|
CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITHOUT MANIPULATION
|
Facility
|
OP
|
$658.55
|
|
|
Service Code
|
CPT 27750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Exchange |
$447.10
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: VA VA |
$233.95
|
|
|
CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$4,393.64
|
|
|
Service Code
|
CPT 27818
|
|
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
|
|
|
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$658.55
|
|
|
Service Code
|
CPT 25535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Exchange |
$447.10
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: VA VA |
$233.95
|
|
|
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITHOUT MANIPULATION
|
Facility
|
OP
|
$658.55
|
|
|
Service Code
|
CPT 25530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Exchange |
$447.10
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: VA VA |
$233.95
|
|
|
CLOSED TREATMENT OF ULNAR STYLOID FRACTURE
|
Facility
|
OP
|
$658.55
|
|
|
Service Code
|
CPT 25650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$658.55 |
| Rate for Payer: Aetna Medicare |
$243.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.44
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS MAPPO |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$233.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.95
|
| Rate for Payer: Mclaren Medicaid |
$125.40
|
| Rate for Payer: Mclaren Medicare |
$233.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.65
|
| Rate for Payer: Meridian Medicaid |
$131.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.04
|
| Rate for Payer: PACE Medicare |
$222.25
|
| Rate for Payer: PACE SWMI |
$233.95
|
| Rate for Payer: PHP Medicare Advantage |
$233.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.40
|
| Rate for Payer: Priority Health Medicare |
$233.95
|
| Rate for Payer: Railroad Medicare Medicare |
$233.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.95
|
| Rate for Payer: UHC Exchange |
$447.10
|
| Rate for Payer: UHC Medicare Advantage |
$233.95
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: VA VA |
$233.95
|
|
|
CLOSURE OF GASTROSTOMY, SURGICAL
|
Facility
|
OP
|
$10,444.63
|
|
|
Service Code
|
CPT 43870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,988.82 |
| Max. Negotiated Rate |
$10,444.63 |
| Rate for Payer: Aetna Medicare |
$3,858.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,638.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,638.10
|
| Rate for Payer: BCBS Complete |
$2,088.26
|
| Rate for Payer: BCBS MAPPO |
$3,710.48
|
| Rate for Payer: BCN Medicare Advantage |
$3,710.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,710.48
|
| Rate for Payer: Mclaren Medicaid |
$1,988.82
|
| Rate for Payer: Mclaren Medicare |
$3,710.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,896.00
|
| Rate for Payer: Meridian Medicaid |
$2,088.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,267.05
|
| Rate for Payer: PACE Medicare |
$3,524.96
|
| Rate for Payer: PACE SWMI |
$3,710.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,710.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,988.82
|
| Rate for Payer: Priority Health Medicare |
$3,710.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,710.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,444.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,710.48
|
| Rate for Payer: UHC Exchange |
$7,091.10
|
| Rate for Payer: UHC Medicare Advantage |
$3,710.48
|
| Rate for Payer: UHCCP Medicaid |
$1,988.82
|
| Rate for Payer: VA VA |
$3,710.48
|
|
|
CLOSURE OF RECTOVAGINAL FISTULA; VAGINAL OR TRANSANAL APPROACH
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 57300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$5,926.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
CLOSURE OF URETHROSTOMY OR URETHROCUTANEOUS FISTULA, MALE (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$13,956.13
|
|
|
Service Code
|
CPT 53520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Exchange |
$9,475.14
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,657.46
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
IP
|
$662.01
|
|
|
Service Code
|
NDC 00054814622
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.28 |
| Max. Negotiated Rate |
$595.81 |
| Rate for Payer: Aetna American Axle |
$430.31
|
| Rate for Payer: Aetna Commercial |
$562.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.31
|
| Rate for Payer: Cash Price |
$529.61
|
| Rate for Payer: Cofinity Commercial |
$463.41
|
| Rate for Payer: Cofinity Commercial |
$569.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.61
|
| Rate for Payer: Healthscope Commercial |
$595.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$463.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$562.71
|
| Rate for Payer: PHP Commercial |
$562.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.31
|
| Rate for Payer: Priority Health SBD |
$417.07
|
| Rate for Payer: UMR Bronson Commercial |
$291.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.51
|
|
|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
OP
|
$258.72
|
|
|
Service Code
|
NDC 00574010777
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.73 |
| Max. Negotiated Rate |
$232.85 |
| Rate for Payer: Aetna American Axle |
$168.17
|
| Rate for Payer: Aetna Commercial |
$219.91
|
| Rate for Payer: Aetna Medicare |
$129.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.17
|
| Rate for Payer: BCBS Complete |
$103.49
|
| Rate for Payer: Cash Price |
$206.98
|
| Rate for Payer: Cofinity Commercial |
$181.10
|
| Rate for Payer: Cofinity Commercial |
$222.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.98
|
| Rate for Payer: Healthscope Commercial |
$232.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.91
|
| Rate for Payer: PHP Commercial |
$219.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.17
|
| Rate for Payer: Priority Health SBD |
$162.99
|
| Rate for Payer: UMR Bronson Commercial |
$95.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.04
|
|
|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
IP
|
$299.92
|
|
|
Service Code
|
NDC 00574010770
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.96 |
| Max. Negotiated Rate |
$269.93 |
| Rate for Payer: Aetna American Axle |
$194.95
|
| Rate for Payer: Aetna Commercial |
$254.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.95
|
| Rate for Payer: Cash Price |
$239.94
|
| Rate for Payer: Cofinity Commercial |
$209.94
|
| Rate for Payer: Cofinity Commercial |
$257.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.94
|
| Rate for Payer: Healthscope Commercial |
$269.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.93
|
| Rate for Payer: PHP Commercial |
$254.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.95
|
| Rate for Payer: Priority Health SBD |
$188.95
|
| Rate for Payer: UMR Bronson Commercial |
$131.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.94
|
|
|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
OP
|
$662.01
|
|
|
Service Code
|
NDC 00054814622
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.94 |
| Max. Negotiated Rate |
$595.81 |
| Rate for Payer: Aetna American Axle |
$430.31
|
| Rate for Payer: Aetna Commercial |
$562.71
|
| Rate for Payer: Aetna Medicare |
$331.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.31
|
| Rate for Payer: BCBS Complete |
$264.80
|
| Rate for Payer: Cash Price |
$529.61
|
| Rate for Payer: Cofinity Commercial |
$463.41
|
| Rate for Payer: Cofinity Commercial |
$569.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.61
|
| Rate for Payer: Healthscope Commercial |
$595.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$463.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$562.71
|
| Rate for Payer: PHP Commercial |
$562.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.31
|
| Rate for Payer: Priority Health SBD |
$417.07
|
| Rate for Payer: UMR Bronson Commercial |
$244.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.51
|
|
|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
IP
|
$258.72
|
|
|
Service Code
|
NDC 00574010777
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.84 |
| Max. Negotiated Rate |
$232.85 |
| Rate for Payer: Aetna American Axle |
$168.17
|
| Rate for Payer: Aetna Commercial |
$219.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.17
|
| Rate for Payer: Cash Price |
$206.98
|
| Rate for Payer: Cofinity Commercial |
$181.10
|
| Rate for Payer: Cofinity Commercial |
$222.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.98
|
| Rate for Payer: Healthscope Commercial |
$232.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.91
|
| Rate for Payer: PHP Commercial |
$219.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.17
|
| Rate for Payer: Priority Health SBD |
$162.99
|
| Rate for Payer: UMR Bronson Commercial |
$113.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.04
|
|
|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
OP
|
$299.92
|
|
|
Service Code
|
NDC 00574010770
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.97 |
| Max. Negotiated Rate |
$269.93 |
| Rate for Payer: Aetna American Axle |
$194.95
|
| Rate for Payer: Aetna Commercial |
$254.93
|
| Rate for Payer: Aetna Medicare |
$149.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.95
|
| Rate for Payer: BCBS Complete |
$119.97
|
| Rate for Payer: Cash Price |
$239.94
|
| Rate for Payer: Cofinity Commercial |
$209.94
|
| Rate for Payer: Cofinity Commercial |
$257.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.94
|
| Rate for Payer: Healthscope Commercial |
$269.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.93
|
| Rate for Payer: PHP Commercial |
$254.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.95
|
| Rate for Payer: Priority Health SBD |
$188.95
|
| Rate for Payer: UMR Bronson Commercial |
$110.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.94
|
|
|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
OP
|
$618.24
|
|
|
Service Code
|
NDC 00054414622
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.75 |
| Max. Negotiated Rate |
$556.42 |
| Rate for Payer: Aetna American Axle |
$401.86
|
| Rate for Payer: Aetna Commercial |
$525.50
|
| Rate for Payer: Aetna Medicare |
$309.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.86
|
| Rate for Payer: BCBS Complete |
$247.30
|
| Rate for Payer: Cash Price |
$494.59
|
| Rate for Payer: Cofinity Commercial |
$432.77
|
| Rate for Payer: Cofinity Commercial |
$531.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.59
|
| Rate for Payer: Healthscope Commercial |
$556.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.50
|
| Rate for Payer: PHP Commercial |
$525.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.86
|
| Rate for Payer: Priority Health SBD |
$389.49
|
| Rate for Payer: UMR Bronson Commercial |
$228.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.68
|
|
|
CLOTRIMAZOLE 10 MG TROCHE
|
Facility
|
IP
|
$618.24
|
|
|
Service Code
|
NDC 00054414622
|
| Hospital Charge Code |
9644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.03 |
| Max. Negotiated Rate |
$556.42 |
| Rate for Payer: Aetna American Axle |
$401.86
|
| Rate for Payer: Aetna Commercial |
$525.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.86
|
| Rate for Payer: Cash Price |
$494.59
|
| Rate for Payer: Cofinity Commercial |
$432.77
|
| Rate for Payer: Cofinity Commercial |
$531.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.59
|
| Rate for Payer: Healthscope Commercial |
$556.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.50
|
| Rate for Payer: PHP Commercial |
$525.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.86
|
| Rate for Payer: Priority Health SBD |
$389.49
|
| Rate for Payer: UMR Bronson Commercial |
$272.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.68
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
NDC 51672200201
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$6.81
|
|
|
Service Code
|
NDC 00536127211
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Aetna American Axle |
$4.43
|
| Rate for Payer: Aetna Commercial |
$5.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.43
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cofinity Commercial |
$4.77
|
| Rate for Payer: Cofinity Commercial |
$5.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.45
|
| Rate for Payer: Healthscope Commercial |
$6.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.79
|
| Rate for Payer: PHP Commercial |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.43
|
| Rate for Payer: Priority Health SBD |
$4.29
|
| Rate for Payer: UMR Bronson Commercial |
$3.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.11
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$6.81
|
|
|
Service Code
|
NDC 00536127211
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Aetna American Axle |
$4.43
|
| Rate for Payer: Aetna Commercial |
$5.79
|
| Rate for Payer: Aetna Medicare |
$3.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.43
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: Cash Price |
$5.45
|
| Rate for Payer: Cofinity Commercial |
$4.77
|
| Rate for Payer: Cofinity Commercial |
$5.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.45
|
| Rate for Payer: Healthscope Commercial |
$6.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.79
|
| Rate for Payer: PHP Commercial |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.43
|
| Rate for Payer: Priority Health SBD |
$4.29
|
| Rate for Payer: UMR Bronson Commercial |
$2.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.11
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$31.61
|
|
|
Service Code
|
NDC 68462018117
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$28.45 |
| Rate for Payer: Aetna American Axle |
$20.55
|
| Rate for Payer: Aetna Commercial |
$26.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.55
|
| Rate for Payer: Cash Price |
$25.29
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$27.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.29
|
| Rate for Payer: Healthscope Commercial |
$28.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.87
|
| Rate for Payer: PHP Commercial |
$26.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health SBD |
$19.91
|
| Rate for Payer: UMR Bronson Commercial |
$13.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.71
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
NDC 51672200201
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$13.44
|
|
|
Service Code
|
NDC 45802043401
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna American Axle |
$8.74
|
| Rate for Payer: Aetna Commercial |
$11.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.74
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$9.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.75
|
| Rate for Payer: Healthscope Commercial |
$12.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.42
|
| Rate for Payer: PHP Commercial |
$11.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.74
|
| Rate for Payer: Priority Health SBD |
$8.47
|
| Rate for Payer: UMR Bronson Commercial |
$5.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.08
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$13.44
|
|
|
Service Code
|
NDC 45802043401
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna American Axle |
$8.74
|
| Rate for Payer: Aetna Commercial |
$11.42
|
| Rate for Payer: Aetna Medicare |
$6.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.74
|
| Rate for Payer: BCBS Complete |
$5.38
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$9.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.75
|
| Rate for Payer: Healthscope Commercial |
$12.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.42
|
| Rate for Payer: PHP Commercial |
$11.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.74
|
| Rate for Payer: Priority Health SBD |
$8.47
|
| Rate for Payer: UMR Bronson Commercial |
$4.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.08
|
|
|
CLOTRIMAZOLE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$31.61
|
|
|
Service Code
|
NDC 68462018117
|
| Hospital Charge Code |
1767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$28.45 |
| Rate for Payer: Aetna American Axle |
$20.55
|
| Rate for Payer: Aetna Commercial |
$26.87
|
| Rate for Payer: Aetna Medicare |
$15.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.55
|
| Rate for Payer: BCBS Complete |
$12.64
|
| Rate for Payer: Cash Price |
$25.29
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$27.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.29
|
| Rate for Payer: Healthscope Commercial |
$28.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.87
|
| Rate for Payer: PHP Commercial |
$26.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health SBD |
$19.91
|
| Rate for Payer: UMR Bronson Commercial |
$11.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.71
|
|
|
CLOTRIMAZOLE 1 % VAGINAL CREAM
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 51672200306
|
| Hospital Charge Code |
1769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna American Axle |
$10.53
|
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$8.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Commercial |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.53
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
