|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$381.90
|
|
|
Service Code
|
NDC 51079011820
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.80 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: BCBS Trust/PPO |
$315.41
|
| Rate for Payer: BCN Commercial |
$315.41
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Nomi Health Commercial |
$313.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.43
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$332.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.07
|
| Rate for Payer: UHC Core |
$318.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.43
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$381.90
|
|
|
Service Code
|
NDC 51079011820
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.33 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna Medicare |
$99.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.34
|
| Rate for Payer: BCBS Complete |
$70.69
|
| Rate for Payer: BCBS MAPPO |
$95.47
|
| Rate for Payer: BCBS Trust/PPO |
$313.96
|
| Rate for Payer: BCN Commercial |
$313.96
|
| Rate for Payer: BCN Medicare Advantage |
$95.47
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.47
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.43
|
| Rate for Payer: Mclaren Medicaid |
$67.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.25
|
| Rate for Payer: Meridian Medicaid |
$70.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Nomi Health Commercial |
$313.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.43
|
| Rate for Payer: PACE Senior Care Partners |
$90.70
|
| Rate for Payer: PACE SWMI |
$95.47
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: PHP Medicare Advantage |
$95.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$332.25
|
| Rate for Payer: Priority Health Medicare |
$96.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.80
|
| Rate for Payer: Railroad Medicare Medicare |
$95.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.07
|
| Rate for Payer: UHC Core |
$318.89
|
| Rate for Payer: UHC Exchange |
$95.47
|
| Rate for Payer: UHC Medicaid |
$67.33
|
| Rate for Payer: UHC Medicare Advantage |
$95.47
|
| Rate for Payer: UHCCP Medicaid |
$67.33
|
| Rate for Payer: VA VA |
$95.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.43
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$458.85
|
|
|
Service Code
|
NDC 60687036901
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$319.36 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna Commercial |
$390.02
|
| Rate for Payer: BCBS Trust/PPO |
$378.96
|
| Rate for Payer: BCN Commercial |
$378.96
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Commercial |
$394.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Healthscope Commercial |
$412.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Nomi Health Commercial |
$376.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.14
|
| Rate for Payer: PHP Commercial |
$390.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$399.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.79
|
| Rate for Payer: UHC Core |
$383.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.14
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$458.85
|
|
|
Service Code
|
NDC 60687036901
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.90 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna Commercial |
$390.02
|
| Rate for Payer: Aetna Medicare |
$119.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.39
|
| Rate for Payer: BCBS Complete |
$84.93
|
| Rate for Payer: BCBS MAPPO |
$114.71
|
| Rate for Payer: BCBS Trust/PPO |
$377.22
|
| Rate for Payer: BCN Commercial |
$377.22
|
| Rate for Payer: BCN Medicare Advantage |
$114.71
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Commercial |
$394.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.71
|
| Rate for Payer: Healthscope Commercial |
$412.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.14
|
| Rate for Payer: Mclaren Medicaid |
$80.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.45
|
| Rate for Payer: Meridian Medicaid |
$84.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$126.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Nomi Health Commercial |
$376.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.14
|
| Rate for Payer: PACE Senior Care Partners |
$108.98
|
| Rate for Payer: PACE SWMI |
$114.71
|
| Rate for Payer: PHP Commercial |
$390.02
|
| Rate for Payer: PHP Medicare Advantage |
$114.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$399.20
|
| Rate for Payer: Priority Health Medicare |
$115.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.36
|
| Rate for Payer: Railroad Medicare Medicare |
$114.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.79
|
| Rate for Payer: UHC Core |
$383.14
|
| Rate for Payer: UHC Exchange |
$114.71
|
| Rate for Payer: UHC Medicaid |
$80.90
|
| Rate for Payer: UHC Medicare Advantage |
$114.71
|
| Rate for Payer: UHCCP Medicaid |
$80.90
|
| Rate for Payer: VA VA |
$114.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.14
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 51079011801
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.19
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: BCBS MAPPO |
$0.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.14
|
| Rate for Payer: BCN Commercial |
$3.14
|
| Rate for Payer: BCN Medicare Advantage |
$0.96
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.96
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Mclaren Medicaid |
$0.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.00
|
| Rate for Payer: Meridian Medicaid |
$0.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PACE Senior Care Partners |
$0.91
|
| Rate for Payer: PACE SWMI |
$0.96
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: PHP Medicare Advantage |
$0.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.32
|
| Rate for Payer: Priority Health Medicare |
$0.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.66
|
| Rate for Payer: Railroad Medicare Medicare |
$0.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.36
|
| Rate for Payer: UHC Core |
$3.19
|
| Rate for Payer: UHC Exchange |
$0.96
|
| Rate for Payer: UHC Medicaid |
$0.67
|
| Rate for Payer: UHC Medicare Advantage |
$0.96
|
| Rate for Payer: UHCCP Medicaid |
$0.67
|
| Rate for Payer: VA VA |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 60687036911
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.79
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$417.05
|
|
|
Service Code
|
NDC 00904698761
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.53 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: Aetna Medicare |
$108.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.33
|
| Rate for Payer: BCBS Complete |
$77.20
|
| Rate for Payer: BCBS MAPPO |
$104.26
|
| Rate for Payer: BCBS Trust/PPO |
$342.86
|
| Rate for Payer: BCN Commercial |
$342.86
|
| Rate for Payer: BCN Medicare Advantage |
$104.26
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.26
|
| Rate for Payer: Healthscope Commercial |
$375.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Mclaren Medicaid |
$73.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.48
|
| Rate for Payer: Meridian Medicaid |
$77.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: PACE Senior Care Partners |
$99.05
|
| Rate for Payer: PACE SWMI |
$104.26
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: PHP Medicare Advantage |
$104.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$362.83
|
| Rate for Payer: Priority Health Medicare |
$105.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.27
|
| Rate for Payer: Railroad Medicare Medicare |
$104.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.00
|
| Rate for Payer: UHC Core |
$348.24
|
| Rate for Payer: UHC Exchange |
$104.26
|
| Rate for Payer: UHC Medicaid |
$73.53
|
| Rate for Payer: UHC Medicare Advantage |
$104.26
|
| Rate for Payer: UHCCP Medicaid |
$73.53
|
| Rate for Payer: VA VA |
$104.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 51079011801
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.36
|
| Rate for Payer: UHC Core |
$3.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$417.05
|
|
|
Service Code
|
NDC 00904698761
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.27 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: BCBS Trust/PPO |
$344.44
|
| Rate for Payer: BCN Commercial |
$344.44
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$375.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$362.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.00
|
| Rate for Payer: UHC Core |
$348.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$154.86
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$139.37 |
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Commercial |
$23.39
|
| Rate for Payer: Aetna Commercial |
$235.89
|
| Rate for Payer: BCBS Trust/PPO |
$22.73
|
| Rate for Payer: BCBS Trust/PPO |
$127.90
|
| Rate for Payer: BCBS Trust/PPO |
$229.20
|
| Rate for Payer: BCN Commercial |
$22.73
|
| Rate for Payer: BCN Commercial |
$127.90
|
| Rate for Payer: BCN Commercial |
$229.20
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Commercial |
$238.67
|
| Rate for Payer: Cofinity Commercial |
$23.67
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Healthscope Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$249.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: Nomi Health Commercial |
$126.99
|
| Rate for Payer: Nomi Health Commercial |
$22.57
|
| Rate for Payer: Nomi Health Commercial |
$227.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.14
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Commercial |
$235.89
|
| Rate for Payer: PHP Commercial |
$23.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.28
|
| Rate for Payer: UHC Core |
$129.31
|
| Rate for Payer: UHC Core |
$231.73
|
| Rate for Payer: UHC Core |
$22.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.64
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$154.86
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$139.37 |
| Rate for Payer: Aetna Commercial |
$131.63
|
| Rate for Payer: Aetna Commercial |
$235.89
|
| Rate for Payer: Aetna Commercial |
$23.39
|
| Rate for Payer: Aetna Medicare |
$72.16
|
| Rate for Payer: Aetna Medicare |
$40.26
|
| Rate for Payer: Aetna Medicare |
$7.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.72
|
| Rate for Payer: BCBS Complete |
$5.09
|
| Rate for Payer: BCBS Complete |
$28.66
|
| Rate for Payer: BCBS Complete |
$51.37
|
| Rate for Payer: BCBS MAPPO |
$69.38
|
| Rate for Payer: BCBS MAPPO |
$38.72
|
| Rate for Payer: BCBS MAPPO |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$127.31
|
| Rate for Payer: BCBS Trust/PPO |
$22.62
|
| Rate for Payer: BCBS Trust/PPO |
$228.15
|
| Rate for Payer: BCN Commercial |
$22.62
|
| Rate for Payer: BCN Commercial |
$228.15
|
| Rate for Payer: BCN Commercial |
$127.31
|
| Rate for Payer: BCN Medicare Advantage |
$69.38
|
| Rate for Payer: BCN Medicare Advantage |
$6.88
|
| Rate for Payer: BCN Medicare Advantage |
$38.72
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$123.89
|
| Rate for Payer: Cofinity Commercial |
$133.18
|
| Rate for Payer: Cofinity Commercial |
$23.67
|
| Rate for Payer: Cofinity Commercial |
$238.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.72
|
| Rate for Payer: Healthscope Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$139.37
|
| Rate for Payer: Healthscope Commercial |
$249.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.64
|
| Rate for Payer: Mclaren Medicaid |
$27.30
|
| Rate for Payer: Mclaren Medicaid |
$48.93
|
| Rate for Payer: Mclaren Medicaid |
$4.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.85
|
| Rate for Payer: Meridian Medicaid |
$51.37
|
| Rate for Payer: Meridian Medicaid |
$28.66
|
| Rate for Payer: Meridian Medicaid |
$5.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.39
|
| Rate for Payer: Nomi Health Commercial |
$227.57
|
| Rate for Payer: Nomi Health Commercial |
$22.57
|
| Rate for Payer: Nomi Health Commercial |
$126.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.14
|
| Rate for Payer: PACE Senior Care Partners |
$6.54
|
| Rate for Payer: PACE Senior Care Partners |
$36.78
|
| Rate for Payer: PACE Senior Care Partners |
$65.91
|
| Rate for Payer: PACE SWMI |
$69.38
|
| Rate for Payer: PACE SWMI |
$6.88
|
| Rate for Payer: PACE SWMI |
$38.72
|
| Rate for Payer: PHP Commercial |
$131.63
|
| Rate for Payer: PHP Commercial |
$235.89
|
| Rate for Payer: PHP Commercial |
$23.39
|
| Rate for Payer: PHP Medicare Advantage |
$6.88
|
| Rate for Payer: PHP Medicare Advantage |
$38.72
|
| Rate for Payer: PHP Medicare Advantage |
$69.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$241.44
|
| Rate for Payer: Priority Health Medicare |
$70.07
|
| Rate for Payer: Priority Health Medicare |
$6.95
|
| Rate for Payer: Priority Health Medicare |
$39.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.78
|
| Rate for Payer: Railroad Medicare Medicare |
$6.88
|
| Rate for Payer: Railroad Medicare Medicare |
$69.38
|
| Rate for Payer: Railroad Medicare Medicare |
$38.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.28
|
| Rate for Payer: UHC Core |
$129.31
|
| Rate for Payer: UHC Core |
$231.73
|
| Rate for Payer: UHC Core |
$22.98
|
| Rate for Payer: UHC Exchange |
$69.38
|
| Rate for Payer: UHC Exchange |
$6.88
|
| Rate for Payer: UHC Exchange |
$38.72
|
| Rate for Payer: UHC Medicaid |
$27.30
|
| Rate for Payer: UHC Medicaid |
$48.93
|
| Rate for Payer: UHC Medicaid |
$4.85
|
| Rate for Payer: UHC Medicare Advantage |
$6.88
|
| Rate for Payer: UHC Medicare Advantage |
$38.72
|
| Rate for Payer: UHC Medicare Advantage |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$4.85
|
| Rate for Payer: UHCCP Medicaid |
$27.30
|
| Rate for Payer: UHCCP Medicaid |
$48.93
|
| Rate for Payer: VA VA |
$38.72
|
| Rate for Payer: VA VA |
$69.38
|
| Rate for Payer: VA VA |
$6.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.14
|
|
|
DICYCLOMINE 20 MG TABLET
|
Facility
|
OP
|
$390.45
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.84 |
| Max. Negotiated Rate |
$351.40 |
| Rate for Payer: Aetna Commercial |
$331.88
|
| Rate for Payer: Aetna Medicare |
$101.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.02
|
| Rate for Payer: BCBS Complete |
$72.27
|
| Rate for Payer: BCBS MAPPO |
$97.61
|
| Rate for Payer: BCBS Trust/PPO |
$320.99
|
| Rate for Payer: BCN Commercial |
$320.99
|
| Rate for Payer: BCN Medicare Advantage |
$97.61
|
| Rate for Payer: Cash Price |
$312.36
|
| Rate for Payer: Cofinity Commercial |
$335.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.61
|
| Rate for Payer: Healthscope Commercial |
$351.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.84
|
| Rate for Payer: Mclaren Medicaid |
$68.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.49
|
| Rate for Payer: Meridian Medicaid |
$72.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.88
|
| Rate for Payer: Nomi Health Commercial |
$320.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.84
|
| Rate for Payer: PACE Senior Care Partners |
$92.73
|
| Rate for Payer: PACE SWMI |
$97.61
|
| Rate for Payer: PHP Commercial |
$331.88
|
| Rate for Payer: PHP Medicare Advantage |
$97.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.69
|
| Rate for Payer: Priority Health Medicare |
$98.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.75
|
| Rate for Payer: Railroad Medicare Medicare |
$97.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.60
|
| Rate for Payer: UHC Core |
$326.03
|
| Rate for Payer: UHC Exchange |
$97.61
|
| Rate for Payer: UHC Medicaid |
$68.84
|
| Rate for Payer: UHC Medicare Advantage |
$97.61
|
| Rate for Payer: UHCCP Medicaid |
$68.84
|
| Rate for Payer: VA VA |
$97.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.84
|
|
|
DICYCLOMINE 20 MG TABLET
|
Facility
|
IP
|
$390.45
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$271.75 |
| Max. Negotiated Rate |
$351.40 |
| Rate for Payer: Aetna Commercial |
$331.88
|
| Rate for Payer: BCBS Trust/PPO |
$322.47
|
| Rate for Payer: BCN Commercial |
$322.47
|
| Rate for Payer: Cash Price |
$312.36
|
| Rate for Payer: Cofinity Commercial |
$335.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.36
|
| Rate for Payer: Healthscope Commercial |
$351.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.88
|
| Rate for Payer: Nomi Health Commercial |
$320.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.84
|
| Rate for Payer: PHP Commercial |
$331.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$339.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.60
|
| Rate for Payer: UHC Core |
$326.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.84
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$5,877.31
|
|
|
Service Code
|
APR-DRG 2402
|
| Min. Negotiated Rate |
$5,597.44 |
| Max. Negotiated Rate |
$5,877.31 |
| Rate for Payer: BCBS Complete |
$5,877.31
|
| Rate for Payer: Mclaren Medicaid |
$5,597.44
|
| Rate for Payer: Meridian Medicaid |
$5,877.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,597.44
|
| Rate for Payer: UHC Medicaid |
$5,597.44
|
| Rate for Payer: UHCCP Medicaid |
$5,597.44
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$11,655.77
|
|
|
Service Code
|
APR-DRG 2404
|
| Min. Negotiated Rate |
$11,100.73 |
| Max. Negotiated Rate |
$11,655.77 |
| Rate for Payer: BCBS Complete |
$11,655.77
|
| Rate for Payer: Mclaren Medicaid |
$11,100.73
|
| Rate for Payer: Meridian Medicaid |
$11,655.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,100.73
|
| Rate for Payer: UHC Medicaid |
$11,100.73
|
| Rate for Payer: UHCCP Medicaid |
$11,100.73
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$4,827.21
|
|
|
Service Code
|
APR-DRG 2401
|
| Min. Negotiated Rate |
$4,597.34 |
| Max. Negotiated Rate |
$4,827.21 |
| Rate for Payer: BCBS Complete |
$4,827.21
|
| Rate for Payer: Mclaren Medicaid |
$4,597.34
|
| Rate for Payer: Meridian Medicaid |
$4,827.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,597.34
|
| Rate for Payer: UHC Medicaid |
$4,597.34
|
| Rate for Payer: UHCCP Medicaid |
$4,597.34
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$8,433.42
|
|
|
Service Code
|
APR-DRG 2403
|
| Min. Negotiated Rate |
$8,031.83 |
| Max. Negotiated Rate |
$8,433.42 |
| Rate for Payer: BCBS Complete |
$8,433.42
|
| Rate for Payer: Mclaren Medicaid |
$8,031.83
|
| Rate for Payer: Meridian Medicaid |
$8,433.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,031.83
|
| Rate for Payer: UHC Medicaid |
$8,031.83
|
| Rate for Payer: UHCCP Medicaid |
$8,031.83
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.67 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: BCBS Trust/PPO |
$356.79
|
| Rate for Payer: BCN Commercial |
$356.79
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cofinity Commercial |
$371.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.60
|
| Rate for Payer: Healthscope Commercial |
$388.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.20
|
| Rate for Payer: Nomi Health Commercial |
$354.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.00
|
| Rate for Payer: PHP Commercial |
$367.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$375.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.16
|
| Rate for Payer: UHC Core |
$360.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.00
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
NDC 00904592161
|
| Hospital Charge Code |
2444
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.16 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: Aetna Medicare |
$112.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.00
|
| Rate for Payer: BCBS Complete |
$79.96
|
| Rate for Payer: BCBS MAPPO |
$108.00
|
| Rate for Payer: BCBS Trust/PPO |
$355.15
|
| Rate for Payer: BCN Commercial |
$355.15
|
| Rate for Payer: BCN Medicare Advantage |
$108.00
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cofinity Commercial |
$371.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.00
|
| Rate for Payer: Healthscope Commercial |
$388.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.00
|
| Rate for Payer: Mclaren Medicaid |
$76.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.40
|
| Rate for Payer: Meridian Medicaid |
$79.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.20
|
| Rate for Payer: Nomi Health Commercial |
$354.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.00
|
| Rate for Payer: PACE Senior Care Partners |
$102.60
|
| Rate for Payer: PACE SWMI |
$108.00
|
| Rate for Payer: PHP Commercial |
$367.20
|
| Rate for Payer: PHP Medicare Advantage |
$108.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$375.84
|
| Rate for Payer: Priority Health Medicare |
$109.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.67
|
| Rate for Payer: Railroad Medicare Medicare |
$108.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.16
|
| Rate for Payer: UHC Core |
$360.72
|
| Rate for Payer: UHC Exchange |
$108.00
|
| Rate for Payer: UHC Medicaid |
$76.16
|
| Rate for Payer: UHC Medicare Advantage |
$108.00
|
| Rate for Payer: UHCCP Medicaid |
$76.16
|
| Rate for Payer: VA VA |
$108.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.00
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$21.14
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$19.03 |
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: BCBS Trust/PPO |
$17.46
|
| Rate for Payer: BCN Commercial |
$17.46
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Nomi Health Commercial |
$17.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.86
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.60
|
| Rate for Payer: UHC Core |
$17.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$21.14
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$19.03 |
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.61
|
| Rate for Payer: BCBS Complete |
$3.91
|
| Rate for Payer: BCBS MAPPO |
$5.29
|
| Rate for Payer: BCBS Trust/PPO |
$17.38
|
| Rate for Payer: BCN Commercial |
$17.38
|
| Rate for Payer: BCN Medicare Advantage |
$5.29
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.29
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Mclaren Medicaid |
$3.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.55
|
| Rate for Payer: Meridian Medicaid |
$3.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Nomi Health Commercial |
$17.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.86
|
| Rate for Payer: PACE Senior Care Partners |
$5.02
|
| Rate for Payer: PACE SWMI |
$5.29
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Medicare Advantage |
$5.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.39
|
| Rate for Payer: Priority Health Medicare |
$5.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.71
|
| Rate for Payer: Railroad Medicare Medicare |
$5.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.60
|
| Rate for Payer: UHC Core |
$17.65
|
| Rate for Payer: UHC Exchange |
$5.29
|
| Rate for Payer: UHC Medicaid |
$3.73
|
| Rate for Payer: UHC Medicare Advantage |
$5.29
|
| Rate for Payer: UHCCP Medicaid |
$3.73
|
| Rate for Payer: VA VA |
$5.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,027.14
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,370.89 |
| Max. Negotiated Rate |
$10,824.43 |
| Rate for Payer: Aetna Commercial |
$10,223.07
|
| Rate for Payer: BCBS Trust/PPO |
$9,933.21
|
| Rate for Payer: BCN Commercial |
$9,933.21
|
| Rate for Payer: Cash Price |
$9,621.71
|
| Rate for Payer: Cofinity Commercial |
$10,343.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,621.71
|
| Rate for Payer: Healthscope Commercial |
$10,824.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,020.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,223.07
|
| Rate for Payer: Nomi Health Commercial |
$9,862.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,020.35
|
| Rate for Payer: PHP Commercial |
$10,223.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10,463.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,370.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,583.88
|
| Rate for Payer: UHC Core |
$10,042.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,020.35
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,027.14
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,120.38 |
| Max. Negotiated Rate |
$10,824.43 |
| Rate for Payer: Aetna Commercial |
$10,223.07
|
| Rate for Payer: Aetna Medicare |
$3,127.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,758.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,758.48
|
| Rate for Payer: BCBS Complete |
$2,226.22
|
| Rate for Payer: BCBS MAPPO |
$3,006.78
|
| Rate for Payer: BCBS Trust/PPO |
$9,887.51
|
| Rate for Payer: BCN Commercial |
$9,887.51
|
| Rate for Payer: BCN Medicare Advantage |
$3,006.78
|
| Rate for Payer: Cash Price |
$9,621.71
|
| Rate for Payer: Cofinity Commercial |
$10,343.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,621.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,006.78
|
| Rate for Payer: Healthscope Commercial |
$10,824.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,020.35
|
| Rate for Payer: Mclaren Medicaid |
$2,120.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,157.12
|
| Rate for Payer: Meridian Medicaid |
$2,226.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,457.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,307.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,223.07
|
| Rate for Payer: Nomi Health Commercial |
$9,862.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,020.35
|
| Rate for Payer: PACE Senior Care Partners |
$2,856.45
|
| Rate for Payer: PACE SWMI |
$3,006.78
|
| Rate for Payer: PHP Commercial |
$10,223.07
|
| Rate for Payer: PHP Medicare Advantage |
$3,006.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,120.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10,463.61
|
| Rate for Payer: Priority Health Medicare |
$3,036.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,370.89
|
| Rate for Payer: Railroad Medicare Medicare |
$3,006.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,583.88
|
| Rate for Payer: UHC Core |
$10,042.66
|
| Rate for Payer: UHC Exchange |
$3,006.78
|
| Rate for Payer: UHC Medicaid |
$2,120.38
|
| Rate for Payer: UHC Medicare Advantage |
$3,006.78
|
| Rate for Payer: UHCCP Medicaid |
$2,120.38
|
| Rate for Payer: VA VA |
$3,006.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,020.35
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$180.65
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.73 |
| Max. Negotiated Rate |
$162.59 |
| Rate for Payer: Aetna Commercial |
$153.55
|
| Rate for Payer: Aetna Commercial |
$170.62
|
| Rate for Payer: Aetna Commercial |
$370.74
|
| Rate for Payer: BCBS Trust/PPO |
$165.78
|
| Rate for Payer: BCBS Trust/PPO |
$149.20
|
| Rate for Payer: BCBS Trust/PPO |
$360.23
|
| Rate for Payer: BCN Commercial |
$165.78
|
| Rate for Payer: BCN Commercial |
$149.20
|
| Rate for Payer: BCN Commercial |
$360.23
|
| Rate for Payer: Cash Price |
$144.52
|
| Rate for Payer: Cash Price |
$348.94
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cofinity Commercial |
$375.11
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$155.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.94
|
| Rate for Payer: Healthscope Commercial |
$180.66
|
| Rate for Payer: Healthscope Commercial |
$162.59
|
| Rate for Payer: Healthscope Commercial |
$392.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.74
|
| Rate for Payer: Nomi Health Commercial |
$148.13
|
| Rate for Payer: Nomi Health Commercial |
$164.60
|
| Rate for Payer: Nomi Health Commercial |
$357.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.13
|
| Rate for Payer: PHP Commercial |
$153.55
|
| Rate for Payer: PHP Commercial |
$370.74
|
| Rate for Payer: PHP Commercial |
$170.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$379.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$157.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$303.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.97
|
| Rate for Payer: UHC Core |
$150.84
|
| Rate for Payer: UHC Core |
$364.20
|
| Rate for Payer: UHC Core |
$167.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.55
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$180.65
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$162.59 |
| Rate for Payer: Aetna Commercial |
$153.55
|
| Rate for Payer: Aetna Commercial |
$370.74
|
| Rate for Payer: Aetna Commercial |
$170.62
|
| Rate for Payer: Aetna Medicare |
$113.40
|
| Rate for Payer: Aetna Medicare |
$46.97
|
| Rate for Payer: Aetna Medicare |
$52.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.30
|
| Rate for Payer: BCBS Complete |
$37.16
|
| Rate for Payer: BCBS Complete |
$33.44
|
| Rate for Payer: BCBS Complete |
$80.74
|
| Rate for Payer: BCBS MAPPO |
$109.04
|
| Rate for Payer: BCBS MAPPO |
$45.16
|
| Rate for Payer: BCBS MAPPO |
$50.18
|
| Rate for Payer: BCBS Trust/PPO |
$148.51
|
| Rate for Payer: BCBS Trust/PPO |
$165.02
|
| Rate for Payer: BCBS Trust/PPO |
$358.58
|
| Rate for Payer: BCN Commercial |
$165.02
|
| Rate for Payer: BCN Commercial |
$358.58
|
| Rate for Payer: BCN Commercial |
$148.51
|
| Rate for Payer: BCN Medicare Advantage |
$109.04
|
| Rate for Payer: BCN Medicare Advantage |
$50.18
|
| Rate for Payer: BCN Medicare Advantage |
$45.16
|
| Rate for Payer: Cash Price |
$348.94
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cash Price |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$155.36
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$375.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.16
|
| Rate for Payer: Healthscope Commercial |
$180.66
|
| Rate for Payer: Healthscope Commercial |
$162.59
|
| Rate for Payer: Healthscope Commercial |
$392.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.55
|
| Rate for Payer: Mclaren Medicaid |
$31.85
|
| Rate for Payer: Mclaren Medicaid |
$76.90
|
| Rate for Payer: Mclaren Medicaid |
$35.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.49
|
| Rate for Payer: Meridian Medicaid |
$80.74
|
| Rate for Payer: Meridian Medicaid |
$33.44
|
| Rate for Payer: Meridian Medicaid |
$37.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$119.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.62
|
| Rate for Payer: Nomi Health Commercial |
$357.66
|
| Rate for Payer: Nomi Health Commercial |
$164.60
|
| Rate for Payer: Nomi Health Commercial |
$148.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.49
|
| Rate for Payer: PACE Senior Care Partners |
$47.67
|
| Rate for Payer: PACE Senior Care Partners |
$42.90
|
| Rate for Payer: PACE Senior Care Partners |
$103.59
|
| Rate for Payer: PACE SWMI |
$109.04
|
| Rate for Payer: PACE SWMI |
$50.18
|
| Rate for Payer: PACE SWMI |
$45.16
|
| Rate for Payer: PHP Commercial |
$153.55
|
| Rate for Payer: PHP Commercial |
$370.74
|
| Rate for Payer: PHP Commercial |
$170.62
|
| Rate for Payer: PHP Medicare Advantage |
$50.18
|
| Rate for Payer: PHP Medicare Advantage |
$45.16
|
| Rate for Payer: PHP Medicare Advantage |
$109.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$157.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$379.47
|
| Rate for Payer: Priority Health Medicare |
$110.13
|
| Rate for Payer: Priority Health Medicare |
$50.68
|
| Rate for Payer: Priority Health Medicare |
$45.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$303.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.73
|
| Rate for Payer: Railroad Medicare Medicare |
$50.18
|
| Rate for Payer: Railroad Medicare Medicare |
$109.04
|
| Rate for Payer: Railroad Medicare Medicare |
$45.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.97
|
| Rate for Payer: UHC Core |
$150.84
|
| Rate for Payer: UHC Core |
$364.20
|
| Rate for Payer: UHC Core |
$167.61
|
| Rate for Payer: UHC Exchange |
$109.04
|
| Rate for Payer: UHC Exchange |
$50.18
|
| Rate for Payer: UHC Exchange |
$45.16
|
| Rate for Payer: UHC Medicaid |
$31.85
|
| Rate for Payer: UHC Medicaid |
$76.90
|
| Rate for Payer: UHC Medicaid |
$35.39
|
| Rate for Payer: UHC Medicare Advantage |
$50.18
|
| Rate for Payer: UHC Medicare Advantage |
$45.16
|
| Rate for Payer: UHC Medicare Advantage |
$109.04
|
| Rate for Payer: UHCCP Medicaid |
$35.39
|
| Rate for Payer: UHCCP Medicaid |
$31.85
|
| Rate for Payer: UHCCP Medicaid |
$76.90
|
| Rate for Payer: VA VA |
$45.16
|
| Rate for Payer: VA VA |
$109.04
|
| Rate for Payer: VA VA |
$50.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.13
|
|
