage |
$13,393.96
|
| Rate for Payer: VA VA |
$13,003.84
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,487.41
|
|
|
Service Code
|
MS-DRG 514
|
| Min. Negotiated Rate |
$8,111.27 |
| Max. Negotiated Rate |
$18,487.41 |
| Rate for Payer: Aetna Medicare |
$8,879.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,672.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,672.72
|
| Rate for Payer: BCBS MAPPO |
$8,538.18
|
| Rate for Payer: BCBS Trust/PPO |
$18,487.41
|
| Rate for Payer: BCN Medicare Advantage |
$8,538.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,538.18
|
| Rate for Payer: Mclaren Medicare |
$8,538.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,965.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,818.91
|
| Rate for Payer: PACE Medicare |
$8,111.27
|
| Rate for Payer: PACE SWMI |
$8,538.18
|
| Rate for Payer: PHP Medicare Advantage |
$8,538.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,945.44
|
| Rate for Payer: Priority Health Medicare |
$8,538.18
|
| Rate for Payer: Priority Health Narrow Network |
$11,956.35
|
| Rate for Payer: Railroad Medicare Medicare |
$8,538.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,887.04
|
| Rate for Payer: UHC Core |
$13,027.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,538.18
|
| Rate for Payer: UHC Exchange |
$10,356.68
|
| Rate for Payer: UHC Medicare Advantage |
$8,794.33
|
| Rate for Payer: VA VA |
$8,538.18
|
|
