|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$254.40
|
|
|
Service Code
|
NDC 00378018101
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.42 |
| Max. Negotiated Rate |
$228.96 |
| Rate for Payer: Aetna Commercial |
$216.24
|
| Rate for Payer: Aetna Medicare |
$66.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.50
|
| Rate for Payer: BCBS Complete |
$101.76
|
| Rate for Payer: BCBS MAPPO |
$63.60
|
| Rate for Payer: BCBS Trust/PPO |
$209.14
|
| Rate for Payer: BCN Commercial |
$197.80
|
| Rate for Payer: BCN Medicare Advantage |
$63.60
|
| Rate for Payer: Cash Price |
$203.52
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.60
|
| Rate for Payer: Healthscope Commercial |
$228.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.24
|
| Rate for Payer: Nomi Health Commercial |
$208.61
|
| Rate for Payer: PACE Senior Care Partners |
$60.42
|
| Rate for Payer: PACE SWMI |
$63.60
|
| Rate for Payer: PHP Commercial |
$216.24
|
| Rate for Payer: PHP Medicare Advantage |
$63.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.36
|
| Rate for Payer: Priority Health HMO/PPO |
$221.33
|
| Rate for Payer: Priority Health Medicare |
$64.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.45
|
| Rate for Payer: Railroad Medicare Medicare |
$63.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.87
|
| Rate for Payer: UHC Core |
$212.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.60
|
| Rate for Payer: UHC Exchange |
$63.60
|
| Rate for Payer: UHC Medicare Advantage |
$63.60
|
| Rate for Payer: VA VA |
$63.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.80
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$254.40
|
|
|
Service Code
|
NDC 00378018101
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$228.96 |
| Rate for Payer: Aetna Commercial |
$216.24
|
| Rate for Payer: BCBS Trust/PPO |
$207.67
|
| Rate for Payer: BCN Commercial |
$196.60
|
| Rate for Payer: Cash Price |
$203.52
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.52
|
| Rate for Payer: Healthscope Commercial |
$228.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.24
|
| Rate for Payer: Nomi Health Commercial |
$208.61
|
| Rate for Payer: PHP Commercial |
$216.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.36
|
| Rate for Payer: Priority Health HMO/PPO |
$221.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.87
|
| Rate for Payer: UHC Core |
$212.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.80
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 00591554401
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: BCBS Trust/PPO |
$218.64
|
| Rate for Payer: BCN Commercial |
$206.99
|
| Rate for Payer: Cash Price |
$214.27
|
| 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: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health HMO/PPO |
$233.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
| Rate for Payer: UHC Core |
$223.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 00603211621
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: BCBS Trust/PPO |
$218.64
|
| Rate for Payer: BCN Commercial |
$206.99
|
| Rate for Payer: Cash Price |
$214.27
|
| 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: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health HMO/PPO |
$233.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
| Rate for Payer: UHC Core |
$223.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$337.25
|
|
|
Service Code
|
NDC 00904657261
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.10 |
| Max. Negotiated Rate |
$303.52 |
| Rate for Payer: Aetna Commercial |
$286.66
|
| Rate for Payer: Aetna Medicare |
$87.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.39
|
| Rate for Payer: BCBS Complete |
$134.90
|
| Rate for Payer: BCBS MAPPO |
$84.31
|
| Rate for Payer: BCBS Trust/PPO |
$277.25
|
| Rate for Payer: BCN Commercial |
$262.21
|
| Rate for Payer: BCN Medicare Advantage |
$84.31
|
| Rate for Payer: Cash Price |
$269.80
|
| Rate for Payer: Cofinity Commercial |
$290.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.31
|
| Rate for Payer: Healthscope Commercial |
$303.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.66
|
| Rate for Payer: Nomi Health Commercial |
$276.54
|
| Rate for Payer: PACE Senior Care Partners |
$80.10
|
| Rate for Payer: PACE SWMI |
$84.31
|
| Rate for Payer: PHP Commercial |
$286.66
|
| Rate for Payer: PHP Medicare Advantage |
$84.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.21
|
| Rate for Payer: Priority Health HMO/PPO |
$293.41
|
| Rate for Payer: Priority Health Medicare |
$85.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.96
|
| Rate for Payer: Railroad Medicare Medicare |
$84.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.78
|
| Rate for Payer: UHC Core |
$281.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.31
|
| Rate for Payer: UHC Exchange |
$84.31
|
| Rate for Payer: UHC Medicare Advantage |
$84.31
|
| Rate for Payer: VA VA |
$84.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.94
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
NDC 00781106101
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: BCBS Trust/PPO |
$34.28
|
| Rate for Payer: BCN Commercial |
$32.46
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: Aetna Medicare |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.23
|
| Rate for Payer: BCBS Complete |
$25.90
|
| Rate for Payer: BCBS MAPPO |
$16.19
|
| Rate for Payer: BCBS Trust/PPO |
$53.23
|
| Rate for Payer: BCN Commercial |
$50.34
|
| Rate for Payer: BCN Medicare Advantage |
$16.19
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.19
|
| Rate for Payer: Healthscope Commercial |
$58.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Nomi Health Commercial |
$53.10
|
| Rate for Payer: PACE Senior Care Partners |
$15.38
|
| Rate for Payer: PACE SWMI |
$16.19
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: PHP Medicare Advantage |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.09
|
| Rate for Payer: Priority Health HMO/PPO |
$56.33
|
| Rate for Payer: Priority Health Medicare |
$16.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.38
|
| Rate for Payer: Railroad Medicare Medicare |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.98
|
| Rate for Payer: UHC Core |
$54.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.19
|
| Rate for Payer: UHC Exchange |
$16.19
|
| Rate for Payer: UHC Medicare Advantage |
$16.19
|
| Rate for Payer: VA VA |
$16.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
NDC 00781106101
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.12
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$34.53
|
| Rate for Payer: BCN Commercial |
$32.66
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: PACE Senior Care Partners |
$9.98
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Medicare |
$10.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.50
|
| Rate for Payer: UHC Exchange |
$10.50
|
| Rate for Payer: UHC Medicare Advantage |
$10.50
|
| Rate for Payer: VA VA |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
ALPRAZOLAM 0.25 MG TABLET
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 65862067601
|
| Hospital Charge Code |
324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: BCBS Trust/PPO |
$52.86
|
| Rate for Payer: BCN Commercial |
$50.04
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.04
|
| Rate for Payer: Nomi Health Commercial |
$53.10
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.09
|
| Rate for Payer: Priority Health HMO/PPO |
$56.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.98
|
| Rate for Payer: UHC Core |
$54.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$598.50
|
|
|
Service Code
|
NDC 60687038801
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.14 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Aetna Commercial |
$508.72
|
| Rate for Payer: Aetna Medicare |
$155.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.03
|
| Rate for Payer: BCBS Complete |
$239.40
|
| Rate for Payer: BCBS MAPPO |
$149.62
|
| Rate for Payer: BCBS Trust/PPO |
$492.03
|
| Rate for Payer: BCN Commercial |
$465.33
|
| Rate for Payer: BCN Medicare Advantage |
$149.62
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cofinity Commercial |
$514.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.62
|
| Rate for Payer: Healthscope Commercial |
$538.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.72
|
| Rate for Payer: Nomi Health Commercial |
$490.77
|
| Rate for Payer: PACE Senior Care Partners |
$142.14
|
| Rate for Payer: PACE SWMI |
$149.62
|
| Rate for Payer: PHP Commercial |
$508.72
|
| Rate for Payer: PHP Medicare Advantage |
$149.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.02
|
| Rate for Payer: Priority Health HMO/PPO |
$520.70
|
| Rate for Payer: Priority Health Medicare |
$151.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$401.00
|
| Rate for Payer: Railroad Medicare Medicare |
$149.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$526.68
|
| Rate for Payer: UHC Core |
$499.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.62
|
| Rate for Payer: UHC Exchange |
$149.62
|
| Rate for Payer: UHC Medicare Advantage |
$149.62
|
| Rate for Payer: VA VA |
$149.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.88
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
NDC 60687038811
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$4.89
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Commercial |
$5.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$5.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Nomi Health Commercial |
$4.91
|
| Rate for Payer: PHP Commercial |
$5.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.89
|
| Rate for Payer: Priority Health HMO/PPO |
$5.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.27
|
| Rate for Payer: UHC Core |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.49
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$59.50
|
|
|
Service Code
|
NDC 65862067701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.68 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Aetna Commercial |
$50.58
|
| Rate for Payer: BCBS Trust/PPO |
$48.57
|
| Rate for Payer: BCN Commercial |
$45.98
|
| Rate for Payer: Cash Price |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$51.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.60
|
| Rate for Payer: Healthscope Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.58
|
| Rate for Payer: Nomi Health Commercial |
$48.79
|
| Rate for Payer: PHP Commercial |
$50.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.68
|
| Rate for Payer: Priority Health HMO/PPO |
$51.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.36
|
| Rate for Payer: UHC Core |
$49.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.62
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$598.50
|
|
|
Service Code
|
NDC 60687038801
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$389.02 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Aetna Commercial |
$508.72
|
| Rate for Payer: BCBS Trust/PPO |
$488.56
|
| Rate for Payer: BCN Commercial |
$462.52
|
| Rate for Payer: Cash Price |
$478.80
|
| Rate for Payer: Cofinity Commercial |
$514.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.80
|
| Rate for Payer: Healthscope Commercial |
$538.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.72
|
| Rate for Payer: Nomi Health Commercial |
$490.77
|
| Rate for Payer: PHP Commercial |
$508.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.02
|
| Rate for Payer: Priority Health HMO/PPO |
$520.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$401.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$526.68
|
| Rate for Payer: UHC Core |
$499.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.88
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$59.50
|
|
|
Service Code
|
NDC 65862067701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Aetna Commercial |
$50.58
|
| Rate for Payer: Aetna Medicare |
$15.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.59
|
| Rate for Payer: BCBS Complete |
$23.80
|
| Rate for Payer: BCBS MAPPO |
$14.88
|
| Rate for Payer: BCBS Trust/PPO |
$48.91
|
| Rate for Payer: BCN Commercial |
$46.26
|
| Rate for Payer: BCN Medicare Advantage |
$14.88
|
| Rate for Payer: Cash Price |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$51.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.88
|
| Rate for Payer: Healthscope Commercial |
$53.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.58
|
| Rate for Payer: Nomi Health Commercial |
$48.79
|
| Rate for Payer: PACE Senior Care Partners |
$14.13
|
| Rate for Payer: PACE SWMI |
$14.88
|
| Rate for Payer: PHP Commercial |
$50.58
|
| Rate for Payer: PHP Medicare Advantage |
$14.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.68
|
| Rate for Payer: Priority Health HMO/PPO |
$51.76
|
| Rate for Payer: Priority Health Medicare |
$15.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.86
|
| Rate for Payer: Railroad Medicare Medicare |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.36
|
| Rate for Payer: UHC Core |
$49.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.88
|
| Rate for Payer: UHC Exchange |
$14.88
|
| Rate for Payer: UHC Medicare Advantage |
$14.88
|
| Rate for Payer: VA VA |
$14.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.62
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
NDC 60687038811
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$5.39 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.87
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$4.92
|
| Rate for Payer: BCN Commercial |
$4.66
|
| Rate for Payer: BCN Medicare Advantage |
$1.50
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Commercial |
$5.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.50
|
| Rate for Payer: Healthscope Commercial |
$5.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Nomi Health Commercial |
$4.91
|
| Rate for Payer: PACE Senior Care Partners |
$1.42
|
| Rate for Payer: PACE SWMI |
$1.50
|
| Rate for Payer: PHP Commercial |
$5.09
|
| Rate for Payer: PHP Medicare Advantage |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.89
|
| Rate for Payer: Priority Health HMO/PPO |
$5.21
|
| Rate for Payer: Priority Health Medicare |
$1.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.27
|
| Rate for Payer: UHC Core |
$5.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.50
|
| Rate for Payer: UHC Exchange |
$1.50
|
| Rate for Payer: UHC Medicare Advantage |
$1.50
|
| Rate for Payer: VA VA |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.49
|
|
|
ALPRAZOLAM 1 MG TABLET
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
NDC 65862067801
|
| Hospital Charge Code |
326
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Aetna Medicare |
$23.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.91
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: BCBS MAPPO |
$22.32
|
| Rate for Payer: BCBS Trust/PPO |
$73.41
|
| Rate for Payer: BCN Commercial |
$69.43
|
| Rate for Payer: BCN Medicare Advantage |
$22.32
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.90
|
| Rate for Payer: Nomi Health Commercial |
$73.23
|
| Rate for Payer: PACE Senior Care Partners |
$21.21
|
| Rate for Payer: PACE SWMI |
$22.32
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: PHP Medicare Advantage |
$22.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.04
|
| Rate for Payer: Priority Health HMO/PPO |
$77.69
|
| Rate for Payer: Priority Health Medicare |
$22.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.83
|
| Rate for Payer: Railroad Medicare Medicare |
$22.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.58
|
| Rate for Payer: UHC Core |
$74.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.32
|
| Rate for Payer: UHC Exchange |
$22.32
|
| Rate for Payer: UHC Medicare Advantage |
$22.32
|
| Rate for Payer: VA VA |
$22.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.98
|
|
|
ALPRAZOLAM 1 MG TABLET
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 65862067801
|
| Hospital Charge Code |
326
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.04 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: BCBS Trust/PPO |
$72.90
|
| Rate for Payer: BCN Commercial |
$69.01
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.90
|
| Rate for Payer: Nomi Health Commercial |
$73.23
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.04
|
| Rate for Payer: Priority Health HMO/PPO |
$77.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.58
|
| Rate for Payer: UHC Core |
$74.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.98
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,743.40 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: BCBS Trust/PPO |
$23,538.83
|
| Rate for Payer: BCN Commercial |
$22,284.46
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,320.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.14 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$7,497.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,011.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,011.25
|
| Rate for Payer: BCBS Complete |
$69.45
|
| Rate for Payer: BCBS MAPPO |
$7,209.00
|
| Rate for Payer: BCBS Trust/PPO |
$23,706.08
|
| Rate for Payer: BCN Commercial |
$22,419.99
|
| Rate for Payer: BCN Medicare Advantage |
$7,209.00
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,209.00
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Mclaren Medicaid |
$66.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,569.45
|
| Rate for Payer: Meridian Medicaid |
$69.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,290.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: PACE Senior Care Partners |
$6,848.55
|
| Rate for Payer: PACE SWMI |
$7,209.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$7,209.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Medicare |
$7,281.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,320.12
|
| Rate for Payer: Railroad Medicare Medicare |
$7,209.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,209.00
|
| Rate for Payer: UHC Exchange |
$7,209.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,209.00
|
| Rate for Payer: UHCCP Medicaid |
$66.14
|
| Rate for Payer: VA VA |
$7,209.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,743.40 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: BCBS Trust/PPO |
$23,538.83
|
| Rate for Payer: BCN Commercial |
$22,284.46
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,320.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.14 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$7,497.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,011.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,011.25
|
| Rate for Payer: BCBS Complete |
$69.45
|
| Rate for Payer: BCBS MAPPO |
$7,209.00
|
| Rate for Payer: BCBS Trust/PPO |
$23,706.08
|
| Rate for Payer: BCN Commercial |
$22,419.99
|
| Rate for Payer: BCN Medicare Advantage |
$7,209.00
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,209.00
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Mclaren Medicaid |
$66.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,569.45
|
| Rate for Payer: Meridian Medicaid |
$69.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,290.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: PACE Senior Care Partners |
$6,848.55
|
| Rate for Payer: PACE SWMI |
$7,209.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$7,209.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Medicare |
$7,281.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,320.12
|
| Rate for Payer: Railroad Medicare Medicare |
$7,209.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,209.00
|
| Rate for Payer: UHC Exchange |
$7,209.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,209.00
|
| Rate for Payer: UHCCP Medicaid |
$66.14
|
| Rate for Payer: VA VA |
$7,209.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.14 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$7,497.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,011.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,011.25
|
| Rate for Payer: BCBS Complete |
$69.45
|
| Rate for Payer: BCBS MAPPO |
$7,209.00
|
| Rate for Payer: BCBS Trust/PPO |
$23,706.08
|
| Rate for Payer: BCN Commercial |
$22,419.99
|
| Rate for Payer: BCN Medicare Advantage |
$7,209.00
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,209.00
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Mclaren Medicaid |
$66.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,569.45
|
| Rate for Payer: Meridian Medicaid |
$69.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,290.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: PACE Senior Care Partners |
$6,848.55
|
| Rate for Payer: PACE SWMI |
$7,209.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$7,209.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Medicare |
$7,281.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,320.12
|
| Rate for Payer: Railroad Medicare Medicare |
$7,209.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,209.00
|
| Rate for Payer: UHC Exchange |
$7,209.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,209.00
|
| Rate for Payer: UHCCP Medicaid |
$66.14
|
| Rate for Payer: VA VA |
$7,209.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,743.40 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: BCBS Trust/PPO |
$23,538.83
|
| Rate for Payer: BCN Commercial |
$22,284.46
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,320.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
OP
|
$640.92
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.14 |
| Max. Negotiated Rate |
$576.83 |
| Rate for Payer: Aetna Commercial |
$544.78
|
| Rate for Payer: Aetna Medicare |
$166.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$200.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$200.29
|
| Rate for Payer: BCBS Complete |
$69.45
|
| Rate for Payer: BCBS MAPPO |
$160.23
|
| Rate for Payer: BCBS Trust/PPO |
$526.90
|
| Rate for Payer: BCN Commercial |
$498.32
|
| Rate for Payer: BCN Medicare Advantage |
$160.23
|
| Rate for Payer: Cash Price |
$512.74
|
| Rate for Payer: Cash Price |
$512.74
|
| Rate for Payer: Cofinity Commercial |
$551.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.23
|
| Rate for Payer: Healthscope Commercial |
$576.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.69
|
| Rate for Payer: Mclaren Medicaid |
$66.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.24
|
| Rate for Payer: Meridian Medicaid |
$69.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.78
|
| Rate for Payer: Nomi Health Commercial |
$525.55
|
| Rate for Payer: PACE Senior Care Partners |
$152.22
|
| Rate for Payer: PACE SWMI |
$160.23
|
| Rate for Payer: PHP Commercial |
$544.78
|
| Rate for Payer: PHP Medicare Advantage |
$160.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.60
|
| Rate for Payer: Priority Health HMO/PPO |
$557.60
|
| Rate for Payer: Priority Health Medicare |
$161.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.42
|
| Rate for Payer: Railroad Medicare Medicare |
$160.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.01
|
| Rate for Payer: UHC Core |
$535.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.23
|
| Rate for Payer: UHC Exchange |
$160.23
|
| Rate for Payer: UHC Medicare Advantage |
$160.23
|
| Rate for Payer: UHCCP Medicaid |
$66.14
|
| Rate for Payer: VA VA |
$160.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.69
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
IP
|
$640.92
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$576.83 |
| Rate for Payer: Aetna Commercial |
$544.78
|
| Rate for Payer: BCBS Trust/PPO |
$523.18
|
| Rate for Payer: BCN Commercial |
$495.30
|
| Rate for Payer: Cash Price |
$512.74
|
| Rate for Payer: Cofinity Commercial |
$551.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.74
|
| Rate for Payer: Healthscope Commercial |
$576.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.78
|
| Rate for Payer: Nomi Health Commercial |
$525.55
|
| Rate for Payer: PHP Commercial |
$544.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.60
|
| Rate for Payer: Priority Health HMO/PPO |
$557.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.01
|
| Rate for Payer: UHC Core |
$535.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.69
|
|
