|
CAPLACIZUMAB-YHDP 11 MG INJECTION KIT
|
Facility
|
IP
|
$23,177.83
|
|
|
Service Code
|
HCPCS C9047
|
| Hospital Charge Code |
189691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,198.25 |
| Max. Negotiated Rate |
$20,860.05 |
| Rate for Payer: Aetna American Axle |
$15,065.59
|
| Rate for Payer: Aetna Commercial |
$19,701.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,065.59
|
| Rate for Payer: Cash Price |
$18,542.26
|
| Rate for Payer: Cofinity Advantage |
$16,224.48
|
| Rate for Payer: Cofinity Commercial |
$19,932.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,542.26
|
| Rate for Payer: Healthscope Commercial |
$20,860.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,224.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,383.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,701.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17,383.37
|
| Rate for Payer: PHP Commercial |
$19,701.16
|
| Rate for Payer: Priority Health SBD |
$14,602.03
|
| Rate for Payer: UMR Bronson Commercial |
$10,198.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,383.37
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM
|
Facility
|
OP
|
$15.39
|
|
|
Service Code
|
NDC 00536252525
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$13.85 |
| Rate for Payer: Aetna American Axle |
$10.00
|
| Rate for Payer: Aetna Commercial |
$13.08
|
| Rate for Payer: Aetna Medicare |
$7.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: BCBS Complete |
$6.16
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cofinity Advantage |
$10.77
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$13.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: PHP Commercial |
$13.08
|
| Rate for Payer: Priority Health SBD |
$9.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.00
|
| Rate for Payer: UHC Core |
$8.02
|
| Rate for Payer: UHC Exchange |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$5.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.54
|
|
|
CAPSAICIN 0.025 % TOPICAL CREAM
|
Facility
|
IP
|
$15.39
|
|
|
Service Code
|
NDC 00536252525
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$13.85 |
| Rate for Payer: Aetna American Axle |
$10.00
|
| Rate for Payer: Aetna Commercial |
$13.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cofinity Advantage |
$10.77
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$13.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: PHP Commercial |
$13.08
|
| Rate for Payer: Priority Health SBD |
$9.70
|
| Rate for Payer: UMR Bronson Commercial |
$6.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.54
|
|
|
CAPSAICIN 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$38.83
|
|
|
Service Code
|
NDC 00536126456
|
| Hospital Charge Code |
70403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Aetna American Axle |
$25.24
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Medicare |
$19.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.24
|
| Rate for Payer: BCBS Complete |
$15.53
|
| Rate for Payer: Cash Price |
$31.06
|
| Rate for Payer: Cofinity Advantage |
$27.18
|
| Rate for Payer: Cofinity Commercial |
$33.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.06
|
| Rate for Payer: Healthscope Commercial |
$34.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.12
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: Priority Health SBD |
$24.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.24
|
| Rate for Payer: UHC Core |
$20.23
|
| Rate for Payer: UHC Exchange |
$15.26
|
| Rate for Payer: UMR Bronson Commercial |
$14.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.12
|
|
|
CAPSAICIN 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$38.83
|
|
|
Service Code
|
NDC 00536126456
|
| Hospital Charge Code |
70403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Aetna American Axle |
$25.24
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.24
|
| Rate for Payer: Cash Price |
$31.06
|
| Rate for Payer: Cofinity Advantage |
$27.18
|
| Rate for Payer: Cofinity Commercial |
$33.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.06
|
| Rate for Payer: Healthscope Commercial |
$34.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.12
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: Priority Health SBD |
$24.46
|
| Rate for Payer: UMR Bronson Commercial |
$17.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.12
|
|
|
CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 26525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,293.43
|
| Rate for Payer: BCN Commercial |
$2,293.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESS TRANSFER
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 23462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,985.59
|
| Rate for Payer: BCN Commercial |
$4,985.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, OPEN (EG, CAPSULODESIS, LIGAMENT REPAIR, TENDON TRANSFER OR GRAFT) (INCLUDES SYNOVECTOMY, CAPSULOTOMY AND OPEN REDUCTION) FOR CARPAL INSTABILITY
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 25320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,985.59
|
| Rate for Payer: BCN Commercial |
$4,985.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUT TENORRHAPHY, EACH JOINT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,293.43
|
| Rate for Payer: BCN Commercial |
$2,293.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
CAPSULOTOMY, MIDFOOT; EXTENSIVE, INCLUDING POSTERIOR TALOTIBIAL CAPSULOTOMY AND TENDON(S) LENGTHENING (EG, RESISTANT CLUBFOOT DEFORMITY)
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 28262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,896.28
|
| Rate for Payer: BCN Commercial |
$3,896.28
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,065.94
|
| Rate for Payer: BCN Commercial |
$2,065.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
CAPTOPRIL 12.5 MG TABLET
|
Facility
|
IP
|
$621.12
|
|
|
Service Code
|
NDC 00904710561
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.29 |
| Max. Negotiated Rate |
$559.01 |
| Rate for Payer: Aetna American Axle |
$403.73
|
| Rate for Payer: Aetna Commercial |
$527.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.73
|
| Rate for Payer: Cash Price |
$496.90
|
| Rate for Payer: Cofinity Advantage |
$434.78
|
| Rate for Payer: Cofinity Commercial |
$534.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$496.90
|
| Rate for Payer: Healthscope Commercial |
$559.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$465.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$527.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$465.84
|
| Rate for Payer: PHP Commercial |
$527.95
|
| Rate for Payer: Priority Health SBD |
$391.31
|
| Rate for Payer: UMR Bronson Commercial |
$273.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$465.84
|
|
|
CAPTOPRIL 12.5 MG TABLET
|
Facility
|
OP
|
$621.12
|
|
|
Service Code
|
NDC 00904710561
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.81 |
| Max. Negotiated Rate |
$559.01 |
| Rate for Payer: Aetna American Axle |
$403.73
|
| Rate for Payer: Aetna Commercial |
$527.95
|
| Rate for Payer: Aetna Medicare |
$310.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.73
|
| Rate for Payer: BCBS Complete |
$248.45
|
| Rate for Payer: Cash Price |
$496.90
|
| Rate for Payer: Cofinity Advantage |
$434.78
|
| Rate for Payer: Cofinity Commercial |
$534.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$496.90
|
| Rate for Payer: Healthscope Commercial |
$559.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$465.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$496.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$527.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$465.84
|
| Rate for Payer: PHP Commercial |
$527.95
|
| Rate for Payer: Priority Health SBD |
$391.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.73
|
| Rate for Payer: UHC Core |
$323.60
|
| Rate for Payer: UHC Exchange |
$244.10
|
| Rate for Payer: UMR Bronson Commercial |
$229.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$465.84
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$678.72
|
|
|
Service Code
|
NDC 00904710661
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$298.64 |
| Max. Negotiated Rate |
$610.85 |
| Rate for Payer: Aetna American Axle |
$441.17
|
| Rate for Payer: Aetna Commercial |
$576.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.17
|
| Rate for Payer: Cash Price |
$542.98
|
| Rate for Payer: Cofinity Advantage |
$475.10
|
| Rate for Payer: Cofinity Commercial |
$583.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.98
|
| Rate for Payer: Healthscope Commercial |
$610.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$475.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$576.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.04
|
| Rate for Payer: PHP Commercial |
$576.91
|
| Rate for Payer: Priority Health SBD |
$427.59
|
| Rate for Payer: UMR Bronson Commercial |
$298.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.04
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$422.75
|
|
|
Service Code
|
NDC 27241016101
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.42 |
| Max. Negotiated Rate |
$380.48 |
| Rate for Payer: Aetna American Axle |
$274.79
|
| Rate for Payer: Aetna Commercial |
$359.34
|
| Rate for Payer: Aetna Medicare |
$211.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.79
|
| Rate for Payer: BCBS Complete |
$169.10
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Cofinity Advantage |
$295.93
|
| Rate for Payer: Cofinity Commercial |
$363.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.20
|
| Rate for Payer: Healthscope Commercial |
$380.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.06
|
| Rate for Payer: PHP Commercial |
$359.34
|
| Rate for Payer: Priority Health SBD |
$266.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.79
|
| Rate for Payer: UHC Core |
$220.25
|
| Rate for Payer: UHC Exchange |
$166.14
|
| Rate for Payer: UMR Bronson Commercial |
$156.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.06
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$198.72
|
|
|
Service Code
|
NDC 60687031521
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.53 |
| Max. Negotiated Rate |
$178.85 |
| Rate for Payer: Aetna American Axle |
$129.17
|
| Rate for Payer: Aetna Commercial |
$168.91
|
| Rate for Payer: Aetna Medicare |
$99.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.17
|
| Rate for Payer: BCBS Complete |
$79.49
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Advantage |
$139.10
|
| Rate for Payer: Cofinity Commercial |
$170.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Healthscope Commercial |
$178.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.04
|
| Rate for Payer: PHP Commercial |
$168.91
|
| Rate for Payer: Priority Health SBD |
$125.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.17
|
| Rate for Payer: UHC Core |
$103.53
|
| Rate for Payer: UHC Exchange |
$78.10
|
| Rate for Payer: UMR Bronson Commercial |
$73.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.04
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$6.63
|
|
|
Service Code
|
NDC 60687031511
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna American Axle |
$4.31
|
| Rate for Payer: Aetna Commercial |
$5.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.31
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Advantage |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$5.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.97
|
| Rate for Payer: PHP Commercial |
$5.64
|
| Rate for Payer: Priority Health SBD |
$4.18
|
| Rate for Payer: UMR Bronson Commercial |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.97
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$422.75
|
|
|
Service Code
|
NDC 27241016101
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.01 |
| Max. Negotiated Rate |
$380.48 |
| Rate for Payer: Aetna American Axle |
$274.79
|
| Rate for Payer: Aetna Commercial |
$359.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.79
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Cofinity Advantage |
$295.93
|
| Rate for Payer: Cofinity Commercial |
$363.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.20
|
| Rate for Payer: Healthscope Commercial |
$380.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.06
|
| Rate for Payer: PHP Commercial |
$359.34
|
| Rate for Payer: Priority Health SBD |
$266.33
|
| Rate for Payer: UMR Bronson Commercial |
$186.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.06
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
IP
|
$198.72
|
|
|
Service Code
|
NDC 60687031521
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.44 |
| Max. Negotiated Rate |
$178.85 |
| Rate for Payer: Aetna American Axle |
$129.17
|
| Rate for Payer: Aetna Commercial |
$168.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.17
|
| Rate for Payer: Cash Price |
$158.98
|
| Rate for Payer: Cofinity Advantage |
$139.10
|
| Rate for Payer: Cofinity Commercial |
$170.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.98
|
| Rate for Payer: Healthscope Commercial |
$178.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.04
|
| Rate for Payer: PHP Commercial |
$168.91
|
| Rate for Payer: Priority Health SBD |
$125.19
|
| Rate for Payer: UMR Bronson Commercial |
$87.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.04
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$6.63
|
|
|
Service Code
|
NDC 60687031511
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna American Axle |
$4.31
|
| Rate for Payer: Aetna Commercial |
$5.64
|
| Rate for Payer: Aetna Medicare |
$3.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.31
|
| Rate for Payer: BCBS Complete |
$2.65
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Advantage |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$5.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.97
|
| Rate for Payer: PHP Commercial |
$5.64
|
| Rate for Payer: Priority Health SBD |
$4.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.31
|
| Rate for Payer: UHC Core |
$3.45
|
| Rate for Payer: UHC Exchange |
$2.61
|
| Rate for Payer: UMR Bronson Commercial |
$2.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.97
|
|
|
CAPTOPRIL 25 MG TABLET
|
Facility
|
OP
|
$678.72
|
|
|
Service Code
|
NDC 00904710661
|
| Hospital Charge Code |
9402
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.13 |
| Max. Negotiated Rate |
$610.85 |
| Rate for Payer: Aetna American Axle |
$441.17
|
| Rate for Payer: Aetna Commercial |
$576.91
|
| Rate for Payer: Aetna Medicare |
$339.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.17
|
| Rate for Payer: BCBS Complete |
$271.49
|
| Rate for Payer: Cash Price |
$542.98
|
| Rate for Payer: Cofinity Advantage |
$475.10
|
| Rate for Payer: Cofinity Commercial |
$583.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.98
|
| Rate for Payer: Healthscope Commercial |
$610.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$475.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$542.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$576.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.04
|
| Rate for Payer: PHP Commercial |
$576.91
|
| Rate for Payer: Priority Health SBD |
$427.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.17
|
| Rate for Payer: UHC Core |
$353.61
|
| Rate for Payer: UHC Exchange |
$266.74
|
| Rate for Payer: UMR Bronson Commercial |
$251.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.04
|
|
|
CARBACHOL 0.01 % INTRAOCULAR SOLUTION
|
Facility
|
IP
|
$41.89
|
|
|
Service Code
|
NDC 00065002315
|
| Hospital Charge Code |
19704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Aetna American Axle |
$27.23
|
| Rate for Payer: Aetna Commercial |
$35.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.23
|
| Rate for Payer: Cash Price |
$33.51
|
| Rate for Payer: Cofinity Advantage |
$29.32
|
| Rate for Payer: Cofinity Commercial |
$36.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.51
|
| Rate for Payer: Healthscope Commercial |
$37.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.42
|
| Rate for Payer: PHP Commercial |
$35.61
|
| Rate for Payer: Priority Health SBD |
$26.39
|
| Rate for Payer: UMR Bronson Commercial |
$18.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.42
|
|
|
CARBACHOL 0.01 % INTRAOCULAR SOLUTION
|
Facility
|
OP
|
$41.89
|
|
|
Service Code
|
NDC 00065002315
|
| Hospital Charge Code |
19704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Aetna American Axle |
$27.23
|
| Rate for Payer: Aetna Commercial |
$35.61
|
| Rate for Payer: Aetna Medicare |
$20.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.23
|
| Rate for Payer: BCBS Complete |
$16.76
|
| Rate for Payer: Cash Price |
$33.51
|
| Rate for Payer: Cofinity Advantage |
$29.32
|
| Rate for Payer: Cofinity Commercial |
$36.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.51
|
| Rate for Payer: Healthscope Commercial |
$37.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.42
|
| Rate for Payer: PHP Commercial |
$35.61
|
| Rate for Payer: Priority Health SBD |
$26.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.23
|
| Rate for Payer: UHC Core |
$21.82
|
| Rate for Payer: UHC Exchange |
$16.46
|
| Rate for Payer: UMR Bronson Commercial |
$15.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.42
|
|
|
CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,290.15
|
|
|
Service Code
|
NDC 51672404709
|
| Hospital Charge Code |
109663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$477.36 |
| Max. Negotiated Rate |
$1,161.13 |
| Rate for Payer: Aetna American Axle |
$838.60
|
| Rate for Payer: Aetna Commercial |
$1,096.63
|
| Rate for Payer: Aetna Medicare |
$645.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.60
|
| Rate for Payer: BCBS Complete |
$516.06
|
| Rate for Payer: Cash Price |
$1,032.12
|
| Rate for Payer: Cofinity Advantage |
$903.11
|
| Rate for Payer: Cofinity Commercial |
$1,109.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.12
|
| Rate for Payer: Healthscope Commercial |
$1,161.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$903.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$967.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,032.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,096.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$967.61
|
| Rate for Payer: PHP Commercial |
$1,096.63
|
| Rate for Payer: Priority Health SBD |
$812.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$838.60
|
| Rate for Payer: UHC Core |
$672.17
|
| Rate for Payer: UHC Exchange |
$507.03
|
| Rate for Payer: UMR Bronson Commercial |
$477.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$967.61
|
|
|
CARBAMAZEPINE 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,290.15
|
|
|
Service Code
|
NDC 51672404709
|
| Hospital Charge Code |
109663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$567.67 |
| Max. Negotiated Rate |
$1,161.13 |
| Rate for Payer: Aetna American Axle |
$838.60
|
| Rate for Payer: Aetna Commercial |
$1,096.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.60
|
| Rate for Payer: Cash Price |
$1,032.12
|
| Rate for Payer: Cofinity Advantage |
$903.11
|
| Rate for Payer: Cofinity Commercial |
$1,109.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.12
|
| Rate for Payer: Healthscope Commercial |
$1,161.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$903.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$967.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,096.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$967.61
|
| Rate for Payer: PHP Commercial |
$1,096.63
|
| Rate for Payer: Priority Health SBD |
$812.79
|
| Rate for Payer: UMR Bronson Commercial |
$567.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$967.61
|
|
