|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$103.47
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.26 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: BCBS Trust/PPO |
$84.46
|
| Rate for Payer: BCN Commercial |
$79.96
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.26
|
| Rate for Payer: Priority Health HMO/PPO |
$90.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.05
|
| Rate for Payer: UHC Core |
$86.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$103.47
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.33
|
| Rate for Payer: BCBS Complete |
$41.39
|
| Rate for Payer: BCBS MAPPO |
$25.87
|
| Rate for Payer: BCBS Trust/PPO |
$85.06
|
| Rate for Payer: BCN Commercial |
$80.45
|
| Rate for Payer: BCN Medicare Advantage |
$25.87
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.87
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: PACE Senior Care Partners |
$24.57
|
| Rate for Payer: PACE SWMI |
$25.87
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Medicare Advantage |
$25.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.26
|
| Rate for Payer: Priority Health HMO/PPO |
$90.02
|
| Rate for Payer: Priority Health Medicare |
$26.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.32
|
| Rate for Payer: Railroad Medicare Medicare |
$25.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.05
|
| Rate for Payer: UHC Core |
$86.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.87
|
| Rate for Payer: UHC Exchange |
$25.87
|
| Rate for Payer: UHC Medicare Advantage |
$25.87
|
| Rate for Payer: VA VA |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$153.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.46 |
| Max. Negotiated Rate |
$138.18 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Medicare |
$39.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.98
|
| Rate for Payer: BCBS Complete |
$61.41
|
| Rate for Payer: BCBS MAPPO |
$38.38
|
| Rate for Payer: BCBS Trust/PPO |
$126.22
|
| Rate for Payer: BCN Commercial |
$119.37
|
| Rate for Payer: BCN Medicare Advantage |
$38.38
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.38
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: Nomi Health Commercial |
$125.89
|
| Rate for Payer: PACE Senior Care Partners |
$36.46
|
| Rate for Payer: PACE SWMI |
$38.38
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: PHP Medicare Advantage |
$38.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health HMO/PPO |
$133.57
|
| Rate for Payer: Priority Health Medicare |
$38.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.87
|
| Rate for Payer: Railroad Medicare Medicare |
$38.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.11
|
| Rate for Payer: UHC Core |
$128.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.38
|
| Rate for Payer: UHC Exchange |
$38.38
|
| Rate for Payer: UHC Medicare Advantage |
$38.38
|
| Rate for Payer: VA VA |
$38.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.15
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$153.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.79 |
| Max. Negotiated Rate |
$138.18 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: BCBS Trust/PPO |
$125.33
|
| Rate for Payer: BCN Commercial |
$118.65
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: Nomi Health Commercial |
$125.89
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health HMO/PPO |
$133.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.11
|
| Rate for Payer: UHC Core |
$128.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.15
|
|
|
BIOPSY, MUSCLE; SUPERFICIAL
|
Facility
|
OP
|
$1,230.09
|
|
|
Service Code
|
CPT 20200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,171.43 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
|
|
BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION
|
Facility
|
OP
|
$661.07
|
|
|
Service Code
|
CPT 56605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$629.55 |
| Max. Negotiated Rate |
$661.07 |
| Rate for Payer: BCBS Complete |
$661.07
|
| Rate for Payer: Mclaren Medicaid |
$629.55
|
| Rate for Payer: Meridian Medicaid |
$661.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$629.55
|
| Rate for Payer: UHCCP Medicaid |
$629.55
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)
|
Facility
|
OP
|
$2,907.19
|
|
|
Service Code
|
CPT 38510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,768.57 |
| Max. Negotiated Rate |
$2,907.19 |
| Rate for Payer: BCBS Complete |
$2,907.19
|
| Rate for Payer: Mclaren Medicaid |
$2,768.57
|
| Rate for Payer: Meridian Medicaid |
$2,907.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,768.57
|
| Rate for Payer: UHCCP Medicaid |
$2,768.57
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL
|
Facility
|
OP
|
$2,907.19
|
|
|
Service Code
|
CPT 38500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,768.57 |
| Max. Negotiated Rate |
$2,907.19 |
| Rate for Payer: BCBS Complete |
$2,907.19
|
| Rate for Payer: Mclaren Medicaid |
$2,768.57
|
| Rate for Payer: Meridian Medicaid |
$2,907.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,768.57
|
| Rate for Payer: UHCCP Medicaid |
$2,768.57
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$25.88
|
|
|
Service Code
|
NDC 00574705012
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.15 |
| Max. Negotiated Rate |
$23.29 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.28
|
| Rate for Payer: BCN Commercial |
$20.12
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$22.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.00
|
| Rate for Payer: Nomi Health Commercial |
$21.22
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.00
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health HMO/PPO |
$22.52
|
| Rate for Payer: Priority Health Medicare |
$6.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.77
|
| Rate for Payer: UHC Core |
$21.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.41
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$38.42
|
|
|
Service Code
|
NDC 00904714212
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$34.58 |
| Rate for Payer: Aetna Commercial |
$32.66
|
| Rate for Payer: Aetna Medicare |
$9.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.01
|
| Rate for Payer: BCBS Complete |
$15.37
|
| Rate for Payer: BCBS MAPPO |
$9.61
|
| Rate for Payer: BCBS Trust/PPO |
$31.59
|
| Rate for Payer: BCN Commercial |
$29.87
|
| Rate for Payer: BCN Medicare Advantage |
$9.61
|
| Rate for Payer: Cash Price |
$30.74
|
| Rate for Payer: Cofinity Commercial |
$33.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.61
|
| Rate for Payer: Healthscope Commercial |
$34.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.66
|
| Rate for Payer: Nomi Health Commercial |
$31.50
|
| Rate for Payer: PACE Senior Care Partners |
$9.12
|
| Rate for Payer: PACE SWMI |
$9.61
|
| Rate for Payer: PHP Commercial |
$32.66
|
| Rate for Payer: PHP Medicare Advantage |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.97
|
| Rate for Payer: Priority Health HMO/PPO |
$33.43
|
| Rate for Payer: Priority Health Medicare |
$9.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.74
|
| Rate for Payer: Railroad Medicare Medicare |
$9.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.81
|
| Rate for Payer: UHC Core |
$32.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.61
|
| Rate for Payer: UHC Exchange |
$9.61
|
| Rate for Payer: UHC Medicare Advantage |
$9.61
|
| Rate for Payer: VA VA |
$9.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.82
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$124.06
|
|
|
Service Code
|
NDC 81421002105
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.64 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: BCBS Trust/PPO |
$101.27
|
| Rate for Payer: BCN Commercial |
$95.87
|
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Cofinity Commercial |
$106.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.25
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.45
|
| Rate for Payer: Nomi Health Commercial |
$101.73
|
| Rate for Payer: PHP Commercial |
$105.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.64
|
| Rate for Payer: Priority Health HMO/PPO |
$107.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.17
|
| Rate for Payer: UHC Core |
$103.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.05
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$38.42
|
|
|
Service Code
|
NDC 00904714212
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$34.58 |
| Rate for Payer: Aetna Commercial |
$32.66
|
| Rate for Payer: BCBS Trust/PPO |
$31.36
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: Cash Price |
$30.74
|
| Rate for Payer: Cofinity Commercial |
$33.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.74
|
| Rate for Payer: Healthscope Commercial |
$34.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.66
|
| Rate for Payer: Nomi Health Commercial |
$31.50
|
| Rate for Payer: PHP Commercial |
$32.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.97
|
| Rate for Payer: Priority Health HMO/PPO |
$33.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.81
|
| Rate for Payer: UHC Core |
$32.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.82
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$25.88
|
|
|
Service Code
|
NDC 00574705012
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$23.29 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: BCN Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$22.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Healthscope Commercial |
$23.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.00
|
| Rate for Payer: Nomi Health Commercial |
$21.22
|
| Rate for Payer: PHP Commercial |
$22.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health HMO/PPO |
$22.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.77
|
| Rate for Payer: UHC Core |
$21.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.41
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$124.06
|
|
|
Service Code
|
NDC 81421002105
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.46 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Medicare |
$32.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.77
|
| Rate for Payer: BCBS Complete |
$49.62
|
| Rate for Payer: BCBS MAPPO |
$31.02
|
| Rate for Payer: BCBS Trust/PPO |
$101.99
|
| Rate for Payer: BCN Commercial |
$96.46
|
| Rate for Payer: BCN Medicare Advantage |
$31.02
|
| Rate for Payer: Cash Price |
$99.25
|
| Rate for Payer: Cofinity Commercial |
$106.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.02
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.45
|
| Rate for Payer: Nomi Health Commercial |
$101.73
|
| Rate for Payer: PACE Senior Care Partners |
$29.46
|
| Rate for Payer: PACE SWMI |
$31.02
|
| Rate for Payer: PHP Commercial |
$105.45
|
| Rate for Payer: PHP Medicare Advantage |
$31.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.64
|
| Rate for Payer: Priority Health HMO/PPO |
$107.93
|
| Rate for Payer: Priority Health Medicare |
$31.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.12
|
| Rate for Payer: Railroad Medicare Medicare |
$31.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.17
|
| Rate for Payer: UHC Core |
$103.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.02
|
| Rate for Payer: UHC Exchange |
$31.02
|
| Rate for Payer: UHC Medicare Advantage |
$31.02
|
| Rate for Payer: VA VA |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.05
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$5.88
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$4.80
|
| Rate for Payer: BCN Commercial |
$4.54
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$5.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.00
|
| Rate for Payer: Nomi Health Commercial |
$4.82
|
| Rate for Payer: PHP Commercial |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.82
|
| Rate for Payer: Priority Health HMO/PPO |
$5.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.17
|
| Rate for Payer: UHC Core |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.41
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$5.88
|
|
|
Service Code
|
NDC 00904640761
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: Aetna Medicare |
$1.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.84
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$4.83
|
| Rate for Payer: BCN Commercial |
$4.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.47
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.47
|
| Rate for Payer: Healthscope Commercial |
$5.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.00
|
| Rate for Payer: Nomi Health Commercial |
$4.82
|
| Rate for Payer: PACE Senior Care Partners |
$1.40
|
| Rate for Payer: PACE SWMI |
$1.47
|
| Rate for Payer: PHP Commercial |
$5.00
|
| Rate for Payer: PHP Medicare Advantage |
$1.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.82
|
| Rate for Payer: Priority Health HMO/PPO |
$5.12
|
| Rate for Payer: Priority Health Medicare |
$1.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.17
|
| Rate for Payer: UHC Core |
$4.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.47
|
| Rate for Payer: UHC Exchange |
$1.47
|
| Rate for Payer: UHC Medicare Advantage |
$1.47
|
| Rate for Payer: VA VA |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.41
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$173.96
|
|
|
Service Code
|
NDC 60687067921
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.32 |
| Max. Negotiated Rate |
$156.56 |
| Rate for Payer: Aetna Commercial |
$147.87
|
| Rate for Payer: Aetna Medicare |
$45.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.36
|
| Rate for Payer: BCBS Complete |
$69.58
|
| Rate for Payer: BCBS MAPPO |
$43.49
|
| Rate for Payer: BCBS Trust/PPO |
$143.01
|
| Rate for Payer: BCN Commercial |
$135.25
|
| Rate for Payer: BCN Medicare Advantage |
$43.49
|
| Rate for Payer: Cash Price |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$149.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.49
|
| Rate for Payer: Healthscope Commercial |
$156.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.87
|
| Rate for Payer: Nomi Health Commercial |
$142.65
|
| Rate for Payer: PACE Senior Care Partners |
$41.32
|
| Rate for Payer: PACE SWMI |
$43.49
|
| Rate for Payer: PHP Commercial |
$147.87
|
| Rate for Payer: PHP Medicare Advantage |
$43.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.07
|
| Rate for Payer: Priority Health HMO/PPO |
$151.35
|
| Rate for Payer: Priority Health Medicare |
$43.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.55
|
| Rate for Payer: Railroad Medicare Medicare |
$43.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.08
|
| Rate for Payer: UHC Core |
$145.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.49
|
| Rate for Payer: UHC Exchange |
$43.49
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: VA VA |
$43.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.47
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$5.80
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.81
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS MAPPO |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.77
|
| Rate for Payer: BCN Commercial |
$4.51
|
| Rate for Payer: BCN Medicare Advantage |
$1.45
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: PACE Senior Care Partners |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.45
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: PHP Medicare Advantage |
$1.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Medicare |
$1.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.10
|
| Rate for Payer: UHC Core |
$4.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.45
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UHC Medicare Advantage |
$1.45
|
| Rate for Payer: VA VA |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$5.80
|
|
|
Service Code
|
NDC 60687067911
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: BCBS Trust/PPO |
$4.73
|
| Rate for Payer: BCN Commercial |
$4.48
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.77
|
| Rate for Payer: Priority Health HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.10
|
| Rate for Payer: UHC Core |
$4.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$75.81
|
|
|
Service Code
|
NDC 29300012613
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$68.23 |
| Rate for Payer: Aetna Commercial |
$64.44
|
| Rate for Payer: Aetna Medicare |
$19.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.69
|
| Rate for Payer: BCBS Complete |
$30.32
|
| Rate for Payer: BCBS MAPPO |
$18.95
|
| Rate for Payer: BCBS Trust/PPO |
$62.32
|
| Rate for Payer: BCN Commercial |
$58.94
|
| Rate for Payer: BCN Medicare Advantage |
$18.95
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.95
|
| Rate for Payer: Healthscope Commercial |
$68.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.44
|
| Rate for Payer: Nomi Health Commercial |
$62.16
|
| Rate for Payer: PACE Senior Care Partners |
$18.00
|
| Rate for Payer: PACE SWMI |
$18.95
|
| Rate for Payer: PHP Commercial |
$64.44
|
| Rate for Payer: PHP Medicare Advantage |
$18.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.28
|
| Rate for Payer: Priority Health HMO/PPO |
$65.95
|
| Rate for Payer: Priority Health Medicare |
$19.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.79
|
| Rate for Payer: Railroad Medicare Medicare |
$18.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.71
|
| Rate for Payer: UHC Core |
$63.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.95
|
| Rate for Payer: UHC Exchange |
$18.95
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.86
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$75.81
|
|
|
Service Code
|
NDC 29300012613
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.28 |
| Max. Negotiated Rate |
$68.23 |
| Rate for Payer: Aetna Commercial |
$64.44
|
| Rate for Payer: BCBS Trust/PPO |
$61.88
|
| Rate for Payer: BCN Commercial |
$58.59
|
| Rate for Payer: Cash Price |
$60.65
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.65
|
| Rate for Payer: Healthscope Commercial |
$68.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.44
|
| Rate for Payer: Nomi Health Commercial |
$62.16
|
| Rate for Payer: PHP Commercial |
$64.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.28
|
| Rate for Payer: Priority Health HMO/PPO |
$65.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.71
|
| Rate for Payer: UHC Core |
$63.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.86
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$124.79
|
|
|
Service Code
|
NDC 52817027030
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.11 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Aetna Commercial |
$106.07
|
| Rate for Payer: BCBS Trust/PPO |
$101.87
|
| Rate for Payer: BCN Commercial |
$96.44
|
| Rate for Payer: Cash Price |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.83
|
| Rate for Payer: Healthscope Commercial |
$112.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.07
|
| Rate for Payer: Nomi Health Commercial |
$102.33
|
| Rate for Payer: PHP Commercial |
$106.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.11
|
| Rate for Payer: Priority Health HMO/PPO |
$108.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.82
|
| Rate for Payer: UHC Core |
$104.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.59
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$173.96
|
|
|
Service Code
|
NDC 60687067921
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.07 |
| Max. Negotiated Rate |
$156.56 |
| Rate for Payer: Aetna Commercial |
$147.87
|
| Rate for Payer: BCBS Trust/PPO |
$142.00
|
| Rate for Payer: BCN Commercial |
$134.44
|
| Rate for Payer: Cash Price |
$139.17
|
| Rate for Payer: Cofinity Commercial |
$149.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.17
|
| Rate for Payer: Healthscope Commercial |
$156.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.87
|
| Rate for Payer: Nomi Health Commercial |
$142.65
|
| Rate for Payer: PHP Commercial |
$147.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.07
|
| Rate for Payer: Priority Health HMO/PPO |
$151.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.08
|
| Rate for Payer: UHC Core |
$145.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.47
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$124.79
|
|
|
Service Code
|
NDC 52817027030
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Aetna Commercial |
$106.07
|
| Rate for Payer: Aetna Medicare |
$32.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.00
|
| Rate for Payer: BCBS Complete |
$49.92
|
| Rate for Payer: BCBS MAPPO |
$31.20
|
| Rate for Payer: BCBS Trust/PPO |
$102.59
|
| Rate for Payer: BCN Commercial |
$97.02
|
| Rate for Payer: BCN Medicare Advantage |
$31.20
|
| Rate for Payer: Cash Price |
$99.83
|
| Rate for Payer: Cofinity Commercial |
$107.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$112.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.07
|
| Rate for Payer: Nomi Health Commercial |
$102.33
|
| Rate for Payer: PACE Senior Care Partners |
$29.64
|
| Rate for Payer: PACE SWMI |
$31.20
|
| Rate for Payer: PHP Commercial |
$106.07
|
| Rate for Payer: PHP Medicare Advantage |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.11
|
| Rate for Payer: Priority Health HMO/PPO |
$108.57
|
| Rate for Payer: Priority Health Medicare |
$31.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.61
|
| Rate for Payer: Railroad Medicare Medicare |
$31.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.82
|
| Rate for Payer: UHC Core |
$104.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.20
|
| Rate for Payer: UHC Exchange |
$31.20
|
| Rate for Payer: UHC Medicare Advantage |
$31.20
|
| Rate for Payer: VA VA |
$31.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.59
|
|
|
BREAST REDUCTION
|
Facility
|
OP
|
$4,951.09
|
|
|
Service Code
|
CPT 19318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,715.02 |
| Max. Negotiated Rate |
$4,951.09 |
| Rate for Payer: BCBS Complete |
$4,951.09
|
| Rate for Payer: Mclaren Medicaid |
$4,715.02
|
| Rate for Payer: Meridian Medicaid |
$4,951.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,715.02
|
| Rate for Payer: UHCCP Medicaid |
$4,715.02
|
|
