|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$20.79
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Aetna Commercial |
$17.67
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$3.85
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.09
|
| Rate for Payer: BCN Commercial |
$17.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.59
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$3.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$17.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.59
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.09
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.47
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.30
|
| Rate for Payer: UHC Core |
$17.36
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicaid |
$3.67
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$3.67
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.59
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$29.26
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: BCBS Trust/PPO |
$24.17
|
| Rate for Payer: BCN Commercial |
$24.17
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Nomi Health Commercial |
$23.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.95
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.75
|
| Rate for Payer: UHC Core |
$24.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.95
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$20.79
|
|
|
Service Code
|
NDC 51672131200
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Aetna Commercial |
$17.67
|
| Rate for Payer: BCBS Trust/PPO |
$17.17
|
| Rate for Payer: BCN Commercial |
$17.17
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Healthscope Commercial |
$18.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$17.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.59
|
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.30
|
| Rate for Payer: UHC Core |
$17.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.59
|
|
|
MUPIROCIN 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$29.26
|
|
|
Service Code
|
NDC 45802011222
|
| Hospital Charge Code |
10674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna Medicare |
$7.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$5.42
|
| Rate for Payer: BCBS MAPPO |
$7.32
|
| Rate for Payer: BCBS Trust/PPO |
$24.05
|
| Rate for Payer: BCN Commercial |
$24.05
|
| Rate for Payer: BCN Medicare Advantage |
$7.32
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.32
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.95
|
| Rate for Payer: Mclaren Medicaid |
$5.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$5.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Nomi Health Commercial |
$23.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.95
|
| Rate for Payer: PACE Senior Care Partners |
$6.95
|
| Rate for Payer: PACE SWMI |
$7.32
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: PHP Medicare Advantage |
$7.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.46
|
| Rate for Payer: Priority Health Medicare |
$7.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.36
|
| Rate for Payer: Railroad Medicare Medicare |
$7.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.75
|
| Rate for Payer: UHC Core |
$24.43
|
| Rate for Payer: UHC Exchange |
$7.32
|
| Rate for Payer: UHC Medicaid |
$5.16
|
| Rate for Payer: UHC Medicare Advantage |
$7.32
|
| Rate for Payer: UHCCP Medicaid |
$5.16
|
| Rate for Payer: VA VA |
$7.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.95
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$31,827.52
|
|
|
Service Code
|
APR-DRG 9124
|
| Min. Negotiated Rate |
$30,311.92 |
| Max. Negotiated Rate |
$31,827.52 |
| Rate for Payer: BCBS Complete |
$31,827.52
|
| Rate for Payer: Mclaren Medicaid |
$30,311.92
|
| Rate for Payer: Meridian Medicaid |
$31,827.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$30,311.92
|
| Rate for Payer: UHC Medicaid |
$30,311.92
|
| Rate for Payer: UHCCP Medicaid |
$30,311.92
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$15,176.27
|
|
|
Service Code
|
APR-DRG 9122
|
| Min. Negotiated Rate |
$14,453.59 |
| Max. Negotiated Rate |
$15,176.27 |
| Rate for Payer: BCBS Complete |
$15,176.27
|
| Rate for Payer: Mclaren Medicaid |
$14,453.59
|
| Rate for Payer: Meridian Medicaid |
$15,176.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,453.59
|
| Rate for Payer: UHC Medicaid |
$14,453.59
|
| Rate for Payer: UHCCP Medicaid |
$14,453.59
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$20,400.49
|
|
|
Service Code
|
APR-DRG 9123
|
| Min. Negotiated Rate |
$19,429.04 |
| Max. Negotiated Rate |
$20,400.49 |
| Rate for Payer: BCBS Complete |
$20,400.49
|
| Rate for Payer: Mclaren Medicaid |
$19,429.04
|
| Rate for Payer: Meridian Medicaid |
$20,400.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,429.04
|
| Rate for Payer: UHC Medicaid |
$19,429.04
|
| Rate for Payer: UHCCP Medicaid |
$19,429.04
|
|
|
MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$11,415.99
|
|
|
Service Code
|
APR-DRG 9121
|
| Min. Negotiated Rate |
$10,872.37 |
| Max. Negotiated Rate |
$11,415.99 |
| Rate for Payer: BCBS Complete |
$11,415.99
|
| Rate for Payer: Mclaren Medicaid |
$10,872.37
|
| Rate for Payer: Meridian Medicaid |
$11,415.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,872.37
|
| Rate for Payer: UHC Medicaid |
$10,872.37
|
| Rate for Payer: UHCCP Medicaid |
$10,872.37
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG
|
Facility
|
IP
|
$9,856.87
|
|
|
Service Code
|
APR-DRG 3433
|
| Min. Negotiated Rate |
$9,387.50 |
| Max. Negotiated Rate |
$9,856.87 |
| Rate for Payer: BCBS Complete |
$9,856.87
|
| Rate for Payer: Mclaren Medicaid |
$9,387.50
|
| Rate for Payer: Meridian Medicaid |
$9,856.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,387.50
|
| Rate for Payer: UHC Medicaid |
$9,387.50
|
| Rate for Payer: UHCCP Medicaid |
$9,387.50
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG
|
Facility
|
IP
|
$5,434.03
|
|
|
Service Code
|
APR-DRG 3431
|
| Min. Negotiated Rate |
$5,175.27 |
| Max. Negotiated Rate |
$5,434.03 |
| Rate for Payer: BCBS Complete |
$5,434.03
|
| Rate for Payer: Mclaren Medicaid |
$5,175.27
|
| Rate for Payer: Meridian Medicaid |
$5,434.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,175.27
|
| Rate for Payer: UHC Medicaid |
$5,175.27
|
| Rate for Payer: UHCCP Medicaid |
$5,175.27
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG
|
Facility
|
IP
|
$15,946.62
|
|
|
Service Code
|
APR-DRG 3434
|
| Min. Negotiated Rate |
$15,187.26 |
| Max. Negotiated Rate |
$15,946.62 |
| Rate for Payer: BCBS Complete |
$15,946.62
|
| Rate for Payer: Mclaren Medicaid |
$15,187.26
|
| Rate for Payer: Meridian Medicaid |
$15,946.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,187.26
|
| Rate for Payer: UHC Medicaid |
$15,187.26
|
| Rate for Payer: UHCCP Medicaid |
$15,187.26
|
|
|
MUSCULOSKELETAL MALIGNANCY AND PATHOLOGICAL FRACTURE DUE TO MUSCULOSKELETAL MALIG
|
Facility
|
IP
|
$6,643.46
|
|
|
Service Code
|
APR-DRG 3432
|
| Min. Negotiated Rate |
$6,327.11 |
| Max. Negotiated Rate |
$6,643.46 |
| Rate for Payer: BCBS Complete |
$6,643.46
|
| Rate for Payer: Mclaren Medicaid |
$6,327.11
|
| Rate for Payer: Meridian Medicaid |
$6,643.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,327.11
|
| Rate for Payer: UHC Medicaid |
$6,327.11
|
| Rate for Payer: UHCCP Medicaid |
$6,327.11
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$42.01
|
|
|
Service Code
|
NDC 54643900701
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$37.81 |
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: BCBS Trust/PPO |
$34.70
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.61
|
| Rate for Payer: Healthscope Commercial |
$37.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.71
|
| Rate for Payer: Nomi Health Commercial |
$34.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.51
|
| Rate for Payer: PHP Commercial |
$35.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.97
|
| Rate for Payer: UHC Core |
$35.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.51
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$291.10
|
|
|
Service Code
|
NDC 54643565002
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$202.61 |
| Max. Negotiated Rate |
$261.99 |
| Rate for Payer: Aetna Commercial |
$247.44
|
| Rate for Payer: BCBS Trust/PPO |
$240.42
|
| Rate for Payer: BCN Commercial |
$240.42
|
| Rate for Payer: Cash Price |
$232.88
|
| Rate for Payer: Cofinity Commercial |
$250.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.88
|
| Rate for Payer: Healthscope Commercial |
$261.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.44
|
| Rate for Payer: Nomi Health Commercial |
$238.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.32
|
| Rate for Payer: PHP Commercial |
$247.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$253.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.17
|
| Rate for Payer: UHC Core |
$243.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.32
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$42.01
|
|
|
Service Code
|
NDC 54643900701
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$37.81 |
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.13
|
| Rate for Payer: BCBS Complete |
$7.78
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$34.54
|
| Rate for Payer: BCN Commercial |
$34.54
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$37.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.51
|
| Rate for Payer: Mclaren Medicaid |
$7.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.03
|
| Rate for Payer: Meridian Medicaid |
$7.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.71
|
| Rate for Payer: Nomi Health Commercial |
$34.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.51
|
| Rate for Payer: PACE Senior Care Partners |
$9.98
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$35.71
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.55
|
| Rate for Payer: Priority Health Medicare |
$10.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.24
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.97
|
| Rate for Payer: UHC Core |
$35.08
|
| Rate for Payer: UHC Exchange |
$10.50
|
| Rate for Payer: UHC Medicaid |
$7.41
|
| Rate for Payer: UHC Medicare Advantage |
$10.50
|
| Rate for Payer: UHCCP Medicaid |
$7.41
|
| Rate for Payer: VA VA |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.51
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$291.10
|
|
|
Service Code
|
NDC 54643565002
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.32 |
| Max. Negotiated Rate |
$261.99 |
| Rate for Payer: Aetna Commercial |
$247.44
|
| Rate for Payer: Aetna Medicare |
$75.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.97
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS MAPPO |
$72.78
|
| Rate for Payer: BCBS Trust/PPO |
$239.31
|
| Rate for Payer: BCN Commercial |
$239.31
|
| Rate for Payer: BCN Medicare Advantage |
$72.78
|
| Rate for Payer: Cash Price |
$232.88
|
| Rate for Payer: Cofinity Commercial |
$250.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.78
|
| Rate for Payer: Healthscope Commercial |
$261.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.32
|
| Rate for Payer: Mclaren Medicaid |
$51.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.41
|
| Rate for Payer: Meridian Medicaid |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.44
|
| Rate for Payer: Nomi Health Commercial |
$238.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.32
|
| Rate for Payer: PACE Senior Care Partners |
$69.14
|
| Rate for Payer: PACE SWMI |
$72.78
|
| Rate for Payer: PHP Commercial |
$247.44
|
| Rate for Payer: PHP Medicare Advantage |
$72.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$253.26
|
| Rate for Payer: Priority Health Medicare |
$73.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.61
|
| Rate for Payer: Railroad Medicare Medicare |
$72.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.17
|
| Rate for Payer: UHC Core |
$243.07
|
| Rate for Payer: UHC Exchange |
$72.78
|
| Rate for Payer: UHC Medicaid |
$51.32
|
| Rate for Payer: UHC Medicare Advantage |
$72.78
|
| Rate for Payer: UHCCP Medicaid |
$51.32
|
| Rate for Payer: VA VA |
$72.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.32
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$42.01
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$37.81 |
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: BCBS Trust/PPO |
$34.70
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.61
|
| Rate for Payer: Healthscope Commercial |
$37.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.71
|
| Rate for Payer: Nomi Health Commercial |
$34.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.51
|
| Rate for Payer: PHP Commercial |
$35.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.97
|
| Rate for Payer: UHC Core |
$35.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.51
|
|
|
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$42.01
|
|
|
Service Code
|
NDC 54643564901
|
| Hospital Charge Code |
161578
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$37.81 |
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.13
|
| Rate for Payer: BCBS Complete |
$7.78
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$34.54
|
| Rate for Payer: BCN Commercial |
$34.54
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$33.61
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$37.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.51
|
| Rate for Payer: Mclaren Medicaid |
$7.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.03
|
| Rate for Payer: Meridian Medicaid |
$7.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.71
|
| Rate for Payer: Nomi Health Commercial |
$34.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.51
|
| Rate for Payer: PACE Senior Care Partners |
$9.98
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$35.71
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.55
|
| Rate for Payer: Priority Health Medicare |
$10.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.24
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.97
|
| Rate for Payer: UHC Core |
$35.08
|
| Rate for Payer: UHC Exchange |
$10.50
|
| Rate for Payer: UHC Medicaid |
$7.41
|
| Rate for Payer: UHC Medicare Advantage |
$10.50
|
| Rate for Payer: UHCCP Medicaid |
$7.41
|
| Rate for Payer: VA VA |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.51
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
OP
|
$370.50
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.32 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Medicare |
$112.42
|
| Rate for Payer: Aetna Medicare |
$96.33
|
| Rate for Payer: Aetna Medicare |
$105.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.12
|
| Rate for Payer: BCBS Complete |
$74.82
|
| Rate for Payer: BCBS Complete |
$68.58
|
| Rate for Payer: BCBS Complete |
$80.04
|
| Rate for Payer: BCBS MAPPO |
$108.10
|
| Rate for Payer: BCBS MAPPO |
$92.62
|
| Rate for Payer: BCBS MAPPO |
$101.05
|
| Rate for Payer: BCBS Trust/PPO |
$304.59
|
| Rate for Payer: BCBS Trust/PPO |
$332.29
|
| Rate for Payer: BCBS Trust/PPO |
$355.48
|
| Rate for Payer: BCN Commercial |
$332.29
|
| Rate for Payer: BCN Commercial |
$355.48
|
| Rate for Payer: BCN Commercial |
$304.59
|
| Rate for Payer: BCN Medicare Advantage |
$108.10
|
| Rate for Payer: BCN Medicare Advantage |
$101.05
|
| Rate for Payer: BCN Medicare Advantage |
$92.62
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.62
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Mclaren Medicaid |
$65.32
|
| Rate for Payer: Mclaren Medicaid |
$76.23
|
| Rate for Payer: Mclaren Medicaid |
$71.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.50
|
| Rate for Payer: Meridian Medicaid |
$80.04
|
| Rate for Payer: Meridian Medicaid |
$68.58
|
| Rate for Payer: Meridian Medicaid |
$74.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Nomi Health Commercial |
$303.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: PACE Senior Care Partners |
$96.00
|
| Rate for Payer: PACE Senior Care Partners |
$87.99
|
| Rate for Payer: PACE Senior Care Partners |
$102.69
|
| Rate for Payer: PACE SWMI |
$108.10
|
| Rate for Payer: PACE SWMI |
$101.05
|
| Rate for Payer: PACE SWMI |
$92.62
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: PHP Medicare Advantage |
$101.05
|
| Rate for Payer: PHP Medicare Advantage |
$92.62
|
| Rate for Payer: PHP Medicare Advantage |
$108.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$322.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$376.19
|
| Rate for Payer: Priority Health Medicare |
$109.18
|
| Rate for Payer: Priority Health Medicare |
$102.06
|
| Rate for Payer: Priority Health Medicare |
$93.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.87
|
| Rate for Payer: Railroad Medicare Medicare |
$101.05
|
| Rate for Payer: Railroad Medicare Medicare |
$108.10
|
| Rate for Payer: Railroad Medicare Medicare |
$92.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.04
|
| Rate for Payer: UHC Core |
$309.37
|
| Rate for Payer: UHC Core |
$361.05
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: UHC Exchange |
$108.10
|
| Rate for Payer: UHC Exchange |
$101.05
|
| Rate for Payer: UHC Exchange |
$92.62
|
| Rate for Payer: UHC Medicaid |
$65.32
|
| Rate for Payer: UHC Medicaid |
$76.23
|
| Rate for Payer: UHC Medicaid |
$71.26
|
| Rate for Payer: UHC Medicare Advantage |
$101.05
|
| Rate for Payer: UHC Medicare Advantage |
$92.62
|
| Rate for Payer: UHC Medicare Advantage |
$108.10
|
| Rate for Payer: UHCCP Medicaid |
$71.26
|
| Rate for Payer: UHCCP Medicaid |
$65.32
|
| Rate for Payer: UHCCP Medicaid |
$76.23
|
| Rate for Payer: VA VA |
$92.62
|
| Rate for Payer: VA VA |
$108.10
|
| Rate for Payer: VA VA |
$101.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
MYCOPHENOLATE MOFETIL 250 MG CAPSULE
|
Facility
|
IP
|
$370.50
|
|
|
Service Code
|
HCPCS J7517
|
| Hospital Charge Code |
15113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$257.87 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna Commercial |
$314.93
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: BCBS Trust/PPO |
$333.83
|
| Rate for Payer: BCBS Trust/PPO |
$306.00
|
| Rate for Payer: BCBS Trust/PPO |
$357.12
|
| Rate for Payer: BCN Commercial |
$333.83
|
| Rate for Payer: BCN Commercial |
$306.00
|
| Rate for Payer: BCN Commercial |
$357.12
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Commercial |
$318.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Healthscope Commercial |
$333.45
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Nomi Health Commercial |
$303.81
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Nomi Health Commercial |
$354.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.30
|
| Rate for Payer: PHP Commercial |
$314.93
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$376.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$322.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.04
|
| Rate for Payer: UHC Core |
$309.37
|
| Rate for Payer: UHC Core |
$361.05
|
| Rate for Payer: UHC Core |
$337.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.81 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Commercial |
$23.56
|
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.89
|
| Rate for Payer: BCBS Trust/PPO |
$76.91
|
| Rate for Payer: BCBS Trust/PPO |
$22.65
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$15.52
|
| Rate for Payer: BCN Commercial |
$22.89
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Commercial |
$15.52
|
| Rate for Payer: BCN Commercial |
$18.29
|
| Rate for Payer: BCN Commercial |
$76.91
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$21.94
|
| Rate for Payer: Cash Price |
$17.72
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$23.84
|
| Rate for Payer: Cofinity Commercial |
$23.58
|
| Rate for Payer: Cofinity Commercial |
$19.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$19.93
|
| Rate for Payer: Healthscope Commercial |
$24.68
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$24.95
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.56
|
| Rate for Payer: Nomi Health Commercial |
$15.41
|
| Rate for Payer: Nomi Health Commercial |
$18.16
|
| Rate for Payer: Nomi Health Commercial |
$22.48
|
| Rate for Payer: Nomi Health Commercial |
$22.73
|
| Rate for Payer: Nomi Health Commercial |
$76.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: PHP Commercial |
$18.83
|
| Rate for Payer: PHP Commercial |
$23.31
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.39
|
| Rate for Payer: UHC Core |
$15.69
|
| Rate for Payer: UHC Core |
$18.50
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: UHC Core |
$77.76
|
| Rate for Payer: UHC Core |
$22.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.79
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: Aetna Commercial |
$23.56
|
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Aetna Medicare |
$24.21
|
| Rate for Payer: Aetna Medicare |
$7.13
|
| Rate for Payer: Aetna Medicare |
$4.89
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.66
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: BCBS Complete |
$3.48
|
| Rate for Payer: BCBS Complete |
$5.08
|
| Rate for Payer: BCBS Complete |
$17.24
|
| Rate for Payer: BCBS Complete |
$5.13
|
| Rate for Payer: BCBS MAPPO |
$23.28
|
| Rate for Payer: BCBS MAPPO |
$5.54
|
| Rate for Payer: BCBS MAPPO |
$4.70
|
| Rate for Payer: BCBS MAPPO |
$6.86
|
| Rate for Payer: BCBS MAPPO |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$22.54
|
| Rate for Payer: BCBS Trust/PPO |
$15.45
|
| Rate for Payer: BCBS Trust/PPO |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$76.55
|
| Rate for Payer: BCBS Trust/PPO |
$22.79
|
| Rate for Payer: BCN Commercial |
$22.54
|
| Rate for Payer: BCN Commercial |
$18.21
|
| Rate for Payer: BCN Commercial |
$15.45
|
| Rate for Payer: BCN Commercial |
$76.55
|
| Rate for Payer: BCN Commercial |
$22.79
|
| Rate for Payer: BCN Medicare Advantage |
$23.28
|
| Rate for Payer: BCN Medicare Advantage |
$6.93
|
| Rate for Payer: BCN Medicare Advantage |
$6.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.54
|
| Rate for Payer: BCN Medicare Advantage |
$4.70
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cash Price |
$17.72
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cash Price |
$21.94
|
| Rate for Payer: Cofinity Commercial |
$23.84
|
| Rate for Payer: Cofinity Commercial |
$23.58
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Cofinity Commercial |
$19.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Healthscope Commercial |
$24.95
|
| Rate for Payer: Healthscope Commercial |
$19.93
|
| Rate for Payer: Healthscope Commercial |
$24.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.57
|
| Rate for Payer: Mclaren Medicaid |
$3.91
|
| Rate for Payer: Mclaren Medicaid |
$4.89
|
| Rate for Payer: Mclaren Medicaid |
$4.83
|
| Rate for Payer: Mclaren Medicaid |
$16.42
|
| Rate for Payer: Mclaren Medicaid |
$3.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.20
|
| Rate for Payer: Meridian Medicaid |
$4.10
|
| Rate for Payer: Meridian Medicaid |
$3.48
|
| Rate for Payer: Meridian Medicaid |
$5.08
|
| Rate for Payer: Meridian Medicaid |
$5.13
|
| Rate for Payer: Meridian Medicaid |
$17.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: Nomi Health Commercial |
$76.36
|
| Rate for Payer: Nomi Health Commercial |
$22.48
|
| Rate for Payer: Nomi Health Commercial |
$22.73
|
| Rate for Payer: Nomi Health Commercial |
$15.41
|
| Rate for Payer: Nomi Health Commercial |
$18.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.84
|
| Rate for Payer: PACE Senior Care Partners |
$4.46
|
| Rate for Payer: PACE Senior Care Partners |
$5.26
|
| Rate for Payer: PACE Senior Care Partners |
$22.12
|
| Rate for Payer: PACE Senior Care Partners |
$6.58
|
| Rate for Payer: PACE Senior Care Partners |
$6.51
|
| Rate for Payer: PACE SWMI |
$4.70
|
| Rate for Payer: PACE SWMI |
$5.54
|
| Rate for Payer: PACE SWMI |
$6.86
|
| Rate for Payer: PACE SWMI |
$6.93
|
| Rate for Payer: PACE SWMI |
$23.28
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: PHP Commercial |
$23.31
|
| Rate for Payer: PHP Commercial |
$18.83
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Medicare Advantage |
$5.54
|
| Rate for Payer: PHP Medicare Advantage |
$23.28
|
| Rate for Payer: PHP Medicare Advantage |
$4.70
|
| Rate for Payer: PHP Medicare Advantage |
$6.93
|
| Rate for Payer: PHP Medicare Advantage |
$6.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.27
|
| Rate for Payer: Priority Health Medicare |
$5.59
|
| Rate for Payer: Priority Health Medicare |
$23.51
|
| Rate for Payer: Priority Health Medicare |
$4.74
|
| Rate for Payer: Priority Health Medicare |
$7.00
|
| Rate for Payer: Priority Health Medicare |
$6.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.08
|
| Rate for Payer: Railroad Medicare Medicare |
$23.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.93
|
| Rate for Payer: Railroad Medicare Medicare |
$6.86
|
| Rate for Payer: Railroad Medicare Medicare |
$4.70
|
| Rate for Payer: Railroad Medicare Medicare |
$5.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.95
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: UHC Core |
$15.69
|
| Rate for Payer: UHC Core |
$77.76
|
| Rate for Payer: UHC Core |
$22.90
|
| Rate for Payer: UHC Core |
$18.50
|
| Rate for Payer: UHC Exchange |
$4.70
|
| Rate for Payer: UHC Exchange |
$6.93
|
| Rate for Payer: UHC Exchange |
$5.54
|
| Rate for Payer: UHC Exchange |
$23.28
|
| Rate for Payer: UHC Exchange |
$6.86
|
| Rate for Payer: UHC Medicaid |
$16.42
|
| Rate for Payer: UHC Medicaid |
$4.89
|
| Rate for Payer: UHC Medicaid |
$3.91
|
| Rate for Payer: UHC Medicaid |
$4.83
|
| Rate for Payer: UHC Medicaid |
$3.31
|
| Rate for Payer: UHC Medicare Advantage |
$6.86
|
| Rate for Payer: UHC Medicare Advantage |
$4.70
|
| Rate for Payer: UHC Medicare Advantage |
$23.28
|
| Rate for Payer: UHC Medicare Advantage |
$5.54
|
| Rate for Payer: UHC Medicare Advantage |
$6.93
|
| Rate for Payer: UHCCP Medicaid |
$4.89
|
| Rate for Payer: UHCCP Medicaid |
$16.42
|
| Rate for Payer: UHCCP Medicaid |
$4.83
|
| Rate for Payer: UHCCP Medicaid |
$3.31
|
| Rate for Payer: UHCCP Medicaid |
$3.91
|
| Rate for Payer: VA VA |
$23.28
|
| Rate for Payer: VA VA |
$4.70
|
| Rate for Payer: VA VA |
$6.93
|
| Rate for Payer: VA VA |
$5.54
|
| Rate for Payer: VA VA |
$6.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.09
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$18.79
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$16.91 |
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: BCBS Trust/PPO |
$15.52
|
| Rate for Payer: BCN Commercial |
$15.52
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Nomi Health Commercial |
$15.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.09
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.54
|
| Rate for Payer: UHC Core |
$15.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.09
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$18.79
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$16.91 |
| Rate for Payer: Aetna Commercial |
$15.97
|
| Rate for Payer: Aetna Medicare |
$4.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.87
|
| Rate for Payer: BCBS Complete |
$3.48
|
| Rate for Payer: BCBS MAPPO |
$4.70
|
| Rate for Payer: BCBS Trust/PPO |
$15.45
|
| Rate for Payer: BCN Commercial |
$15.45
|
| Rate for Payer: BCN Medicare Advantage |
$4.70
|
| Rate for Payer: Cash Price |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$16.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.09
|
| Rate for Payer: Mclaren Medicaid |
$3.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.93
|
| Rate for Payer: Meridian Medicaid |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.97
|
| Rate for Payer: Nomi Health Commercial |
$15.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.09
|
| Rate for Payer: PACE Senior Care Partners |
$4.46
|
| Rate for Payer: PACE SWMI |
$4.70
|
| Rate for Payer: PHP Commercial |
$15.97
|
| Rate for Payer: PHP Medicare Advantage |
$4.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.35
|
| Rate for Payer: Priority Health Medicare |
$4.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.08
|
| Rate for Payer: Railroad Medicare Medicare |
$4.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.54
|
| Rate for Payer: UHC Core |
$15.69
|
| Rate for Payer: UHC Exchange |
$4.70
|
| Rate for Payer: UHC Medicaid |
$3.31
|
| Rate for Payer: UHC Medicare Advantage |
$4.70
|
| Rate for Payer: UHCCP Medicaid |
$3.31
|
| Rate for Payer: VA VA |
$4.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.09
|
|
|
NALOXEGOL 12.5 MG TABLET
|
Facility
|
IP
|
$1,576.76
|
|
|
Service Code
|
NDC 82625880101
|
| Hospital Charge Code |
173967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,097.42 |
| Max. Negotiated Rate |
$1,419.08 |
| Rate for Payer: Aetna Commercial |
$1,340.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,302.25
|
| Rate for Payer: BCN Commercial |
$1,302.25
|
| Rate for Payer: Cash Price |
$1,261.41
|
| Rate for Payer: Cofinity Commercial |
$1,356.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.41
|
| Rate for Payer: Healthscope Commercial |
$1,419.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,182.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.25
|
| Rate for Payer: Nomi Health Commercial |
$1,292.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.57
|
| Rate for Payer: PHP Commercial |
$1,340.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,371.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,097.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,387.55
|
| Rate for Payer: UHC Core |
$1,316.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,182.57
|
|
