|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 00904640161
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$50.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.27
|
| Rate for Payer: BCBS Complete |
$35.70
|
| Rate for Payer: BCBS MAPPO |
$48.21
|
| Rate for Payer: BCBS Trust/PPO |
$158.54
|
| Rate for Payer: BCN Commercial |
$158.54
|
| Rate for Payer: BCN Medicare Advantage |
$48.21
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.21
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Mclaren Medicaid |
$34.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.62
|
| Rate for Payer: Meridian Medicaid |
$35.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.64
|
| Rate for Payer: PACE Senior Care Partners |
$45.80
|
| Rate for Payer: PACE SWMI |
$48.21
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: PHP Medicare Advantage |
$48.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Medicare |
$48.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.22
|
| Rate for Payer: Railroad Medicare Medicare |
$48.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: UHC Exchange |
$48.21
|
| Rate for Payer: UHC Medicaid |
$34.00
|
| Rate for Payer: UHC Medicare Advantage |
$48.21
|
| Rate for Payer: UHCCP Medicaid |
$34.00
|
| Rate for Payer: VA VA |
$48.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$258.40
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.85 |
| Max. Negotiated Rate |
$232.56 |
| Rate for Payer: Aetna Commercial |
$219.64
|
| Rate for Payer: BCBS Trust/PPO |
$213.41
|
| Rate for Payer: BCN Commercial |
$213.41
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Cofinity Commercial |
$222.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.72
|
| Rate for Payer: Healthscope Commercial |
$232.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.64
|
| Rate for Payer: Nomi Health Commercial |
$211.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.80
|
| Rate for Payer: PHP Commercial |
$219.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.39
|
| Rate for Payer: UHC Core |
$215.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.80
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 68084029911
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.81
|
| Rate for Payer: BCBS Complete |
$0.48
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Mclaren Medicaid |
$0.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.68
|
| Rate for Payer: Meridian Medicaid |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PACE Senior Care Partners |
$0.62
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.25
|
| Rate for Payer: Priority Health Medicare |
$0.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.28
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicaid |
$0.46
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: UHCCP Medicaid |
$0.46
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 00904738361
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.37 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna Medicare |
$61.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.33
|
| Rate for Payer: BCBS Complete |
$43.43
|
| Rate for Payer: BCBS MAPPO |
$58.66
|
| Rate for Payer: BCBS Trust/PPO |
$192.91
|
| Rate for Payer: BCN Commercial |
$192.91
|
| Rate for Payer: BCN Medicare Advantage |
$58.66
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.66
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Mclaren Medicaid |
$41.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.60
|
| Rate for Payer: Meridian Medicaid |
$43.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PACE Senior Care Partners |
$55.73
|
| Rate for Payer: PACE SWMI |
$58.66
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: PHP Medicare Advantage |
$58.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.15
|
| Rate for Payer: Priority Health Medicare |
$59.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.32
|
| Rate for Payer: Railroad Medicare Medicare |
$58.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.49
|
| Rate for Payer: UHC Core |
$195.93
|
| Rate for Payer: UHC Exchange |
$58.66
|
| Rate for Payer: UHC Medicaid |
$41.37
|
| Rate for Payer: UHC Medicare Advantage |
$58.66
|
| Rate for Payer: UHCCP Medicaid |
$41.37
|
| Rate for Payer: VA VA |
$58.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 68084029911
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: BCBS Trust/PPO |
$2.14
|
| Rate for Payer: BCN Commercial |
$2.14
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.94
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.28
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 00904738361
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.32 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: BCBS Trust/PPO |
$193.80
|
| Rate for Payer: BCN Commercial |
$193.80
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.49
|
| Rate for Payer: UHC Core |
$195.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$441.75
|
|
|
Service Code
|
NDC 00781207601
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.46 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: BCBS Trust/PPO |
$364.84
|
| Rate for Payer: BCN Commercial |
$364.84
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Nomi Health Commercial |
$362.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.31
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$384.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.74
|
| Rate for Payer: UHC Core |
$368.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$441.75
|
|
|
Service Code
|
NDC 00781207601
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna Medicare |
$114.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.05
|
| Rate for Payer: BCBS Complete |
$81.77
|
| Rate for Payer: BCBS MAPPO |
$110.44
|
| Rate for Payer: BCBS Trust/PPO |
$363.16
|
| Rate for Payer: BCN Commercial |
$363.16
|
| Rate for Payer: BCN Medicare Advantage |
$110.44
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.44
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Mclaren Medicaid |
$77.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.96
|
| Rate for Payer: Meridian Medicaid |
$81.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Nomi Health Commercial |
$362.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.31
|
| Rate for Payer: PACE Senior Care Partners |
$104.92
|
| Rate for Payer: PACE SWMI |
$110.44
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: PHP Medicare Advantage |
$110.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$384.32
|
| Rate for Payer: Priority Health Medicare |
$111.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.46
|
| Rate for Payer: Railroad Medicare Medicare |
$110.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.74
|
| Rate for Payer: UHC Core |
$368.86
|
| Rate for Payer: UHC Exchange |
$110.44
|
| Rate for Payer: UHC Medicaid |
$77.88
|
| Rate for Payer: UHC Medicare Advantage |
$110.44
|
| Rate for Payer: UHCCP Medicaid |
$77.88
|
| Rate for Payer: VA VA |
$110.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 00904640161
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.22 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: BCBS Trust/PPO |
$159.27
|
| Rate for Payer: BCN Commercial |
$159.27
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.64
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
OP
|
$258.40
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.56 |
| Max. Negotiated Rate |
$232.56 |
| Rate for Payer: Aetna Commercial |
$219.64
|
| Rate for Payer: Aetna Medicare |
$67.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.75
|
| Rate for Payer: BCBS Complete |
$47.83
|
| Rate for Payer: BCBS MAPPO |
$64.60
|
| Rate for Payer: BCBS Trust/PPO |
$212.43
|
| Rate for Payer: BCN Commercial |
$212.43
|
| Rate for Payer: BCN Medicare Advantage |
$64.60
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Cofinity Commercial |
$222.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.60
|
| Rate for Payer: Healthscope Commercial |
$232.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.80
|
| Rate for Payer: Mclaren Medicaid |
$45.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.83
|
| Rate for Payer: Meridian Medicaid |
$47.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.64
|
| Rate for Payer: Nomi Health Commercial |
$211.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.80
|
| Rate for Payer: PACE Senior Care Partners |
$61.37
|
| Rate for Payer: PACE SWMI |
$64.60
|
| Rate for Payer: PHP Commercial |
$219.64
|
| Rate for Payer: PHP Medicare Advantage |
$64.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.81
|
| Rate for Payer: Priority Health Medicare |
$65.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.85
|
| Rate for Payer: Railroad Medicare Medicare |
$64.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.39
|
| Rate for Payer: UHC Core |
$215.76
|
| Rate for Payer: UHC Exchange |
$64.60
|
| Rate for Payer: UHC Medicaid |
$45.56
|
| Rate for Payer: UHC Medicare Advantage |
$64.60
|
| Rate for Payer: UHCCP Medicaid |
$45.56
|
| Rate for Payer: VA VA |
$64.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.80
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
NDC 51079041801
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: BCBS Trust/PPO |
$1.23
|
| Rate for Payer: BCN Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: Nomi Health Commercial |
$1.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.12
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.31
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
NDC 51079041801
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna Medicare |
$0.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.47
|
| Rate for Payer: BCBS Complete |
$0.28
|
| Rate for Payer: BCBS MAPPO |
$0.37
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.22
|
| Rate for Payer: BCN Medicare Advantage |
$0.37
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.37
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Mclaren Medicaid |
$0.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.39
|
| Rate for Payer: Meridian Medicaid |
$0.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: Nomi Health Commercial |
$1.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.12
|
| Rate for Payer: PACE Senior Care Partners |
$0.35
|
| Rate for Payer: PACE SWMI |
$0.37
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: PHP Medicare Advantage |
$0.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.04
|
| Rate for Payer: Railroad Medicare Medicare |
$0.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.31
|
| Rate for Payer: UHC Core |
$1.24
|
| Rate for Payer: UHC Exchange |
$0.37
|
| Rate for Payer: UHC Medicaid |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: UHCCP Medicaid |
$0.26
|
| Rate for Payer: VA VA |
$0.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$138.25
|
|
|
Service Code
|
NDC 00228207610
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.22 |
| Max. Negotiated Rate |
$124.42 |
| Rate for Payer: Aetna Commercial |
$117.51
|
| Rate for Payer: BCBS Trust/PPO |
$114.18
|
| Rate for Payer: BCN Commercial |
$114.18
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: Cofinity Commercial |
$118.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.60
|
| Rate for Payer: Healthscope Commercial |
$124.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.51
|
| Rate for Payer: Nomi Health Commercial |
$113.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.69
|
| Rate for Payer: PHP Commercial |
$117.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.66
|
| Rate for Payer: UHC Core |
$115.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.69
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$152.25
|
|
|
Service Code
|
NDC 00378401001
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$137.03 |
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Aetna Medicare |
$39.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.58
|
| Rate for Payer: BCBS Complete |
$28.18
|
| Rate for Payer: BCBS MAPPO |
$38.06
|
| Rate for Payer: BCBS Trust/PPO |
$125.16
|
| Rate for Payer: BCN Commercial |
$125.16
|
| Rate for Payer: BCN Medicare Advantage |
$38.06
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cofinity Commercial |
$130.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.06
|
| Rate for Payer: Healthscope Commercial |
$137.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.19
|
| Rate for Payer: Mclaren Medicaid |
$26.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.97
|
| Rate for Payer: Meridian Medicaid |
$28.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.41
|
| Rate for Payer: Nomi Health Commercial |
$124.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.19
|
| Rate for Payer: PACE Senior Care Partners |
$36.16
|
| Rate for Payer: PACE SWMI |
$38.06
|
| Rate for Payer: PHP Commercial |
$129.41
|
| Rate for Payer: PHP Medicare Advantage |
$38.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.46
|
| Rate for Payer: Priority Health Medicare |
$38.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.97
|
| Rate for Payer: Railroad Medicare Medicare |
$38.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.98
|
| Rate for Payer: UHC Core |
$127.13
|
| Rate for Payer: UHC Exchange |
$38.06
|
| Rate for Payer: UHC Medicaid |
$26.84
|
| Rate for Payer: UHC Medicare Advantage |
$38.06
|
| Rate for Payer: UHCCP Medicaid |
$26.84
|
| Rate for Payer: VA VA |
$38.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.19
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$138.25
|
|
|
Service Code
|
NDC 00228207610
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$124.42 |
| Rate for Payer: Aetna Commercial |
$117.51
|
| Rate for Payer: Aetna Medicare |
$35.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.20
|
| Rate for Payer: BCBS Complete |
$25.59
|
| Rate for Payer: BCBS MAPPO |
$34.56
|
| Rate for Payer: BCBS Trust/PPO |
$113.66
|
| Rate for Payer: BCN Commercial |
$113.66
|
| Rate for Payer: BCN Medicare Advantage |
$34.56
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: Cofinity Commercial |
$118.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.56
|
| Rate for Payer: Healthscope Commercial |
$124.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.69
|
| Rate for Payer: Mclaren Medicaid |
$24.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.29
|
| Rate for Payer: Meridian Medicaid |
$25.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.51
|
| Rate for Payer: Nomi Health Commercial |
$113.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.69
|
| Rate for Payer: PACE Senior Care Partners |
$32.83
|
| Rate for Payer: PACE SWMI |
$34.56
|
| Rate for Payer: PHP Commercial |
$117.51
|
| Rate for Payer: PHP Medicare Advantage |
$34.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.28
|
| Rate for Payer: Priority Health Medicare |
$34.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.22
|
| Rate for Payer: Railroad Medicare Medicare |
$34.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.66
|
| Rate for Payer: UHC Core |
$115.44
|
| Rate for Payer: UHC Exchange |
$34.56
|
| Rate for Payer: UHC Medicaid |
$24.37
|
| Rate for Payer: UHC Medicare Advantage |
$34.56
|
| Rate for Payer: UHCCP Medicaid |
$24.37
|
| Rate for Payer: VA VA |
$34.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.69
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$152.25
|
|
|
Service Code
|
NDC 00378401001
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.97 |
| Max. Negotiated Rate |
$137.03 |
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: BCBS Trust/PPO |
$125.74
|
| Rate for Payer: BCN Commercial |
$125.74
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cofinity Commercial |
$130.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.80
|
| Rate for Payer: Healthscope Commercial |
$137.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.41
|
| Rate for Payer: Nomi Health Commercial |
$124.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.19
|
| Rate for Payer: PHP Commercial |
$129.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.98
|
| Rate for Payer: UHC Core |
$127.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.19
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$338.95
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.91 |
| Max. Negotiated Rate |
$305.06 |
| Rate for Payer: Aetna Commercial |
$288.11
|
| Rate for Payer: BCBS Trust/PPO |
$279.94
|
| Rate for Payer: BCN Commercial |
$279.94
|
| Rate for Payer: Cash Price |
$271.16
|
| Rate for Payer: Cofinity Commercial |
$291.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.16
|
| Rate for Payer: Healthscope Commercial |
$305.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.11
|
| Rate for Payer: Nomi Health Commercial |
$277.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.21
|
| Rate for Payer: PHP Commercial |
$288.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.28
|
| Rate for Payer: UHC Core |
$283.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.21
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$338.95
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$305.06 |
| Rate for Payer: Aetna Commercial |
$288.11
|
| Rate for Payer: Aetna Medicare |
$88.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.92
|
| Rate for Payer: BCBS Complete |
$62.74
|
| Rate for Payer: BCBS MAPPO |
$84.74
|
| Rate for Payer: BCBS Trust/PPO |
$278.65
|
| Rate for Payer: BCN Commercial |
$278.65
|
| Rate for Payer: BCN Medicare Advantage |
$84.74
|
| Rate for Payer: Cash Price |
$271.16
|
| Rate for Payer: Cofinity Commercial |
$291.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.74
|
| Rate for Payer: Healthscope Commercial |
$305.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.21
|
| Rate for Payer: Mclaren Medicaid |
$59.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.97
|
| Rate for Payer: Meridian Medicaid |
$62.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.11
|
| Rate for Payer: Nomi Health Commercial |
$277.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.21
|
| Rate for Payer: PACE Senior Care Partners |
$80.50
|
| Rate for Payer: PACE SWMI |
$84.74
|
| Rate for Payer: PHP Commercial |
$288.11
|
| Rate for Payer: PHP Medicare Advantage |
$84.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.89
|
| Rate for Payer: Priority Health Medicare |
$85.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.91
|
| Rate for Payer: Railroad Medicare Medicare |
$84.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.28
|
| Rate for Payer: UHC Core |
$283.02
|
| Rate for Payer: UHC Exchange |
$84.74
|
| Rate for Payer: UHC Medicaid |
$59.76
|
| Rate for Payer: UHC Medicare Advantage |
$84.74
|
| Rate for Payer: UHCCP Medicaid |
$59.76
|
| Rate for Payer: VA VA |
$84.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.21
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$7,191.91
|
|
|
Service Code
|
APR-DRG 3171
|
| Min. Negotiated Rate |
$6,849.44 |
| Max. Negotiated Rate |
$7,191.91 |
| Rate for Payer: BCBS Complete |
$7,191.91
|
| Rate for Payer: Mclaren Medicaid |
$6,849.44
|
| Rate for Payer: Meridian Medicaid |
$7,191.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,849.44
|
| Rate for Payer: UHC Medicaid |
$6,849.44
|
| Rate for Payer: UHCCP Medicaid |
$6,849.44
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$11,217.74
|
|
|
Service Code
|
APR-DRG 3173
|
| Min. Negotiated Rate |
$10,683.57 |
| Max. Negotiated Rate |
$11,217.74 |
| Rate for Payer: BCBS Complete |
$11,217.74
|
| Rate for Payer: Mclaren Medicaid |
$10,683.57
|
| Rate for Payer: Meridian Medicaid |
$11,217.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,683.57
|
| Rate for Payer: UHC Medicaid |
$10,683.57
|
| Rate for Payer: UHCCP Medicaid |
$10,683.57
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$9,284.23
|
|
|
Service Code
|
APR-DRG 3172
|
| Min. Negotiated Rate |
$8,842.12 |
| Max. Negotiated Rate |
$9,284.23 |
| Rate for Payer: BCBS Complete |
$9,284.23
|
| Rate for Payer: Mclaren Medicaid |
$8,842.12
|
| Rate for Payer: Meridian Medicaid |
$9,284.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,842.12
|
| Rate for Payer: UHC Medicaid |
$8,842.12
|
| Rate for Payer: UHCCP Medicaid |
$8,842.12
|
|
|
TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES
|
Facility
|
IP
|
$17,243.35
|
|
|
Service Code
|
APR-DRG 3174
|
| Min. Negotiated Rate |
$16,422.23 |
| Max. Negotiated Rate |
$17,243.35 |
| Rate for Payer: BCBS Complete |
$17,243.35
|
| Rate for Payer: Mclaren Medicaid |
$16,422.23
|
| Rate for Payer: Meridian Medicaid |
$17,243.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,422.23
|
| Rate for Payer: UHC Medicaid |
$16,422.23
|
| Rate for Payer: UHCCP Medicaid |
$16,422.23
|
|
|
TENECTEPLASE 25 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30,830.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
212669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,435.39 |
| Max. Negotiated Rate |
$27,747.33 |
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: Aetna Medicare |
$8,015.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,634.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,634.49
|
| Rate for Payer: BCBS Complete |
$5,706.70
|
| Rate for Payer: BCBS MAPPO |
$7,707.59
|
| Rate for Payer: BCBS Trust/PPO |
$25,345.65
|
| Rate for Payer: BCN Commercial |
$25,345.65
|
| Rate for Payer: BCN Medicare Advantage |
$7,707.59
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,707.59
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,122.78
|
| Rate for Payer: Mclaren Medicaid |
$5,435.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,092.97
|
| Rate for Payer: Meridian Medicaid |
$5,706.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,863.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,478.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Nomi Health Commercial |
$25,280.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: PACE Senior Care Partners |
$7,322.21
|
| Rate for Payer: PACE SWMI |
$7,707.59
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: PHP Medicare Advantage |
$7,707.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,435.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26,822.42
|
| Rate for Payer: Priority Health Medicare |
$7,784.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21,457.94
|
| Rate for Payer: Railroad Medicare Medicare |
$7,707.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,130.73
|
| Rate for Payer: UHC Core |
$25,743.36
|
| Rate for Payer: UHC Exchange |
$7,707.59
|
| Rate for Payer: UHC Medicaid |
$5,435.39
|
| Rate for Payer: UHC Medicare Advantage |
$7,707.59
|
| Rate for Payer: UHCCP Medicaid |
$5,435.39
|
| Rate for Payer: VA VA |
$7,707.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,122.78
|
|
|
TENECTEPLASE 25 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30,830.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
212669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,457.94 |
| Max. Negotiated Rate |
$27,747.33 |
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: BCBS Trust/PPO |
$25,462.80
|
| Rate for Payer: BCN Commercial |
$25,462.80
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,122.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Nomi Health Commercial |
$25,280.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26,822.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21,457.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,130.73
|
| Rate for Payer: UHC Core |
$25,743.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,122.78
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29,932.38
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,277.08 |
| Max. Negotiated Rate |
$26,939.14 |
| Rate for Payer: Aetna Commercial |
$25,442.52
|
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: Aetna Medicare |
$8,015.90
|
| Rate for Payer: Aetna Medicare |
$7,782.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,634.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,353.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,353.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,634.49
|
| Rate for Payer: BCBS Complete |
$5,540.48
|
| Rate for Payer: BCBS Complete |
$5,706.70
|
| Rate for Payer: BCBS MAPPO |
$7,483.10
|
| Rate for Payer: BCBS MAPPO |
$7,707.59
|
| Rate for Payer: BCBS Trust/PPO |
$24,607.41
|
| Rate for Payer: BCBS Trust/PPO |
$25,345.65
|
| Rate for Payer: BCN Commercial |
$25,345.65
|
| Rate for Payer: BCN Commercial |
$24,607.41
|
| Rate for Payer: BCN Medicare Advantage |
$7,707.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,483.10
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Commercial |
$25,741.85
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,707.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,483.10
|
| Rate for Payer: Healthscope Commercial |
$26,939.14
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,449.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,122.78
|
| Rate for Payer: Mclaren Medicaid |
$5,435.39
|
| Rate for Payer: Mclaren Medicaid |
$5,277.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,092.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,857.25
|
| Rate for Payer: Meridian Medicaid |
$5,540.48
|
| Rate for Payer: Meridian Medicaid |
$5,706.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,863.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,605.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,478.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,231.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.52
|
| Rate for Payer: Nomi Health Commercial |
$25,280.90
|
| Rate for Payer: Nomi Health Commercial |
$24,544.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,449.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: PACE Senior Care Partners |
$7,322.21
|
| Rate for Payer: PACE Senior Care Partners |
$7,108.94
|
| Rate for Payer: PACE SWMI |
$7,707.59
|
| Rate for Payer: PACE SWMI |
$7,483.10
|
| Rate for Payer: PHP Commercial |
$25,442.52
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: PHP Medicare Advantage |
$7,483.10
|
| Rate for Payer: PHP Medicare Advantage |
$7,707.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,435.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,277.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26,822.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26,041.17
|
| Rate for Payer: Priority Health Medicare |
$7,784.67
|
| Rate for Payer: Priority Health Medicare |
$7,557.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,832.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21,457.94
|
| Rate for Payer: Railroad Medicare Medicare |
$7,483.10
|
| Rate for Payer: Railroad Medicare Medicare |
$7,707.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,340.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,130.73
|
| Rate for Payer: UHC Core |
$25,743.36
|
| Rate for Payer: UHC Core |
$24,993.54
|
| Rate for Payer: UHC Exchange |
$7,707.59
|
| Rate for Payer: UHC Exchange |
$7,483.10
|
| Rate for Payer: UHC Medicaid |
$5,435.39
|
| Rate for Payer: UHC Medicaid |
$5,277.08
|
| Rate for Payer: UHC Medicare Advantage |
$7,483.10
|
| Rate for Payer: UHC Medicare Advantage |
$7,707.59
|
| Rate for Payer: UHCCP Medicaid |
$5,277.08
|
| Rate for Payer: UHCCP Medicaid |
$5,435.39
|
| Rate for Payer: VA VA |
$7,483.10
|
| Rate for Payer: VA VA |
$7,707.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,122.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,449.28
|
|
