|
ALPRAZOLAM 1 MG TABLET
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
NDC 65862067801
|
| Hospital Charge Code |
326
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna Medicare |
$23.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.91
|
| Rate for Payer: BCBS Complete |
$16.53
|
| Rate for Payer: BCBS MAPPO |
$22.32
|
| Rate for Payer: BCBS Trust/PPO |
$73.41
|
| Rate for Payer: BCN Commercial |
$73.41
|
| Rate for Payer: BCN Medicare Advantage |
$22.32
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: Mclaren Medicaid |
$15.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.44
|
| Rate for Payer: Meridian Medicaid |
$16.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Nomi Health Commercial |
$73.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PACE Senior Care Partners |
$21.21
|
| Rate for Payer: PACE SWMI |
$22.32
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: PHP Medicare Advantage |
$22.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.69
|
| Rate for Payer: Priority Health Medicare |
$22.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.15
|
| Rate for Payer: Railroad Medicare Medicare |
$22.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.58
|
| Rate for Payer: UHC Core |
$74.57
|
| Rate for Payer: UHC Exchange |
$22.32
|
| Rate for Payer: UHC Medicaid |
$15.74
|
| Rate for Payer: UHC Medicare Advantage |
$22.32
|
| Rate for Payer: UHCCP Medicaid |
$15.74
|
| Rate for Payer: VA VA |
$22.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
ALPRAZOLAM 1 MG TABLET
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 65862067801
|
| Hospital Charge Code |
326
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: BCBS Trust/PPO |
$73.75
|
| Rate for Payer: BCN Commercial |
$73.75
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Nomi Health Commercial |
$73.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.58
|
| Rate for Payer: UHC Core |
$74.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,069.86 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: BCBS Trust/PPO |
$23,815.65
|
| Rate for Payer: BCN Commercial |
$23,815.65
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,069.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,083.79 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$7,497.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,011.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,011.25
|
| Rate for Payer: BCBS Complete |
$5,337.54
|
| Rate for Payer: BCBS MAPPO |
$7,209.00
|
| Rate for Payer: BCBS Trust/PPO |
$23,706.08
|
| Rate for Payer: BCN Commercial |
$23,706.08
|
| Rate for Payer: BCN Medicare Advantage |
$7,209.00
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,209.00
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Mclaren Medicaid |
$5,083.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,569.45
|
| Rate for Payer: Meridian Medicaid |
$5,337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,290.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,929.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Senior Care Partners |
$6,848.55
|
| Rate for Payer: PACE SWMI |
$7,209.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$7,209.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,083.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Medicare |
$7,281.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,069.86
|
| Rate for Payer: Railroad Medicare Medicare |
$7,209.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: UHC Exchange |
$7,209.00
|
| Rate for Payer: UHC Medicaid |
$5,083.79
|
| Rate for Payer: UHC Medicare Advantage |
$7,209.00
|
| Rate for Payer: UHCCP Medicaid |
$5,083.79
|
| Rate for Payer: VA VA |
$7,209.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,083.79 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$7,497.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,011.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,011.25
|
| Rate for Payer: BCBS Complete |
$5,337.54
|
| Rate for Payer: BCBS MAPPO |
$7,209.00
|
| Rate for Payer: BCBS Trust/PPO |
$23,706.08
|
| Rate for Payer: BCN Commercial |
$23,706.08
|
| Rate for Payer: BCN Medicare Advantage |
$7,209.00
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,209.00
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Mclaren Medicaid |
$5,083.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,569.45
|
| Rate for Payer: Meridian Medicaid |
$5,337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,290.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,929.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Senior Care Partners |
$6,848.55
|
| Rate for Payer: PACE SWMI |
$7,209.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$7,209.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,083.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Medicare |
$7,281.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,069.86
|
| Rate for Payer: Railroad Medicare Medicare |
$7,209.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: UHC Exchange |
$7,209.00
|
| Rate for Payer: UHC Medicaid |
$5,083.79
|
| Rate for Payer: UHC Medicare Advantage |
$7,209.00
|
| Rate for Payer: UHCCP Medicaid |
$5,083.79
|
| Rate for Payer: VA VA |
$7,209.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,069.86 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: BCBS Trust/PPO |
$23,815.65
|
| Rate for Payer: BCN Commercial |
$23,815.65
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,069.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,069.86 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: BCBS Trust/PPO |
$23,815.65
|
| Rate for Payer: BCN Commercial |
$23,815.65
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,069.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,083.79 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$7,497.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,011.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,011.25
|
| Rate for Payer: BCBS Complete |
$5,337.54
|
| Rate for Payer: BCBS MAPPO |
$7,209.00
|
| Rate for Payer: BCBS Trust/PPO |
$23,706.08
|
| Rate for Payer: BCN Commercial |
$23,706.08
|
| Rate for Payer: BCN Medicare Advantage |
$7,209.00
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,209.00
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Mclaren Medicaid |
$5,083.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,569.45
|
| Rate for Payer: Meridian Medicaid |
$5,337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,290.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,929.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$23,645.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Senior Care Partners |
$6,848.55
|
| Rate for Payer: PACE SWMI |
$7,209.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$7,209.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,083.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25,087.32
|
| Rate for Payer: Priority Health Medicare |
$7,281.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,069.86
|
| Rate for Payer: Railroad Medicare Medicare |
$7,209.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,375.68
|
| Rate for Payer: UHC Core |
$24,078.06
|
| Rate for Payer: UHC Exchange |
$7,209.00
|
| Rate for Payer: UHC Medicaid |
$5,083.79
|
| Rate for Payer: UHC Medicare Advantage |
$7,209.00
|
| Rate for Payer: UHCCP Medicaid |
$5,083.79
|
| Rate for Payer: VA VA |
$7,209.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
OP
|
$672.98
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.65 |
| Max. Negotiated Rate |
$605.68 |
| Rate for Payer: Aetna Commercial |
$572.03
|
| Rate for Payer: Aetna Medicare |
$174.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.31
|
| Rate for Payer: BCBS Complete |
$124.57
|
| Rate for Payer: BCBS MAPPO |
$168.25
|
| Rate for Payer: BCBS Trust/PPO |
$553.26
|
| Rate for Payer: BCN Commercial |
$553.26
|
| Rate for Payer: BCN Medicare Advantage |
$168.25
|
| Rate for Payer: Cash Price |
$538.38
|
| Rate for Payer: Cofinity Commercial |
$578.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.25
|
| Rate for Payer: Healthscope Commercial |
$605.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.74
|
| Rate for Payer: Mclaren Medicaid |
$118.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.66
|
| Rate for Payer: Meridian Medicaid |
$124.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.03
|
| Rate for Payer: Nomi Health Commercial |
$551.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.74
|
| Rate for Payer: PACE Senior Care Partners |
$159.83
|
| Rate for Payer: PACE SWMI |
$168.25
|
| Rate for Payer: PHP Commercial |
$572.03
|
| Rate for Payer: PHP Medicare Advantage |
$168.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$585.49
|
| Rate for Payer: Priority Health Medicare |
$169.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$468.39
|
| Rate for Payer: Railroad Medicare Medicare |
$168.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.22
|
| Rate for Payer: UHC Core |
$561.94
|
| Rate for Payer: UHC Exchange |
$168.25
|
| Rate for Payer: UHC Medicaid |
$118.65
|
| Rate for Payer: UHC Medicare Advantage |
$168.25
|
| Rate for Payer: UHCCP Medicaid |
$118.65
|
| Rate for Payer: VA VA |
$168.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.74
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
IP
|
$672.98
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$468.39 |
| Max. Negotiated Rate |
$605.68 |
| Rate for Payer: Aetna Commercial |
$572.03
|
| Rate for Payer: BCBS Trust/PPO |
$555.81
|
| Rate for Payer: BCN Commercial |
$555.81
|
| Rate for Payer: Cash Price |
$538.38
|
| Rate for Payer: Cofinity Commercial |
$578.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.38
|
| Rate for Payer: Healthscope Commercial |
$605.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.03
|
| Rate for Payer: Nomi Health Commercial |
$551.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.74
|
| Rate for Payer: PHP Commercial |
$572.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$585.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$468.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.22
|
| Rate for Payer: UHC Core |
$561.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.74
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,541.89 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna Medicare |
$3,748.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,505.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,505.62
|
| Rate for Payer: BCBS Complete |
$2,668.77
|
| Rate for Payer: BCBS MAPPO |
$3,604.50
|
| Rate for Payer: BCBS Trust/PPO |
$11,853.04
|
| Rate for Payer: BCN Commercial |
$11,853.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,604.50
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,604.50
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Mclaren Medicaid |
$2,541.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,784.72
|
| Rate for Payer: Meridian Medicaid |
$2,668.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,145.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,964.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$11,822.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PACE Senior Care Partners |
$3,424.28
|
| Rate for Payer: PACE SWMI |
$3,604.50
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: PHP Medicare Advantage |
$3,604.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,541.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12,543.66
|
| Rate for Payer: Priority Health Medicare |
$3,640.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,034.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,604.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,687.84
|
| Rate for Payer: UHC Core |
$12,039.03
|
| Rate for Payer: UHC Exchange |
$3,604.50
|
| Rate for Payer: UHC Medicaid |
$2,541.89
|
| Rate for Payer: UHC Medicare Advantage |
$3,604.50
|
| Rate for Payer: UHCCP Medicaid |
$2,541.89
|
| Rate for Payer: VA VA |
$3,604.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,034.93 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: BCBS Trust/PPO |
$11,907.83
|
| Rate for Payer: BCN Commercial |
$11,907.83
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$11,822.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12,543.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,034.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,687.84
|
| Rate for Payer: UHC Core |
$12,039.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,034.93 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: BCBS Trust/PPO |
$11,907.83
|
| Rate for Payer: BCN Commercial |
$11,907.83
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$11,822.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12,543.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,034.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,687.84
|
| Rate for Payer: UHC Core |
$12,039.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
OP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,541.89 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna Medicare |
$3,748.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,505.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,505.62
|
| Rate for Payer: BCBS Complete |
$2,668.77
|
| Rate for Payer: BCBS MAPPO |
$3,604.50
|
| Rate for Payer: BCBS Trust/PPO |
$11,853.04
|
| Rate for Payer: BCN Commercial |
$11,853.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,604.50
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,604.50
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Mclaren Medicaid |
$2,541.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,784.72
|
| Rate for Payer: Meridian Medicaid |
$2,668.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,145.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,964.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$11,822.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PACE Senior Care Partners |
$3,424.28
|
| Rate for Payer: PACE SWMI |
$3,604.50
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: PHP Medicare Advantage |
$3,604.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,541.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12,543.66
|
| Rate for Payer: Priority Health Medicare |
$3,640.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,034.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,604.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,687.84
|
| Rate for Payer: UHC Core |
$12,039.03
|
| Rate for Payer: UHC Exchange |
$3,604.50
|
| Rate for Payer: UHC Medicaid |
$2,541.89
|
| Rate for Payer: UHC Medicare Advantage |
$3,604.50
|
| Rate for Payer: UHCCP Medicaid |
$2,541.89
|
| Rate for Payer: VA VA |
$3,604.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$3,621.99
|
|
|
Service Code
|
APR-DRG 0521
|
| Min. Negotiated Rate |
$3,449.51 |
| Max. Negotiated Rate |
$3,621.99 |
| Rate for Payer: BCBS Complete |
$3,621.99
|
| Rate for Payer: Mclaren Medicaid |
$3,449.51
|
| Rate for Payer: Meridian Medicaid |
$3,621.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,449.51
|
| Rate for Payer: UHC Medicaid |
$3,449.51
|
| Rate for Payer: UHCCP Medicaid |
$3,449.51
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$11,167.79
|
|
|
Service Code
|
APR-DRG 0524
|
| Min. Negotiated Rate |
$10,635.99 |
| Max. Negotiated Rate |
$11,167.79 |
| Rate for Payer: BCBS Complete |
$11,167.79
|
| Rate for Payer: Mclaren Medicaid |
$10,635.99
|
| Rate for Payer: Meridian Medicaid |
$11,167.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,635.99
|
| Rate for Payer: UHC Medicaid |
$10,635.99
|
| Rate for Payer: UHCCP Medicaid |
$10,635.99
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$4,897.67
|
|
|
Service Code
|
APR-DRG 0522
|
| Min. Negotiated Rate |
$4,664.45 |
| Max. Negotiated Rate |
$4,897.67 |
| Rate for Payer: BCBS Complete |
$4,897.67
|
| Rate for Payer: Mclaren Medicaid |
$4,664.45
|
| Rate for Payer: Meridian Medicaid |
$4,897.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,664.45
|
| Rate for Payer: UHC Medicaid |
$4,664.45
|
| Rate for Payer: UHCCP Medicaid |
$4,664.45
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$6,729.17
|
|
|
Service Code
|
APR-DRG 0523
|
| Min. Negotiated Rate |
$6,408.74 |
| Max. Negotiated Rate |
$6,729.17 |
| Rate for Payer: BCBS Complete |
$6,729.17
|
| Rate for Payer: Mclaren Medicaid |
$6,408.74
|
| Rate for Payer: Meridian Medicaid |
$6,729.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,408.74
|
| Rate for Payer: UHC Medicaid |
$6,408.74
|
| Rate for Payer: UHCCP Medicaid |
$6,408.74
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$12.83
|
|
|
Service Code
|
NDC 00904732573
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Aetna Commercial |
$10.91
|
| Rate for Payer: BCBS Trust/PPO |
$10.60
|
| Rate for Payer: BCN Commercial |
$10.60
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Healthscope Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.91
|
| Rate for Payer: Nomi Health Commercial |
$10.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.62
|
| Rate for Payer: PHP Commercial |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.29
|
| Rate for Payer: UHC Core |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00121176130
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$12.83
|
|
|
Service Code
|
NDC 00904732562
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Aetna Commercial |
$10.91
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.01
|
| Rate for Payer: BCBS Complete |
$2.37
|
| Rate for Payer: BCBS MAPPO |
$3.21
|
| Rate for Payer: BCBS Trust/PPO |
$10.55
|
| Rate for Payer: BCN Commercial |
$10.55
|
| Rate for Payer: BCN Medicare Advantage |
$3.21
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.21
|
| Rate for Payer: Healthscope Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Mclaren Medicaid |
$2.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.37
|
| Rate for Payer: Meridian Medicaid |
$2.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.91
|
| Rate for Payer: Nomi Health Commercial |
$10.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.62
|
| Rate for Payer: PACE Senior Care Partners |
$3.05
|
| Rate for Payer: PACE SWMI |
$3.21
|
| Rate for Payer: PHP Commercial |
$10.91
|
| Rate for Payer: PHP Medicare Advantage |
$3.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.16
|
| Rate for Payer: Priority Health Medicare |
$3.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.29
|
| Rate for Payer: UHC Core |
$10.71
|
| Rate for Payer: UHC Exchange |
$3.21
|
| Rate for Payer: UHC Medicaid |
$2.26
|
| Rate for Payer: UHC Medicare Advantage |
$3.21
|
| Rate for Payer: UHCCP Medicaid |
$2.26
|
| Rate for Payer: VA VA |
$3.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$15.98
|
|
|
Service Code
|
NDC 57896062912
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Aetna Commercial |
$13.58
|
| Rate for Payer: Aetna Medicare |
$4.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.99
|
| Rate for Payer: BCBS Complete |
$2.96
|
| Rate for Payer: BCBS MAPPO |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$13.14
|
| Rate for Payer: BCN Commercial |
$13.14
|
| Rate for Payer: BCN Medicare Advantage |
$4.00
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cofinity Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.98
|
| Rate for Payer: Mclaren Medicaid |
$2.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.19
|
| Rate for Payer: Meridian Medicaid |
$2.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.58
|
| Rate for Payer: Nomi Health Commercial |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.98
|
| Rate for Payer: PACE Senior Care Partners |
$3.80
|
| Rate for Payer: PACE SWMI |
$4.00
|
| Rate for Payer: PHP Commercial |
$13.58
|
| Rate for Payer: PHP Medicare Advantage |
$4.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.90
|
| Rate for Payer: Priority Health Medicare |
$4.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.12
|
| Rate for Payer: Railroad Medicare Medicare |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.06
|
| Rate for Payer: UHC Core |
$13.34
|
| Rate for Payer: UHC Exchange |
$4.00
|
| Rate for Payer: UHC Medicaid |
$2.82
|
| Rate for Payer: UHC Medicare Advantage |
$4.00
|
| Rate for Payer: UHCCP Medicaid |
$2.82
|
| Rate for Payer: VA VA |
$4.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.98
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$15.21
|
|
|
Service Code
|
NDC 09900000191
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.75
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.50
|
| Rate for Payer: BCN Commercial |
$12.50
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.41
|
| Rate for Payer: Mclaren Medicaid |
$2.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.99
|
| Rate for Payer: Meridian Medicaid |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$12.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.41
|
| Rate for Payer: PACE Senior Care Partners |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$12.93
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.23
|
| Rate for Payer: Priority Health Medicare |
$3.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.38
|
| Rate for Payer: UHC Core |
$12.70
|
| Rate for Payer: UHC Exchange |
$3.80
|
| Rate for Payer: UHC Medicaid |
$2.68
|
| Rate for Payer: UHC Medicare Advantage |
$3.80
|
| Rate for Payer: UHCCP Medicaid |
$2.68
|
| Rate for Payer: VA VA |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.41
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00121176130
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.78
|
| Rate for Payer: BCBS Complete |
$3.42
|
| Rate for Payer: BCBS MAPPO |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$15.21
|
| Rate for Payer: BCN Commercial |
$15.21
|
| Rate for Payer: BCN Medicare Advantage |
$4.62
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.86
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PACE Senior Care Partners |
$4.39
|
| Rate for Payer: PACE SWMI |
$4.62
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.09
|
| Rate for Payer: Priority Health Medicare |
$4.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.28
|
| Rate for Payer: UHC Core |
$15.45
|
| Rate for Payer: UHC Exchange |
$4.62
|
| Rate for Payer: UHC Medicaid |
$3.26
|
| Rate for Payer: UHC Medicare Advantage |
$4.62
|
| Rate for Payer: UHCCP Medicaid |
$3.26
|
| Rate for Payer: VA VA |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$15.98
|
|
|
Service Code
|
NDC 57896062912
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Aetna Commercial |
$13.58
|
| Rate for Payer: BCBS Trust/PPO |
$13.20
|
| Rate for Payer: BCN Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cofinity Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.78
|
| Rate for Payer: Healthscope Commercial |
$14.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.58
|
| Rate for Payer: Nomi Health Commercial |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.06
|
| Rate for Payer: UHC Core |
$13.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.98
|
|
