|
PARICALCITOL 5 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
HCPCS J2501
|
| Hospital Charge Code |
22960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna American Axle |
$26.90
|
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.97
|
| Rate for Payer: Priority Health SBD |
$26.08
|
| Rate for Payer: UMR Bronson Commercial |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE LESION
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$64.30
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.57
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$15.06
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
PAROXETINE 10 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,959.60
|
|
|
Service Code
|
NDC 60505-0402-5
|
| Hospital Charge Code |
22959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna American Axle |
$1,273.74
|
| Rate for Payer: Aetna Commercial |
$1,665.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.74
|
| Rate for Payer: Cash Price |
$1,567.68
|
| Rate for Payer: Cofinity Commercial |
$1,371.72
|
| Rate for Payer: Cofinity Commercial |
$1,685.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.68
|
| Rate for Payer: Healthscope Commercial |
$1,763.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,371.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,665.66
|
| Rate for Payer: PHP Commercial |
$1,665.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.72
|
| Rate for Payer: Priority Health SBD |
$1,234.55
|
| Rate for Payer: UMR Bronson Commercial |
$862.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.70
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 68084-044-01
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.79 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna American Axle |
$287.76
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.89
|
| Rate for Payer: Priority Health SBD |
$278.90
|
| Rate for Payer: UMR Bronson Commercial |
$194.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 68084-044-11
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.79 |
| Max. Negotiated Rate |
$398.43 |
| Rate for Payer: Aetna American Axle |
$287.76
|
| Rate for Payer: Aetna Commercial |
$376.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$380.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$398.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.30
|
| Rate for Payer: PHP Commercial |
$376.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.89
|
| Rate for Payer: Priority Health SBD |
$278.90
|
| Rate for Payer: UMR Bronson Commercial |
$194.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.02
|
|
|
PAROXETINE 10 MG TABLET
|
Facility
|
IP
|
$351.50
|
|
|
Service Code
|
NDC 0904-5676-61
|
| Hospital Charge Code |
16632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.66 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Aetna American Axle |
$228.48
|
| Rate for Payer: Aetna Commercial |
$298.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.48
|
| Rate for Payer: Cash Price |
$281.20
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Cofinity Commercial |
$302.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.20
|
| Rate for Payer: Healthscope Commercial |
$316.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.78
|
| Rate for Payer: PHP Commercial |
$298.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.05
|
| Rate for Payer: Priority Health SBD |
$221.44
|
| Rate for Payer: UMR Bronson Commercial |
$154.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.62
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
IP
|
$427.70
|
|
|
Service Code
|
NDC 68084-045-11
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.19 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna American Axle |
$278.00
|
| Rate for Payer: Aetna Commercial |
$363.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.00
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$299.39
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.54
|
| Rate for Payer: PHP Commercial |
$363.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.39
|
| Rate for Payer: Priority Health SBD |
$269.45
|
| Rate for Payer: UMR Bronson Commercial |
$188.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.78
|
|
|
PAROXETINE 20 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 0904-5677-61
|
| Hospital Charge Code |
10855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.68 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$333.58
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.72
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$423.36
|
|
|
Service Code
|
NDC 68084-046-01
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.28 |
| Max. Negotiated Rate |
$381.02 |
| Rate for Payer: Aetna American Axle |
$275.18
|
| Rate for Payer: Aetna Commercial |
$359.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.18
|
| Rate for Payer: Cash Price |
$338.69
|
| Rate for Payer: Cofinity Commercial |
$296.35
|
| Rate for Payer: Cofinity Commercial |
$364.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.69
|
| Rate for Payer: Healthscope Commercial |
$381.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.86
|
| Rate for Payer: PHP Commercial |
$359.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.35
|
| Rate for Payer: Priority Health SBD |
$266.72
|
| Rate for Payer: UMR Bronson Commercial |
$186.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.52
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 68084-046-11
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna American Axle |
$2.76
|
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.60
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.97
|
| Rate for Payer: Priority Health SBD |
$2.67
|
| Rate for Payer: UMR Bronson Commercial |
$1.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.18
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
NDC 13107-156-30
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna American Axle |
$46.74
|
| Rate for Payer: Aetna Commercial |
$61.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.74
|
| Rate for Payer: Cash Price |
$57.53
|
| Rate for Payer: Cofinity Commercial |
$50.34
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.53
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.12
|
| Rate for Payer: PHP Commercial |
$61.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.34
|
| Rate for Payer: Priority Health SBD |
$45.30
|
| Rate for Payer: UMR Bronson Commercial |
$31.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.93
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$126.20
|
|
|
Service Code
|
NDC 60505-0084-1
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.53 |
| Max. Negotiated Rate |
$113.58 |
| Rate for Payer: Aetna American Axle |
$82.03
|
| Rate for Payer: Aetna Commercial |
$107.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.03
|
| Rate for Payer: Cash Price |
$100.96
|
| Rate for Payer: Cofinity Commercial |
$108.53
|
| Rate for Payer: Cofinity Commercial |
$88.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.96
|
| Rate for Payer: Healthscope Commercial |
$113.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.27
|
| Rate for Payer: PHP Commercial |
$107.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.34
|
| Rate for Payer: Priority Health SBD |
$79.51
|
| Rate for Payer: UMR Bronson Commercial |
$55.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.65
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 50268-642-11
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna American Axle |
$2.00
|
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$1.94
|
| Rate for Payer: UMR Bronson Commercial |
$1.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.31
|
|
|
PAROXETINE 30 MG TABLET
|
Facility
|
IP
|
$153.90
|
|
|
Service Code
|
NDC 50268-642-15
|
| Hospital Charge Code |
10856
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.72 |
| Max. Negotiated Rate |
$138.51 |
| Rate for Payer: Aetna American Axle |
$100.04
|
| Rate for Payer: Aetna Commercial |
$130.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.04
|
| Rate for Payer: Cash Price |
$123.12
|
| Rate for Payer: Cofinity Commercial |
$107.73
|
| Rate for Payer: Cofinity Commercial |
$132.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.12
|
| Rate for Payer: Healthscope Commercial |
$138.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.82
|
| Rate for Payer: PHP Commercial |
$130.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.73
|
| Rate for Payer: Priority Health SBD |
$96.96
|
| Rate for Payer: UMR Bronson Commercial |
$67.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.42
|
|
|
PAROXETINE ER 12.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 0378-2003-93
|
| Hospital Charge Code |
32631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.66
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.49
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
PAROXETINE ER 12.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$265.40
|
|
|
Service Code
|
NDC 60505-3673-3
|
| Hospital Charge Code |
32631
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.78 |
| Max. Negotiated Rate |
$238.86 |
| Rate for Payer: Aetna American Axle |
$172.51
|
| Rate for Payer: Aetna Commercial |
$225.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.51
|
| Rate for Payer: Cash Price |
$212.32
|
| Rate for Payer: Cofinity Commercial |
$185.78
|
| Rate for Payer: Cofinity Commercial |
$228.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.32
|
| Rate for Payer: Healthscope Commercial |
$238.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.59
|
| Rate for Payer: PHP Commercial |
$225.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.78
|
| Rate for Payer: Priority Health SBD |
$167.20
|
| Rate for Payer: UMR Bronson Commercial |
$116.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.05
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); DISTAL PHALANX OF FINGER
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 26236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$444.34 |
| 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 |
$1,334.06
|
| 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) |
$488.77
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$444.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY), BONE (EG, OSTEOMYELITIS); FIBULA
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 27641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$647.03 |
| 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 |
$2,337.98
|
| 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) |
$711.73
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$647.03
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), HUMERUS
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 24140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.73 |
| 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 |
$2,337.98
|
| 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) |
$770.80
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$700.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); METACARPAL
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$501.31 |
| 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) |
$551.44
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$501.31
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), OLECRANON PROCESS
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 24147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$628.36 |
| 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 |
$2,262.55
|
| 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) |
$691.20
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$628.36
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); PROXIMAL OR MIDDLE PHALANX OF FINGER
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 26235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$494.76 |
| 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 |
$1,377.10
|
| 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) |
$544.24
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$494.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY), BONE (EG, OSTEOMYELITIS); TIBIA
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 27640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$823.84 |
| 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 |
$2,460.39
|
| 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) |
$906.22
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$823.84
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); RADIUS
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$584.81 |
| 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 |
$2,413.38
|
| 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) |
$643.29
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$584.81
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); ULNA
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$567.46 |
| 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) |
$624.21
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$567.46
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
