|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$160.56
|
|
|
Service Code
|
NDC 00904750604
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.31 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Aetna Commercial |
$136.48
|
| Rate for Payer: Aetna Medicare |
$41.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.17
|
| Rate for Payer: BCBS Complete |
$29.72
|
| Rate for Payer: BCBS MAPPO |
$40.14
|
| Rate for Payer: BCBS Trust/PPO |
$132.00
|
| Rate for Payer: BCN Commercial |
$132.00
|
| Rate for Payer: BCN Medicare Advantage |
$40.14
|
| Rate for Payer: Cash Price |
$128.45
|
| Rate for Payer: Cofinity Commercial |
$138.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.14
|
| Rate for Payer: Healthscope Commercial |
$144.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.42
|
| Rate for Payer: Mclaren Medicaid |
$28.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.15
|
| Rate for Payer: Meridian Medicaid |
$29.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.48
|
| Rate for Payer: Nomi Health Commercial |
$131.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.42
|
| Rate for Payer: PACE Senior Care Partners |
$38.13
|
| Rate for Payer: PACE SWMI |
$40.14
|
| Rate for Payer: PHP Commercial |
$136.48
|
| Rate for Payer: PHP Medicare Advantage |
$40.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.69
|
| Rate for Payer: Priority Health Medicare |
$40.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.75
|
| Rate for Payer: Railroad Medicare Medicare |
$40.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.29
|
| Rate for Payer: UHC Core |
$134.07
|
| Rate for Payer: UHC Exchange |
$40.14
|
| Rate for Payer: UHC Medicaid |
$28.31
|
| Rate for Payer: UHC Medicare Advantage |
$40.14
|
| Rate for Payer: UHCCP Medicaid |
$28.31
|
| Rate for Payer: VA VA |
$40.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.42
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$5.89
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Aetna Commercial |
$5.01
|
| Rate for Payer: BCBS Trust/PPO |
$4.86
|
| Rate for Payer: BCN Commercial |
$4.86
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$5.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.71
|
| Rate for Payer: Healthscope Commercial |
$5.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.01
|
| Rate for Payer: Nomi Health Commercial |
$4.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.42
|
| Rate for Payer: PHP Commercial |
$5.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.18
|
| Rate for Payer: UHC Core |
$4.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.42
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$381.03
|
|
|
Service Code
|
NDC 45963041806
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.18 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: Aetna Medicare |
$99.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.07
|
| Rate for Payer: BCBS Complete |
$70.53
|
| Rate for Payer: BCBS MAPPO |
$95.26
|
| Rate for Payer: BCBS Trust/PPO |
$313.24
|
| Rate for Payer: BCN Commercial |
$313.24
|
| Rate for Payer: BCN Medicare Advantage |
$95.26
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.26
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.77
|
| Rate for Payer: Mclaren Medicaid |
$67.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.02
|
| Rate for Payer: Meridian Medicaid |
$70.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.88
|
| Rate for Payer: Nomi Health Commercial |
$312.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.77
|
| Rate for Payer: PACE Senior Care Partners |
$90.49
|
| Rate for Payer: PACE SWMI |
$95.26
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: PHP Medicare Advantage |
$95.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$331.50
|
| Rate for Payer: Priority Health Medicare |
$96.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.20
|
| Rate for Payer: Railroad Medicare Medicare |
$95.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.31
|
| Rate for Payer: UHC Core |
$318.16
|
| Rate for Payer: UHC Exchange |
$95.26
|
| Rate for Payer: UHC Medicaid |
$67.18
|
| Rate for Payer: UHC Medicare Advantage |
$95.26
|
| Rate for Payer: UHCCP Medicaid |
$67.18
|
| Rate for Payer: VA VA |
$95.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.77
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$176.55
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$158.90 |
| Rate for Payer: Aetna Commercial |
$150.07
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.17
|
| Rate for Payer: BCBS Complete |
$32.68
|
| Rate for Payer: BCBS MAPPO |
$44.14
|
| Rate for Payer: BCBS Trust/PPO |
$145.14
|
| Rate for Payer: BCN Commercial |
$145.14
|
| Rate for Payer: BCN Medicare Advantage |
$44.14
|
| Rate for Payer: Cash Price |
$141.24
|
| Rate for Payer: Cofinity Commercial |
$151.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.14
|
| Rate for Payer: Healthscope Commercial |
$158.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.41
|
| Rate for Payer: Mclaren Medicaid |
$31.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.34
|
| Rate for Payer: Meridian Medicaid |
$32.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.07
|
| Rate for Payer: Nomi Health Commercial |
$144.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.41
|
| Rate for Payer: PACE Senior Care Partners |
$41.93
|
| Rate for Payer: PACE SWMI |
$44.14
|
| Rate for Payer: PHP Commercial |
$150.07
|
| Rate for Payer: PHP Medicare Advantage |
$44.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$153.60
|
| Rate for Payer: Priority Health Medicare |
$44.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.88
|
| Rate for Payer: Railroad Medicare Medicare |
$44.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.36
|
| Rate for Payer: UHC Core |
$147.42
|
| Rate for Payer: UHC Exchange |
$44.14
|
| Rate for Payer: UHC Medicaid |
$31.13
|
| Rate for Payer: UHC Medicare Advantage |
$44.14
|
| Rate for Payer: UHCCP Medicaid |
$31.13
|
| Rate for Payer: VA VA |
$44.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.41
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$160.56
|
|
|
Service Code
|
NDC 00904750604
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.75 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Aetna Commercial |
$136.48
|
| Rate for Payer: BCBS Trust/PPO |
$132.61
|
| Rate for Payer: BCN Commercial |
$132.61
|
| Rate for Payer: Cash Price |
$128.45
|
| Rate for Payer: Cofinity Commercial |
$138.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.45
|
| Rate for Payer: Healthscope Commercial |
$144.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.48
|
| Rate for Payer: Nomi Health Commercial |
$131.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.42
|
| Rate for Payer: PHP Commercial |
$136.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.29
|
| Rate for Payer: UHC Core |
$134.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.42
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$154.47
|
|
|
Service Code
|
NDC 70756070360
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.27
|
| Rate for Payer: BCBS Complete |
$28.59
|
| Rate for Payer: BCBS MAPPO |
$38.62
|
| Rate for Payer: BCBS Trust/PPO |
$126.99
|
| Rate for Payer: BCN Commercial |
$126.99
|
| Rate for Payer: BCN Medicare Advantage |
$38.62
|
| Rate for Payer: Cash Price |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.62
|
| Rate for Payer: Healthscope Commercial |
$139.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Mclaren Medicaid |
$27.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.55
|
| Rate for Payer: Meridian Medicaid |
$28.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.30
|
| Rate for Payer: Nomi Health Commercial |
$126.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.85
|
| Rate for Payer: PACE Senior Care Partners |
$36.69
|
| Rate for Payer: PACE SWMI |
$38.62
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: PHP Medicare Advantage |
$38.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.39
|
| Rate for Payer: Priority Health Medicare |
$39.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.93
|
| Rate for Payer: UHC Core |
$128.98
|
| Rate for Payer: UHC Exchange |
$38.62
|
| Rate for Payer: UHC Medicaid |
$27.23
|
| Rate for Payer: UHC Medicare Advantage |
$38.62
|
| Rate for Payer: UHCCP Medicaid |
$27.23
|
| Rate for Payer: VA VA |
$38.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$381.03
|
|
|
Service Code
|
NDC 45963041806
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: BCBS Trust/PPO |
$314.69
|
| Rate for Payer: BCN Commercial |
$314.69
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.88
|
| Rate for Payer: Nomi Health Commercial |
$312.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.77
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$331.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.31
|
| Rate for Payer: UHC Core |
$318.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.77
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$154.47
|
|
|
Service Code
|
NDC 31722066860
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.27
|
| Rate for Payer: BCBS Complete |
$28.59
|
| Rate for Payer: BCBS MAPPO |
$38.62
|
| Rate for Payer: BCBS Trust/PPO |
$126.99
|
| Rate for Payer: BCN Commercial |
$126.99
|
| Rate for Payer: BCN Medicare Advantage |
$38.62
|
| Rate for Payer: Cash Price |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.62
|
| Rate for Payer: Healthscope Commercial |
$139.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Mclaren Medicaid |
$27.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.55
|
| Rate for Payer: Meridian Medicaid |
$28.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.30
|
| Rate for Payer: Nomi Health Commercial |
$126.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.85
|
| Rate for Payer: PACE Senior Care Partners |
$36.69
|
| Rate for Payer: PACE SWMI |
$38.62
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: PHP Medicare Advantage |
$38.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.39
|
| Rate for Payer: Priority Health Medicare |
$39.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.93
|
| Rate for Payer: UHC Core |
$128.98
|
| Rate for Payer: UHC Exchange |
$38.62
|
| Rate for Payer: UHC Medicaid |
$27.23
|
| Rate for Payer: UHC Medicare Advantage |
$38.62
|
| Rate for Payer: UHCCP Medicaid |
$27.23
|
| Rate for Payer: VA VA |
$38.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$154.47
|
|
|
Service Code
|
NDC 31722066860
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: BCBS Trust/PPO |
$127.58
|
| Rate for Payer: BCN Commercial |
$127.58
|
| Rate for Payer: Cash Price |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.58
|
| Rate for Payer: Healthscope Commercial |
$139.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.30
|
| Rate for Payer: Nomi Health Commercial |
$126.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.85
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.93
|
| Rate for Payer: UHC Core |
$128.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$176.55
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.88 |
| Max. Negotiated Rate |
$158.90 |
| Rate for Payer: Aetna Commercial |
$150.07
|
| Rate for Payer: BCBS Trust/PPO |
$145.81
|
| Rate for Payer: BCN Commercial |
$145.81
|
| Rate for Payer: Cash Price |
$141.24
|
| Rate for Payer: Cofinity Commercial |
$151.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.24
|
| Rate for Payer: Healthscope Commercial |
$158.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.07
|
| Rate for Payer: Nomi Health Commercial |
$144.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.41
|
| Rate for Payer: PHP Commercial |
$150.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$153.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.36
|
| Rate for Payer: UHC Core |
$147.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.41
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.43 |
| Max. Negotiated Rate |
$1,273.33 |
| Rate for Payer: Aetna Commercial |
$1,202.59
|
| Rate for Payer: Aetna Medicare |
$367.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.13
|
| Rate for Payer: BCBS Complete |
$261.88
|
| Rate for Payer: BCBS MAPPO |
$353.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,163.12
|
| Rate for Payer: BCN Commercial |
$1,163.12
|
| Rate for Payer: BCN Medicare Advantage |
$353.70
|
| Rate for Payer: Cash Price |
$1,131.85
|
| Rate for Payer: Cofinity Commercial |
$1,216.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.70
|
| Rate for Payer: Healthscope Commercial |
$1,273.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.11
|
| Rate for Payer: Mclaren Medicaid |
$249.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.39
|
| Rate for Payer: Meridian Medicaid |
$261.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$406.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$389.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.59
|
| Rate for Payer: Nomi Health Commercial |
$1,160.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,061.11
|
| Rate for Payer: PACE Senior Care Partners |
$336.02
|
| Rate for Payer: PACE SWMI |
$353.70
|
| Rate for Payer: PHP Commercial |
$1,202.59
|
| Rate for Payer: PHP Medicare Advantage |
$353.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,230.88
|
| Rate for Payer: Priority Health Medicare |
$357.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$984.71
|
| Rate for Payer: Railroad Medicare Medicare |
$353.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,245.03
|
| Rate for Payer: UHC Core |
$1,181.37
|
| Rate for Payer: UHC Exchange |
$353.70
|
| Rate for Payer: UHC Medicaid |
$249.43
|
| Rate for Payer: UHC Medicare Advantage |
$353.70
|
| Rate for Payer: UHCCP Medicaid |
$249.43
|
| Rate for Payer: VA VA |
$353.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.11
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$5.89
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Aetna Commercial |
$5.01
|
| Rate for Payer: Aetna Medicare |
$1.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.84
|
| Rate for Payer: BCBS Complete |
$1.09
|
| Rate for Payer: BCBS MAPPO |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$4.84
|
| Rate for Payer: BCN Commercial |
$4.84
|
| Rate for Payer: BCN Medicare Advantage |
$1.47
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$5.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.47
|
| Rate for Payer: Healthscope Commercial |
$5.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.42
|
| Rate for Payer: Mclaren Medicaid |
$1.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.55
|
| Rate for Payer: Meridian Medicaid |
$1.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.01
|
| Rate for Payer: Nomi Health Commercial |
$4.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.42
|
| Rate for Payer: PACE Senior Care Partners |
$1.40
|
| Rate for Payer: PACE SWMI |
$1.47
|
| Rate for Payer: PHP Commercial |
$5.01
|
| Rate for Payer: PHP Medicare Advantage |
$1.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.12
|
| Rate for Payer: Priority Health Medicare |
$1.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.18
|
| Rate for Payer: UHC Core |
$4.92
|
| Rate for Payer: UHC Exchange |
$1.47
|
| Rate for Payer: UHC Medicaid |
$1.04
|
| Rate for Payer: UHC Medicare Advantage |
$1.47
|
| Rate for Payer: UHCCP Medicaid |
$1.04
|
| Rate for Payer: VA VA |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.42
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$851.01
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$592.30 |
| Max. Negotiated Rate |
$765.91 |
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Commercial |
$30.72
|
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: BCBS Trust/PPO |
$702.85
|
| Rate for Payer: BCBS Trust/PPO |
$30.21
|
| Rate for Payer: BCBS Trust/PPO |
$44.44
|
| Rate for Payer: BCBS Trust/PPO |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$85.46
|
| Rate for Payer: BCBS Trust/PPO |
$29.85
|
| Rate for Payer: BCN Commercial |
$44.44
|
| Rate for Payer: BCN Commercial |
$30.21
|
| Rate for Payer: BCN Commercial |
$85.46
|
| Rate for Payer: BCN Commercial |
$29.85
|
| Rate for Payer: BCN Commercial |
$702.85
|
| Rate for Payer: BCN Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cash Price |
$28.91
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Cofinity Commercial |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$31.46
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Healthscope Commercial |
$28.12
|
| Rate for Payer: Healthscope Commercial |
$48.43
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.72
|
| Rate for Payer: Nomi Health Commercial |
$44.12
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: Nomi Health Commercial |
$25.62
|
| Rate for Payer: Nomi Health Commercial |
$30.00
|
| Rate for Payer: Nomi Health Commercial |
$29.63
|
| Rate for Payer: Nomi Health Commercial |
$697.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: PHP Commercial |
$45.74
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Commercial |
$26.55
|
| Rate for Payer: PHP Commercial |
$30.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$740.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$592.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.89
|
| Rate for Payer: UHC Core |
$710.59
|
| Rate for Payer: UHC Core |
$26.09
|
| Rate for Payer: UHC Core |
$30.18
|
| Rate for Payer: UHC Core |
$44.93
|
| Rate for Payer: UHC Core |
$30.54
|
| Rate for Payer: UHC Core |
$86.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$851.01
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.03 |
| Max. Negotiated Rate |
$765.91 |
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: Aetna Commercial |
$31.09
|
| Rate for Payer: Aetna Commercial |
$87.95
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Commercial |
$30.72
|
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna Medicare |
$9.51
|
| Rate for Payer: Aetna Medicare |
$8.12
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: Aetna Medicare |
$221.26
|
| Rate for Payer: Aetna Medicare |
$9.40
|
| Rate for Payer: Aetna Medicare |
$13.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$265.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$265.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.43
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Complete |
$9.96
|
| Rate for Payer: BCBS Complete |
$5.78
|
| Rate for Payer: BCBS Complete |
$19.15
|
| Rate for Payer: BCBS Complete |
$157.52
|
| Rate for Payer: BCBS Complete |
$6.77
|
| Rate for Payer: BCBS MAPPO |
$9.14
|
| Rate for Payer: BCBS MAPPO |
$212.75
|
| Rate for Payer: BCBS MAPPO |
$13.45
|
| Rate for Payer: BCBS MAPPO |
$7.81
|
| Rate for Payer: BCBS MAPPO |
$25.87
|
| Rate for Payer: BCBS MAPPO |
$9.04
|
| Rate for Payer: BCBS Trust/PPO |
$85.06
|
| Rate for Payer: BCBS Trust/PPO |
$44.24
|
| Rate for Payer: BCBS Trust/PPO |
$25.68
|
| Rate for Payer: BCBS Trust/PPO |
$29.71
|
| Rate for Payer: BCBS Trust/PPO |
$30.07
|
| Rate for Payer: BCBS Trust/PPO |
$699.62
|
| Rate for Payer: BCN Commercial |
$29.71
|
| Rate for Payer: BCN Commercial |
$30.07
|
| Rate for Payer: BCN Commercial |
$85.06
|
| Rate for Payer: BCN Commercial |
$25.68
|
| Rate for Payer: BCN Commercial |
$44.24
|
| Rate for Payer: BCN Commercial |
$699.62
|
| Rate for Payer: BCN Medicare Advantage |
$13.45
|
| Rate for Payer: BCN Medicare Advantage |
$212.75
|
| Rate for Payer: BCN Medicare Advantage |
$9.04
|
| Rate for Payer: BCN Medicare Advantage |
$25.87
|
| Rate for Payer: BCN Medicare Advantage |
$9.14
|
| Rate for Payer: BCN Medicare Advantage |
$7.81
|
| Rate for Payer: Cash Price |
$29.26
|
| Rate for Payer: Cash Price |
$82.78
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$28.91
|
| Rate for Payer: Cofinity Commercial |
$31.46
|
| Rate for Payer: Cofinity Commercial |
$31.08
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.81
|
| Rate for Payer: Healthscope Commercial |
$32.92
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Healthscope Commercial |
$28.12
|
| Rate for Payer: Healthscope Commercial |
$93.12
|
| Rate for Payer: Healthscope Commercial |
$48.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.11
|
| Rate for Payer: Mclaren Medicaid |
$5.51
|
| Rate for Payer: Mclaren Medicaid |
$18.24
|
| Rate for Payer: Mclaren Medicaid |
$6.37
|
| Rate for Payer: Mclaren Medicaid |
$6.45
|
| Rate for Payer: Mclaren Medicaid |
$9.49
|
| Rate for Payer: Mclaren Medicaid |
$150.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.49
|
| Rate for Payer: Meridian Medicaid |
$9.96
|
| Rate for Payer: Meridian Medicaid |
$157.52
|
| Rate for Payer: Meridian Medicaid |
$5.78
|
| Rate for Payer: Meridian Medicaid |
$19.15
|
| Rate for Payer: Meridian Medicaid |
$6.69
|
| Rate for Payer: Meridian Medicaid |
$6.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$234.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Nomi Health Commercial |
$29.63
|
| Rate for Payer: Nomi Health Commercial |
$30.00
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: Nomi Health Commercial |
$44.12
|
| Rate for Payer: Nomi Health Commercial |
$697.83
|
| Rate for Payer: Nomi Health Commercial |
$25.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$638.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.43
|
| Rate for Payer: PACE Senior Care Partners |
$8.58
|
| Rate for Payer: PACE Senior Care Partners |
$7.42
|
| Rate for Payer: PACE Senior Care Partners |
$8.69
|
| Rate for Payer: PACE Senior Care Partners |
$12.78
|
| Rate for Payer: PACE Senior Care Partners |
$24.57
|
| Rate for Payer: PACE Senior Care Partners |
$202.11
|
| Rate for Payer: PACE SWMI |
$7.81
|
| Rate for Payer: PACE SWMI |
$9.14
|
| Rate for Payer: PACE SWMI |
$212.75
|
| Rate for Payer: PACE SWMI |
$25.87
|
| Rate for Payer: PACE SWMI |
$13.45
|
| Rate for Payer: PACE SWMI |
$9.04
|
| Rate for Payer: PHP Commercial |
$30.72
|
| Rate for Payer: PHP Commercial |
$26.55
|
| Rate for Payer: PHP Commercial |
$31.09
|
| Rate for Payer: PHP Commercial |
$45.74
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: PHP Commercial |
$87.95
|
| Rate for Payer: PHP Medicare Advantage |
$212.75
|
| Rate for Payer: PHP Medicare Advantage |
$7.81
|
| Rate for Payer: PHP Medicare Advantage |
$13.45
|
| Rate for Payer: PHP Medicare Advantage |
$25.87
|
| Rate for Payer: PHP Medicare Advantage |
$9.14
|
| Rate for Payer: PHP Medicare Advantage |
$9.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$740.38
|
| Rate for Payer: Priority Health Medicare |
$26.13
|
| Rate for Payer: Priority Health Medicare |
$214.88
|
| Rate for Payer: Priority Health Medicare |
$7.89
|
| Rate for Payer: Priority Health Medicare |
$9.24
|
| Rate for Payer: Priority Health Medicare |
$9.13
|
| Rate for Payer: Priority Health Medicare |
$13.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$592.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.46
|
| Rate for Payer: Railroad Medicare Medicare |
$25.87
|
| Rate for Payer: Railroad Medicare Medicare |
$13.45
|
| Rate for Payer: Railroad Medicare Medicare |
$9.14
|
| Rate for Payer: Railroad Medicare Medicare |
$7.81
|
| Rate for Payer: Railroad Medicare Medicare |
$9.04
|
| Rate for Payer: Railroad Medicare Medicare |
$212.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.05
|
| Rate for Payer: UHC Core |
$30.18
|
| Rate for Payer: UHC Core |
$44.93
|
| Rate for Payer: UHC Core |
$30.54
|
| Rate for Payer: UHC Core |
$710.59
|
| Rate for Payer: UHC Core |
$86.40
|
| Rate for Payer: UHC Core |
$26.09
|
| Rate for Payer: UHC Exchange |
$7.81
|
| Rate for Payer: UHC Exchange |
$25.87
|
| Rate for Payer: UHC Exchange |
$9.14
|
| Rate for Payer: UHC Exchange |
$9.04
|
| Rate for Payer: UHC Exchange |
$13.45
|
| Rate for Payer: UHC Exchange |
$212.75
|
| Rate for Payer: UHC Medicaid |
$9.49
|
| Rate for Payer: UHC Medicaid |
$6.45
|
| Rate for Payer: UHC Medicaid |
$5.51
|
| Rate for Payer: UHC Medicaid |
$6.37
|
| Rate for Payer: UHC Medicaid |
$18.24
|
| Rate for Payer: UHC Medicaid |
$150.03
|
| Rate for Payer: UHC Medicare Advantage |
$7.81
|
| Rate for Payer: UHC Medicare Advantage |
$13.45
|
| Rate for Payer: UHC Medicare Advantage |
$9.14
|
| Rate for Payer: UHC Medicare Advantage |
$9.04
|
| Rate for Payer: UHC Medicare Advantage |
$25.87
|
| Rate for Payer: UHC Medicare Advantage |
$212.75
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: UHCCP Medicaid |
$6.45
|
| Rate for Payer: UHCCP Medicaid |
$6.37
|
| Rate for Payer: UHCCP Medicaid |
$5.51
|
| Rate for Payer: UHCCP Medicaid |
$18.24
|
| Rate for Payer: UHCCP Medicaid |
$150.03
|
| Rate for Payer: VA VA |
$9.04
|
| Rate for Payer: VA VA |
$7.81
|
| Rate for Payer: VA VA |
$13.45
|
| Rate for Payer: VA VA |
$9.14
|
| Rate for Payer: VA VA |
$25.87
|
| Rate for Payer: VA VA |
$212.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.11
|
|
|
REHABILITATION
|
Facility
|
IP
|
$13,064.49
|
|
|
Service Code
|
APR-DRG 8604
|
| Min. Negotiated Rate |
$12,442.38 |
| Max. Negotiated Rate |
$13,064.49 |
| Rate for Payer: BCBS Complete |
$13,064.49
|
| Rate for Payer: Mclaren Medicaid |
$12,442.38
|
| Rate for Payer: Meridian Medicaid |
$13,064.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,442.38
|
| Rate for Payer: UHC Medicaid |
$12,442.38
|
| Rate for Payer: UHCCP Medicaid |
$12,442.38
|
|
|
REHABILITATION
|
Facility
|
IP
|
$11,076.82
|
|
|
Service Code
|
APR-DRG 8602
|
| Min. Negotiated Rate |
$10,549.35 |
| Max. Negotiated Rate |
$11,076.82 |
| Rate for Payer: BCBS Complete |
$11,076.82
|
| Rate for Payer: Mclaren Medicaid |
$10,549.35
|
| Rate for Payer: Meridian Medicaid |
$11,076.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,549.35
|
| Rate for Payer: UHC Medicaid |
$10,549.35
|
| Rate for Payer: UHCCP Medicaid |
$10,549.35
|
|
|
REHABILITATION
|
Facility
|
IP
|
$11,122.57
|
|
|
Service Code
|
APR-DRG 8603
|
| Min. Negotiated Rate |
$10,592.92 |
| Max. Negotiated Rate |
$11,122.57 |
| Rate for Payer: BCBS Complete |
$11,122.57
|
| Rate for Payer: Mclaren Medicaid |
$10,592.92
|
| Rate for Payer: Meridian Medicaid |
$11,122.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,592.92
|
| Rate for Payer: UHC Medicaid |
$10,592.92
|
| Rate for Payer: UHCCP Medicaid |
$10,592.92
|
|
|
REHABILITATION
|
Facility
|
IP
|
$8,766.28
|
|
|
Service Code
|
APR-DRG 8601
|
| Min. Negotiated Rate |
$8,348.84 |
| Max. Negotiated Rate |
$8,766.28 |
| Rate for Payer: BCBS Complete |
$8,766.28
|
| Rate for Payer: Mclaren Medicaid |
$8,348.84
|
| Rate for Payer: Meridian Medicaid |
$8,766.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,348.84
|
| Rate for Payer: UHC Medicaid |
$8,348.84
|
| Rate for Payer: UHCCP Medicaid |
$8,348.84
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$2,267.62
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$399.78 |
| Max. Negotiated Rate |
$2,040.86 |
| Rate for Payer: Aetna Commercial |
$1,927.48
|
| Rate for Payer: Aetna Medicare |
$589.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$708.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$708.63
|
| Rate for Payer: BCBS Complete |
$419.74
|
| Rate for Payer: BCBS MAPPO |
$566.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,864.21
|
| Rate for Payer: BCN Commercial |
$1,864.21
|
| Rate for Payer: BCN Medicare Advantage |
$566.90
|
| Rate for Payer: Cash Price |
$1,814.10
|
| Rate for Payer: Cofinity Commercial |
$1,950.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,814.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$566.90
|
| Rate for Payer: Healthscope Commercial |
$2,040.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,700.71
|
| Rate for Payer: Mclaren Medicaid |
$399.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$595.25
|
| Rate for Payer: Meridian Medicaid |
$419.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$651.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$623.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,927.48
|
| Rate for Payer: Nomi Health Commercial |
$1,859.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,700.71
|
| Rate for Payer: PACE Senior Care Partners |
$538.56
|
| Rate for Payer: PACE SWMI |
$566.90
|
| Rate for Payer: PHP Commercial |
$1,927.48
|
| Rate for Payer: PHP Medicare Advantage |
$566.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$399.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,972.83
|
| Rate for Payer: Priority Health Medicare |
$572.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,578.26
|
| Rate for Payer: Railroad Medicare Medicare |
$566.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,995.51
|
| Rate for Payer: UHC Core |
$1,893.46
|
| Rate for Payer: UHC Exchange |
$566.90
|
| Rate for Payer: UHC Medicaid |
$399.78
|
| Rate for Payer: UHC Medicare Advantage |
$566.90
|
| Rate for Payer: UHCCP Medicaid |
$399.78
|
| Rate for Payer: VA VA |
$566.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,700.71
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$2,267.62
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,578.26 |
| Max. Negotiated Rate |
$2,040.86 |
| Rate for Payer: Aetna Commercial |
$1,927.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.83
|
| Rate for Payer: BCN Commercial |
$1,872.83
|
| Rate for Payer: Cash Price |
$1,814.10
|
| Rate for Payer: Cofinity Commercial |
$1,950.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,814.10
|
| Rate for Payer: Healthscope Commercial |
$2,040.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,700.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,927.48
|
| Rate for Payer: Nomi Health Commercial |
$1,859.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,700.71
|
| Rate for Payer: PHP Commercial |
$1,927.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,972.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,578.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,995.51
|
| Rate for Payer: UHC Core |
$1,893.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,700.71
|
|
|
REMDESIVIR 200 MG/250 ML INFUSION (IV PREMIX)
|
Facility
|
OP
|
$3,520.00
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$620.58 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,992.00
|
| Rate for Payer: Aetna Medicare |
$915.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,100.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,100.00
|
| Rate for Payer: BCBS Complete |
$651.55
|
| Rate for Payer: BCBS MAPPO |
$880.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,893.79
|
| Rate for Payer: BCN Commercial |
$2,893.79
|
| Rate for Payer: BCN Medicare Advantage |
$880.00
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Cofinity Commercial |
$3,027.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,816.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$880.00
|
| Rate for Payer: Healthscope Commercial |
$3,168.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,640.00
|
| Rate for Payer: Mclaren Medicaid |
$620.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$924.00
|
| Rate for Payer: Meridian Medicaid |
$651.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,012.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$968.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,992.00
|
| Rate for Payer: Nomi Health Commercial |
$2,886.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,640.00
|
| Rate for Payer: PACE Senior Care Partners |
$836.00
|
| Rate for Payer: PACE SWMI |
$880.00
|
| Rate for Payer: PHP Commercial |
$2,992.00
|
| Rate for Payer: PHP Medicare Advantage |
$880.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$620.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,062.40
|
| Rate for Payer: Priority Health Medicare |
$888.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,449.92
|
| Rate for Payer: Railroad Medicare Medicare |
$880.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,097.60
|
| Rate for Payer: UHC Core |
$2,939.20
|
| Rate for Payer: UHC Exchange |
$880.00
|
| Rate for Payer: UHC Medicaid |
$620.58
|
| Rate for Payer: UHC Medicare Advantage |
$880.00
|
| Rate for Payer: UHCCP Medicaid |
$620.58
|
| Rate for Payer: VA VA |
$880.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,640.00
|
|
|
REMDESIVIR 200 MG/250 ML INFUSION (IV PREMIX)
|
Facility
|
IP
|
$3,520.00
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,449.92 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna Commercial |
$2,992.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,907.17
|
| Rate for Payer: BCN Commercial |
$2,907.17
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Cofinity Commercial |
$3,027.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,816.00
|
| Rate for Payer: Healthscope Commercial |
$3,168.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,640.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,992.00
|
| Rate for Payer: Nomi Health Commercial |
$2,886.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,640.00
|
| Rate for Payer: PHP Commercial |
$2,992.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,062.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,449.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,097.60
|
| Rate for Payer: UHC Core |
$2,939.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,640.00
|
|
|
RENAL DIALYSIS ACCESS PROCEDURES
|
Facility
|
IP
|
$6,525.15
|
|
|
Service Code
|
APR-DRG 4441
|
| Min. Negotiated Rate |
$6,214.43 |
| Max. Negotiated Rate |
$6,525.15 |
| Rate for Payer: BCBS Complete |
$6,525.15
|
| Rate for Payer: Mclaren Medicaid |
$6,214.43
|
| Rate for Payer: Meridian Medicaid |
$6,525.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,214.43
|
| Rate for Payer: UHC Medicaid |
$6,214.43
|
| Rate for Payer: UHCCP Medicaid |
$6,214.43
|
|
|
RENAL DIALYSIS ACCESS PROCEDURES
|
Facility
|
IP
|
$9,509.82
|
|
|
Service Code
|
APR-DRG 4442
|
| Min. Negotiated Rate |
$9,056.97 |
| Max. Negotiated Rate |
$9,509.82 |
| Rate for Payer: BCBS Complete |
$9,509.82
|
| Rate for Payer: Mclaren Medicaid |
$9,056.97
|
| Rate for Payer: Meridian Medicaid |
$9,509.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,056.97
|
| Rate for Payer: UHC Medicaid |
$9,056.97
|
| Rate for Payer: UHCCP Medicaid |
$9,056.97
|
|
|
RENAL DIALYSIS ACCESS PROCEDURES
|
Facility
|
IP
|
$19,415.06
|
|
|
Service Code
|
APR-DRG 4444
|
| Min. Negotiated Rate |
$18,490.54 |
| Max. Negotiated Rate |
$19,415.06 |
| Rate for Payer: BCBS Complete |
$19,415.06
|
| Rate for Payer: Mclaren Medicaid |
$18,490.54
|
| Rate for Payer: Meridian Medicaid |
$19,415.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,490.54
|
| Rate for Payer: UHC Medicaid |
$18,490.54
|
| Rate for Payer: UHCCP Medicaid |
$18,490.54
|
|
