|
CALCIUM GLUCONATE (BULK) POWDER
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
NDC 3877918268
|
| Hospital Charge Code |
1316
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.04 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Aetna American Axle |
$237.90
|
| Rate for Payer: Aetna Commercial |
$311.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.90
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$256.20
|
| Rate for Payer: Cofinity Commercial |
$314.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.80
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.10
|
| Rate for Payer: PHP Commercial |
$311.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.20
|
| Rate for Payer: Priority Health SBD |
$230.58
|
| Rate for Payer: UMR Bronson Commercial |
$161.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.50
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$162.86
|
|
|
Service Code
|
NDC 0904-2500-91
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$146.57 |
| Rate for Payer: Aetna American Axle |
$105.86
|
| Rate for Payer: Aetna Commercial |
$138.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.86
|
| Rate for Payer: Cash Price |
$130.29
|
| Rate for Payer: Cofinity Commercial |
$140.06
|
| Rate for Payer: Cofinity Commercial |
$114.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.29
|
| Rate for Payer: Healthscope Commercial |
$146.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.43
|
| Rate for Payer: PHP Commercial |
$138.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.00
|
| Rate for Payer: Priority Health SBD |
$102.60
|
| Rate for Payer: UMR Bronson Commercial |
$71.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.14
|
|
|
CALCIUM POLYCARBOPHIL 625 MG TABLET
|
Facility
|
IP
|
$116.33
|
|
|
Service Code
|
NDC 0536-4306-11
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$104.70 |
| Rate for Payer: Aetna American Axle |
$75.61
|
| Rate for Payer: Aetna Commercial |
$98.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.61
|
| Rate for Payer: Cash Price |
$93.06
|
| Rate for Payer: Cofinity Commercial |
$100.04
|
| Rate for Payer: Cofinity Commercial |
$81.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.06
|
| Rate for Payer: Healthscope Commercial |
$104.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.88
|
| Rate for Payer: PHP Commercial |
$98.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.43
|
| Rate for Payer: Priority Health SBD |
$73.29
|
| Rate for Payer: UMR Bronson Commercial |
$51.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.25
|
|
|
CAMPHOR-MENTHOL 0.5 %-0.5 % LOTION
|
Facility
|
IP
|
$17.99
|
|
|
Service Code
|
NDC 0536-1268-12
|
| 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: 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 Multiplan/Beech St/PHCS |
$15.29
|
| Rate for Payer: PHP Commercial |
$15.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.59
|
| 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
|
$17.99
|
|
|
Service Code
|
NDC 70000-0546-1
|
| 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: 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 Multiplan/Beech St/PHCS |
$15.29
|
| Rate for Payer: PHP Commercial |
$15.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.59
|
| 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
|
|
|
CANDIDA ALBICANS SKIN TEST FDA STANDARD INTRADERMAL
|
Facility
|
IP
|
$977.25
|
|
|
Service Code
|
NDC 59584-138-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$830.66
|
| Rate for Payer: PHP Commercial |
$830.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.08
|
| 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
|
|
|
CANGRELOR 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,834.44
|
|
|
Service Code
|
HCPCS C9460
|
| Hospital Charge Code |
174562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,247.15 |
| Max. Negotiated Rate |
$2,551.00 |
| Rate for Payer: Aetna American Axle |
$1,842.39
|
| Rate for Payer: Aetna Commercial |
$2,409.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,842.39
|
| Rate for Payer: Cash Price |
$2,267.55
|
| Rate for Payer: Cofinity Commercial |
$1,984.11
|
| Rate for Payer: Cofinity Commercial |
$2,437.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,267.55
|
| Rate for Payer: Healthscope Commercial |
$2,551.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,984.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,125.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,409.27
|
| Rate for Payer: PHP Commercial |
$2,409.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,984.11
|
| Rate for Payer: Priority Health SBD |
$1,785.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,247.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,125.83
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$5,809.00
|
|
|
Service Code
|
NDC 70127-100-01
|
| Hospital Charge Code |
188582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,555.96 |
| Max. Negotiated Rate |
$5,228.10 |
| Rate for Payer: Aetna American Axle |
$3,775.85
|
| Rate for Payer: Aetna Commercial |
$4,937.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,775.85
|
| Rate for Payer: Cash Price |
$4,647.20
|
| Rate for Payer: Cofinity Commercial |
$4,066.30
|
| Rate for Payer: Cofinity Commercial |
$4,995.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,647.20
|
| Rate for Payer: Healthscope Commercial |
$5,228.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,066.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,356.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,937.65
|
| Rate for Payer: PHP Commercial |
$4,937.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,066.30
|
| Rate for Payer: Priority Health SBD |
$3,659.67
|
| Rate for Payer: UMR Bronson Commercial |
$2,555.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,356.75
|
|
|
CANNABIDIOL 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$5,809.00
|
|
|
Service Code
|
NDC 70127-100-10
|
| Hospital Charge Code |
188582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,555.96 |
| Max. Negotiated Rate |
$5,228.10 |
| Rate for Payer: Aetna American Axle |
$3,775.85
|
| Rate for Payer: Aetna Commercial |
$4,937.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,775.85
|
| Rate for Payer: Cash Price |
$4,647.20
|
| Rate for Payer: Cofinity Commercial |
$4,066.30
|
| Rate for Payer: Cofinity Commercial |
$4,995.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,647.20
|
| Rate for Payer: Healthscope Commercial |
$5,228.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,066.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,356.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,937.65
|
| Rate for Payer: PHP Commercial |
$4,937.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,066.30
|
| Rate for Payer: Priority Health SBD |
$3,659.67
|
| Rate for Payer: UMR Bronson Commercial |
$2,555.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,356.75
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$14.85
|
|
|
Service Code
|
NDC 0536-2525-25
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$13.36 |
| Rate for Payer: Aetna American Axle |
$9.65
|
| Rate for Payer: Aetna Commercial |
$12.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Cash Price |
$11.88
|
| Rate for Payer: Cofinity Commercial |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.88
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.62
|
| Rate for Payer: PHP Commercial |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$6.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.14
|
|
|
CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 26525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$682.72 |
| Max. Negotiated Rate |
$4,497.31 |
| Rate for Payer: Aetna Medicare |
$1,485.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,785.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,785.76
|
| Rate for Payer: BCBS Complete |
$820.59
|
| Rate for Payer: BCBS MAPPO |
$1,428.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,428.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,428.61
|
| Rate for Payer: Mclaren Medicaid |
$781.45
|
| Rate for Payer: Mclaren Medicare |
$1,428.61
|
| Rate for Payer: Meridian Medicaid |
$820.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,500.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,642.90
|
| Rate for Payer: PACE Medicare |
$1,357.18
|
| Rate for Payer: PACE SWMI |
$1,428.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,428.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$781.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,497.31
|
| Rate for Payer: Priority Health Medicare |
$1,428.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,428.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.99
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$682.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
CAPSULODESIS, METACARPOPHALANGEAL JOINT; SINGLE DIGIT
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$740.35 |
| 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) |
$814.38
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$740.35
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH BONE BLOCK
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 23460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,078.92 |
| 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 |
$3,934.75
|
| 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) |
$1,186.81
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,078.92
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESS TRANSFER
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 23462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,055.67 |
| 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 |
$3,934.75
|
| 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) |
$1,161.24
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,055.67
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG, BANKART PROCEDURE)
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 23455
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$975.78 |
| 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 |
$5,142.16
|
| 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) |
$1,073.36
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$975.78
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, OPEN (EG, CAPSULODESIS, LIGAMENT REPAIR, TENDON TRANSFER OR GRAFT) (INCLUDES SYNOVECTOMY, CAPSULOTOMY AND OPEN REDUCTION) FOR CARPAL INSTABILITY
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 25320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$986.58 |
| 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 |
$3,934.75
|
| 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) |
$1,085.24
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$986.58
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$331.70 |
| 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 |
$1,810.03
|
| 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) |
$364.87
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$331.70
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$536.02 |
| 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 |
$1,630.49
|
| 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) |
$589.62
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$536.02
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
CAPSULOTOMY, WRIST (EG, CONTRACTURE)
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$451.22 |
| 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) |
$496.34
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$451.22
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
CAPTOPRIL 12.5 MG TABLET
|
Facility
|
IP
|
$5.80
|
|
|
Service Code
|
NDC 51079-863-01
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna American Axle |
$3.77
|
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.77
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$4.06
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.93
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.06
|
| Rate for Payer: Priority Health SBD |
$3.65
|
| Rate for Payer: UMR Bronson Commercial |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
CAPTOPRIL 12.5 MG TABLET
|
Facility
|
IP
|
$579.84
|
|
|
Service Code
|
NDC 51079-863-20
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.13 |
| Max. Negotiated Rate |
$521.86 |
| Rate for Payer: Aetna American Axle |
$376.90
|
| Rate for Payer: Aetna Commercial |
$492.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.90
|
| Rate for Payer: Cash Price |
$463.87
|
| Rate for Payer: Cofinity Commercial |
$405.89
|
| Rate for Payer: Cofinity Commercial |
$498.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.87
|
| Rate for Payer: Healthscope Commercial |
$521.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$405.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$492.86
|
| Rate for Payer: PHP Commercial |
$492.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$405.89
|
| Rate for Payer: Priority Health SBD |
$365.30
|
| Rate for Payer: UMR Bronson Commercial |
$255.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.88
|
|
|
CAPTOPRIL 12.5 MG TABLET
|
Facility
|
IP
|
$523.68
|
|
|
Service Code
|
NDC 0904-7105-61
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.42 |
| Max. Negotiated Rate |
$471.31 |
| Rate for Payer: Aetna American Axle |
$340.39
|
| Rate for Payer: Aetna Commercial |
$445.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.39
|
| Rate for Payer: Cash Price |
$418.94
|
| Rate for Payer: Cofinity Commercial |
$366.58
|
| Rate for Payer: Cofinity Commercial |
$450.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.94
|
| Rate for Payer: Healthscope Commercial |
$471.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.13
|
| Rate for Payer: PHP Commercial |
$445.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.58
|
| Rate for Payer: Priority Health SBD |
$329.92
|
| Rate for Payer: UMR Bronson Commercial |
$230.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.76
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$6.50
|
|
|
Service Code
|
NDC 60687-315-11
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$5.85 |
| Rate for Payer: Aetna American Axle |
$4.22
|
| Rate for Payer: Aetna Commercial |
$5.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.22
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Cofinity Commercial |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$5.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$5.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.52
|
| Rate for Payer: PHP Commercial |
$5.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health SBD |
$4.10
|
| Rate for Payer: UMR Bronson Commercial |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.88
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$595.20
|
|
|
Service Code
|
NDC 51079-864-20
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.89 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna American Axle |
$386.88
|
| Rate for Payer: Aetna Commercial |
$505.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.88
|
| Rate for Payer: Cash Price |
$476.16
|
| Rate for Payer: Cofinity Commercial |
$416.64
|
| Rate for Payer: Cofinity Commercial |
$511.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.16
|
| Rate for Payer: Healthscope Commercial |
$535.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$505.92
|
| Rate for Payer: PHP Commercial |
$505.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.64
|
| Rate for Payer: Priority Health SBD |
$374.98
|
| Rate for Payer: UMR Bronson Commercial |
$261.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.40
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$194.98
|
|
|
Service Code
|
NDC 60687-315-21
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.79 |
| Max. Negotiated Rate |
$175.48 |
| Rate for Payer: Aetna American Axle |
$126.74
|
| Rate for Payer: Aetna Commercial |
$165.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.74
|
| Rate for Payer: Cash Price |
$155.98
|
| Rate for Payer: Cofinity Commercial |
$136.49
|
| Rate for Payer: Cofinity Commercial |
$167.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.98
|
| Rate for Payer: Healthscope Commercial |
$175.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.73
|
| Rate for Payer: PHP Commercial |
$165.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.49
|
| Rate for Payer: Priority Health SBD |
$122.84
|
| Rate for Payer: UMR Bronson Commercial |
$85.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.24
|
|
