|
OPEN TREATMENT OF TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 25685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$715.14 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.65
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$715.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITH FIXATION OF POSTERIOR LIP
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27823
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$949.37 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$7,775.14
|
| Rate for Payer: BCN Commercial |
$7,775.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,044.31
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$949.37
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITHOUT FIXATION OF POSTERIOR LIP
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$840.93 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$6,311.62
|
| Rate for Payer: BCN Commercial |
$6,311.62
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$925.02
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$840.93
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES]), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 24685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$634.42 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$6,558.81
|
| Rate for Payer: BCN Commercial |
$6,558.81
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.86
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$634.42
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OPEN TREATMENT OF ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 25545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$606.87 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.56
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$606.87
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OPEN TREATMENT OF ULNAR STYLOID FRACTURE
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 25652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$605.69 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.26
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$605.69
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
OP
|
$1,339.19
|
|
|
Service Code
|
NDC 62559015304
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$495.50 |
| Max. Negotiated Rate |
$1,205.27 |
| Rate for Payer: Aetna American Axle |
$870.47
|
| Rate for Payer: Aetna Commercial |
$1,138.31
|
| Rate for Payer: Aetna Medicare |
$669.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.47
|
| Rate for Payer: BCBS Complete |
$535.68
|
| Rate for Payer: Cash Price |
$1,071.35
|
| Rate for Payer: Cofinity Commercial |
$1,151.70
|
| Rate for Payer: Cofinity Commercial |
$937.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$937.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.35
|
| Rate for Payer: Healthscope Commercial |
$1,205.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$937.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,004.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,138.31
|
| Rate for Payer: PHP Commercial |
$1,138.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.47
|
| Rate for Payer: Priority Health SBD |
$843.69
|
| Rate for Payer: UMR Bronson Commercial |
$495.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,004.39
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
IP
|
$2,240.26
|
|
|
Service Code
|
NDC 42799021701
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$985.71 |
| Max. Negotiated Rate |
$2,016.23 |
| Rate for Payer: Aetna American Axle |
$1,456.17
|
| Rate for Payer: Aetna Commercial |
$1,904.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,456.17
|
| Rate for Payer: Cash Price |
$1,792.21
|
| Rate for Payer: Cofinity Commercial |
$1,568.18
|
| Rate for Payer: Cofinity Commercial |
$1,926.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,568.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,792.21
|
| Rate for Payer: Healthscope Commercial |
$2,016.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,568.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,680.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,904.22
|
| Rate for Payer: PHP Commercial |
$1,904.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.17
|
| Rate for Payer: Priority Health SBD |
$1,411.36
|
| Rate for Payer: UMR Bronson Commercial |
$985.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,680.20
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
OP
|
$2,240.26
|
|
|
Service Code
|
NDC 42799021701
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$828.90 |
| Max. Negotiated Rate |
$2,016.23 |
| Rate for Payer: Aetna American Axle |
$1,456.17
|
| Rate for Payer: Aetna Commercial |
$1,904.22
|
| Rate for Payer: Aetna Medicare |
$1,120.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,456.17
|
| Rate for Payer: BCBS Complete |
$896.10
|
| Rate for Payer: Cash Price |
$1,792.21
|
| Rate for Payer: Cofinity Commercial |
$1,568.18
|
| Rate for Payer: Cofinity Commercial |
$1,926.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,568.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,792.21
|
| Rate for Payer: Healthscope Commercial |
$2,016.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,568.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,680.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,904.22
|
| Rate for Payer: PHP Commercial |
$1,904.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.17
|
| Rate for Payer: Priority Health SBD |
$1,411.36
|
| Rate for Payer: UMR Bronson Commercial |
$828.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,680.20
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
IP
|
$11.46
|
|
|
Service Code
|
NDC 09900001924
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna American Axle |
$7.45
|
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.45
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.17
|
| Rate for Payer: Healthscope Commercial |
$10.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.74
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.45
|
| Rate for Payer: Priority Health SBD |
$7.22
|
| Rate for Payer: UMR Bronson Commercial |
$5.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.60
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
OP
|
$11.46
|
|
|
Service Code
|
NDC 09900001924
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna American Axle |
$7.45
|
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna Medicare |
$5.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.45
|
| Rate for Payer: BCBS Complete |
$4.58
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.17
|
| Rate for Payer: Healthscope Commercial |
$10.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.74
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.45
|
| Rate for Payer: Priority Health SBD |
$7.22
|
| Rate for Payer: UMR Bronson Commercial |
$4.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.60
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
IP
|
$1,339.19
|
|
|
Service Code
|
NDC 62559015304
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$589.24 |
| Max. Negotiated Rate |
$1,205.27 |
| Rate for Payer: Aetna American Axle |
$870.47
|
| Rate for Payer: Aetna Commercial |
$1,138.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.47
|
| Rate for Payer: Cash Price |
$1,071.35
|
| Rate for Payer: Cofinity Commercial |
$1,151.70
|
| Rate for Payer: Cofinity Commercial |
$937.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$937.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.35
|
| Rate for Payer: Healthscope Commercial |
$1,205.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$937.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,004.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,138.31
|
| Rate for Payer: PHP Commercial |
$1,138.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.47
|
| Rate for Payer: Priority Health SBD |
$843.69
|
| Rate for Payer: UMR Bronson Commercial |
$589.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,004.39
|
|
|
OPPONENSPLASTY; SUPERFICIALIS TENDON TRANSFER TYPE, EACH TENDON
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$800.53 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,372.99
|
| Rate for Payer: BCN Commercial |
$2,372.99
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.58
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$800.53
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF LESION
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 67412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$917.98 |
| Max. Negotiated Rate |
$7,184.18 |
| Rate for Payer: Aetna Medicare |
$2,377.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,857.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,857.24
|
| Rate for Payer: BCBS Complete |
$1,286.44
|
| Rate for Payer: BCBS MAPPO |
$2,285.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.11
|
| Rate for Payer: BCN Commercial |
$1,593.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,285.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,285.79
|
| Rate for Payer: Mclaren Medicaid |
$1,225.18
|
| Rate for Payer: Mclaren Medicare |
$2,285.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,400.08
|
| Rate for Payer: Meridian Medicaid |
$1,286.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,628.66
|
| Rate for Payer: Nomi Health Commercial |
$4,800.16
|
| Rate for Payer: PACE Medicare |
$2,171.50
|
| Rate for Payer: PACE SWMI |
$2,285.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,285.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,225.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,184.18
|
| Rate for Payer: Priority Health Medicare |
$2,285.79
|
| Rate for Payer: Priority Health Narrow Network |
$5,747.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,285.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,009.78
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$917.98
|
| Rate for Payer: UHC Medicare Advantage |
$2,285.79
|
| Rate for Payer: UHCCP Medicaid |
$1,225.18
|
| Rate for Payer: VA VA |
$2,285.79
|
|
|
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
|
Facility
|
OP
|
$10,867.50
|
|
|
Service Code
|
CPT 54530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$490.32 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,991.28
|
| Rate for Payer: BCN Commercial |
$3,991.28
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.35
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$490.32
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,853.33
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR INGUINAL APPROACH
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 54520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$316.64 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,716.60
|
| Rate for Payer: BCN Commercial |
$3,716.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.30
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$316.64
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
ORCHIOPEXY, INGUINAL OR SCROTAL APPROACH
|
Facility
|
OP
|
$10,867.50
|
|
|
Service Code
|
CPT 54640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$416.68 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,700.54
|
| Rate for Payer: BCN Commercial |
$3,700.54
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.35
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$416.68
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,853.33
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,904.58
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
197251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,678.02 |
| Max. Negotiated Rate |
$11,614.12 |
| Rate for Payer: Aetna American Axle |
$8,387.98
|
| Rate for Payer: Aetna Commercial |
$10,968.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,387.98
|
| Rate for Payer: Cash Price |
$10,323.66
|
| Rate for Payer: Cofinity Commercial |
$11,097.94
|
| Rate for Payer: Cofinity Commercial |
$9,033.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,033.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,323.66
|
| Rate for Payer: Healthscope Commercial |
$11,614.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,033.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,678.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,968.89
|
| Rate for Payer: PHP Commercial |
$10,968.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,387.98
|
| Rate for Payer: Priority Health SBD |
$8,129.89
|
| Rate for Payer: UMR Bronson Commercial |
$5,678.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,678.44
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,904.58
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
197251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$11,614.12 |
| Rate for Payer: Aetna American Axle |
$8,387.98
|
| Rate for Payer: Aetna Commercial |
$10,968.89
|
| Rate for Payer: Aetna Medicare |
$45.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,387.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.15
|
| Rate for Payer: BCBS Complete |
$24.38
|
| Rate for Payer: BCBS MAPPO |
$43.32
|
| Rate for Payer: BCBS Trust/PPO |
$116.81
|
| Rate for Payer: BCN Commercial |
$116.81
|
| Rate for Payer: BCN Medicare Advantage |
$43.32
|
| Rate for Payer: Cash Price |
$10,323.66
|
| Rate for Payer: Cash Price |
$10,323.66
|
| Rate for Payer: Cofinity Commercial |
$9,033.21
|
| Rate for Payer: Cofinity Commercial |
$11,097.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,033.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,323.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.32
|
| Rate for Payer: Healthscope Commercial |
$11,614.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,033.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,678.44
|
| Rate for Payer: Mclaren Medicaid |
$23.22
|
| Rate for Payer: Mclaren Medicare |
$43.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.49
|
| Rate for Payer: Meridian Medicaid |
$24.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,968.89
|
| Rate for Payer: Nomi Health Commercial |
$129.96
|
| Rate for Payer: PACE Medicare |
$41.15
|
| Rate for Payer: PACE SWMI |
$43.32
|
| Rate for Payer: PHP Commercial |
$10,968.89
|
| Rate for Payer: PHP Medicare Advantage |
$43.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,387.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.34
|
| Rate for Payer: Priority Health Medicare |
$43.32
|
| Rate for Payer: Priority Health Narrow Network |
$97.87
|
| Rate for Payer: Priority Health SBD |
$8,129.89
|
| Rate for Payer: Railroad Medicare Medicare |
$43.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.32
|
| Rate for Payer: UHC Exchange |
$82.79
|
| Rate for Payer: UHC Medicare Advantage |
$43.32
|
| Rate for Payer: UHCCP Medicaid |
$23.22
|
| Rate for Payer: UMR Bronson Commercial |
$4,774.69
|
| Rate for Payer: VA VA |
$43.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,678.44
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,363.71
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
172319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$9,327.34 |
| Rate for Payer: Aetna American Axle |
$6,736.41
|
| Rate for Payer: Aetna American Axle |
$2,245.47
|
| Rate for Payer: Aetna Commercial |
$2,936.38
|
| Rate for Payer: Aetna Commercial |
$8,809.15
|
| Rate for Payer: Aetna Medicare |
$29.67
|
| Rate for Payer: Aetna Medicare |
$29.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,736.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,245.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.66
|
| Rate for Payer: BCBS Complete |
$16.06
|
| Rate for Payer: BCBS Complete |
$16.06
|
| Rate for Payer: BCBS MAPPO |
$28.53
|
| Rate for Payer: BCBS MAPPO |
$28.53
|
| Rate for Payer: BCBS Trust/PPO |
$76.93
|
| Rate for Payer: BCBS Trust/PPO |
$76.93
|
| Rate for Payer: BCN Commercial |
$76.93
|
| Rate for Payer: BCN Commercial |
$76.93
|
| Rate for Payer: BCN Medicare Advantage |
$28.53
|
| Rate for Payer: BCN Medicare Advantage |
$28.53
|
| Rate for Payer: Cash Price |
$2,763.66
|
| Rate for Payer: Cash Price |
$8,290.97
|
| Rate for Payer: Cash Price |
$2,763.66
|
| Rate for Payer: Cash Price |
$8,290.97
|
| Rate for Payer: Cofinity Commercial |
$2,418.20
|
| Rate for Payer: Cofinity Commercial |
$7,254.60
|
| Rate for Payer: Cofinity Commercial |
$8,912.79
|
| Rate for Payer: Cofinity Commercial |
$2,970.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,254.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,418.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,290.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,763.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.53
|
| Rate for Payer: Healthscope Commercial |
$9,327.34
|
| Rate for Payer: Healthscope Commercial |
$3,109.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,418.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,254.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,772.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,590.93
|
| Rate for Payer: Mclaren Medicaid |
$15.29
|
| Rate for Payer: Mclaren Medicaid |
$15.29
|
| Rate for Payer: Mclaren Medicare |
$28.53
|
| Rate for Payer: Mclaren Medicare |
$28.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.96
|
| Rate for Payer: Meridian Medicaid |
$16.06
|
| Rate for Payer: Meridian Medicaid |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,809.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,936.38
|
| Rate for Payer: Nomi Health Commercial |
$85.59
|
| Rate for Payer: Nomi Health Commercial |
$85.59
|
| Rate for Payer: PACE Medicare |
$27.10
|
| Rate for Payer: PACE Medicare |
$27.10
|
| Rate for Payer: PACE SWMI |
$28.53
|
| Rate for Payer: PACE SWMI |
$28.53
|
| Rate for Payer: PHP Commercial |
$8,809.15
|
| Rate for Payer: PHP Commercial |
$2,936.38
|
| Rate for Payer: PHP Medicare Advantage |
$28.53
|
| Rate for Payer: PHP Medicare Advantage |
$28.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,736.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,245.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.92
|
| Rate for Payer: Priority Health Medicare |
$28.53
|
| Rate for Payer: Priority Health Medicare |
$28.53
|
| Rate for Payer: Priority Health Narrow Network |
$65.54
|
| Rate for Payer: Priority Health Narrow Network |
$65.54
|
| Rate for Payer: Priority Health SBD |
$6,529.14
|
| Rate for Payer: Priority Health SBD |
$2,176.38
|
| Rate for Payer: Railroad Medicare Medicare |
$28.53
|
| Rate for Payer: Railroad Medicare Medicare |
$28.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.53
|
| Rate for Payer: UHC Exchange |
$54.52
|
| Rate for Payer: UHC Exchange |
$54.52
|
| Rate for Payer: UHC Medicare Advantage |
$28.53
|
| Rate for Payer: UHC Medicare Advantage |
$28.53
|
| Rate for Payer: UHCCP Medicaid |
$15.29
|
| Rate for Payer: UHCCP Medicaid |
$15.29
|
| Rate for Payer: UMR Bronson Commercial |
$3,834.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,278.19
|
| Rate for Payer: VA VA |
$28.53
|
| Rate for Payer: VA VA |
$28.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,772.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,590.93
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$10,363.71
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
172319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,560.03 |
| Max. Negotiated Rate |
$9,327.34 |
| Rate for Payer: Aetna American Axle |
$6,736.41
|
| Rate for Payer: Aetna American Axle |
$2,245.47
|
| Rate for Payer: Aetna Commercial |
$8,809.15
|
| Rate for Payer: Aetna Commercial |
$2,936.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,736.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,245.47
|
| Rate for Payer: Cash Price |
$8,290.97
|
| Rate for Payer: Cash Price |
$2,763.66
|
| Rate for Payer: Cofinity Commercial |
$2,970.93
|
| Rate for Payer: Cofinity Commercial |
$2,418.20
|
| Rate for Payer: Cofinity Commercial |
$7,254.60
|
| Rate for Payer: Cofinity Commercial |
$8,912.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,254.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,418.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,290.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,763.66
|
| Rate for Payer: Healthscope Commercial |
$9,327.34
|
| Rate for Payer: Healthscope Commercial |
$3,109.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,254.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,418.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,772.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,590.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,936.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,809.15
|
| Rate for Payer: PHP Commercial |
$2,936.38
|
| Rate for Payer: PHP Commercial |
$8,809.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,736.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,245.47
|
| Rate for Payer: Priority Health SBD |
$6,529.14
|
| Rate for Payer: Priority Health SBD |
$2,176.38
|
| Rate for Payer: UMR Bronson Commercial |
$4,560.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,520.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,772.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,590.93
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$43.19
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna American Axle |
$28.07
|
| Rate for Payer: Aetna American Axle |
$28.71
|
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Medicare |
$21.60
|
| Rate for Payer: Aetna Medicare |
$22.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.71
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCBS Complete |
$17.28
|
| Rate for Payer: BCBS Trust/PPO |
$30.78
|
| Rate for Payer: BCBS Trust/PPO |
$30.78
|
| Rate for Payer: BCN Commercial |
$30.78
|
| Rate for Payer: BCN Commercial |
$30.78
|
| Rate for Payer: Cash Price |
$35.34
|
| Rate for Payer: Cash Price |
$35.34
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$37.99
|
| Rate for Payer: Cofinity Commercial |
$30.23
|
| Rate for Payer: Cofinity Commercial |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.55
|
| Rate for Payer: Healthscope Commercial |
$39.75
|
| Rate for Payer: Healthscope Commercial |
$38.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.71
|
| Rate for Payer: Priority Health SBD |
$27.83
|
| Rate for Payer: Priority Health SBD |
$27.21
|
| Rate for Payer: UMR Bronson Commercial |
$15.98
|
| Rate for Payer: UMR Bronson Commercial |
$16.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.39
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$43.19
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna American Axle |
$28.07
|
| Rate for Payer: Aetna American Axle |
$28.71
|
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.71
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cash Price |
$35.34
|
| Rate for Payer: Cofinity Commercial |
$37.99
|
| Rate for Payer: Cofinity Commercial |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$30.23
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.34
|
| Rate for Payer: Healthscope Commercial |
$38.87
|
| Rate for Payer: Healthscope Commercial |
$39.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.71
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.71
|
| Rate for Payer: Priority Health SBD |
$27.21
|
| Rate for Payer: Priority Health SBD |
$27.83
|
| Rate for Payer: UMR Bronson Commercial |
$19.00
|
| Rate for Payer: UMR Bronson Commercial |
$19.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.13
|
|
|
ORTHODONTIC WAX
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 09900000566
|
| Hospital Charge Code |
168918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna American Axle |
$1.30
|
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health SBD |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
|
ORTHODONTIC WAX
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 09900000566
|
| Hospital Charge Code |
168918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna American Axle |
$1.30
|
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health SBD |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
