|
THERMAGE FACE & NECK
|
Professional
|
Both
|
$2,942.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,176.80 |
| Max. Negotiated Rate |
$2,206.50 |
| Rate for Payer: Aetna Medicare |
$1,471.00
|
| Rate for Payer: BCBS Complete |
$1,176.80
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,206.50
|
|
|
THERMAGE FACE, NECK, & EYES
|
Professional
|
Both
|
$3,677.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,470.80 |
| Max. Negotiated Rate |
$2,757.75 |
| Rate for Payer: Aetna Medicare |
$1,838.50
|
| Rate for Payer: BCBS Complete |
$1,470.80
|
| Rate for Payer: Cash Price |
$2,941.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,757.75
|
|
|
THERMAGE KNEES - BILATERAL
|
Professional
|
Both
|
$1,261.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$945.75 |
| Rate for Payer: Aetna Medicare |
$630.50
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.75
|
|
|
THERMAGE NECK
|
Professional
|
Both
|
$1,261.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$945.75 |
| Rate for Payer: Aetna Medicare |
$630.50
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.75
|
|
|
THERMAGE THIGH - 1 THIGH
|
Professional
|
Both
|
$1,996.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$798.40 |
| Max. Negotiated Rate |
$1,497.00 |
| Rate for Payer: Aetna Medicare |
$998.00
|
| Rate for Payer: BCBS Complete |
$798.40
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.00
|
|
|
THERMAGE THIGH - BILATERAL
|
Professional
|
Both
|
$3,257.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,302.80 |
| Max. Negotiated Rate |
$2,442.75 |
| Rate for Payer: Aetna Medicare |
$1,628.50
|
| Rate for Payer: BCBS Complete |
$1,302.80
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,442.75
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.40
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: BCBS Trust/PPO |
$19.33
|
| Rate for Payer: BCBS Trust/PPO |
$19.85
|
| Rate for Payer: BCBS Trust/PPO |
$16.88
|
| Rate for Payer: BCBS Trust/PPO |
$16.37
|
| Rate for Payer: BCN Commercial |
$19.33
|
| Rate for Payer: BCN Commercial |
$16.37
|
| Rate for Payer: BCN Commercial |
$19.85
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$17.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Nomi Health Commercial |
$16.25
|
| Rate for Payer: Nomi Health Commercial |
$16.76
|
| Rate for Payer: Nomi Health Commercial |
$19.71
|
| Rate for Payer: Nomi Health Commercial |
$19.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.03
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.59
|
| Rate for Payer: UHC Core |
$19.54
|
| Rate for Payer: UHC Core |
$20.07
|
| Rate for Payer: UHC Core |
$17.07
|
| Rate for Payer: UHC Core |
$16.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$19.82
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$17.84 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Medicare |
$5.31
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$6.08
|
| Rate for Payer: Aetna Medicare |
$6.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: BCBS Complete |
$3.67
|
| Rate for Payer: BCBS Complete |
$4.33
|
| Rate for Payer: BCBS MAPPO |
$4.96
|
| Rate for Payer: BCBS MAPPO |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS MAPPO |
$5.85
|
| Rate for Payer: BCBS Trust/PPO |
$19.24
|
| Rate for Payer: BCBS Trust/PPO |
$16.29
|
| Rate for Payer: BCBS Trust/PPO |
$19.76
|
| Rate for Payer: BCBS Trust/PPO |
$16.80
|
| Rate for Payer: BCN Commercial |
$19.24
|
| Rate for Payer: BCN Commercial |
$19.76
|
| Rate for Payer: BCN Commercial |
$16.80
|
| Rate for Payer: BCN Commercial |
$16.29
|
| Rate for Payer: BCN Medicare Advantage |
$5.85
|
| Rate for Payer: BCN Medicare Advantage |
$5.11
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: BCN Medicare Advantage |
$4.96
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.85
|
| Rate for Payer: Healthscope Commercial |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Mclaren Medicaid |
$4.13
|
| Rate for Payer: Mclaren Medicaid |
$3.60
|
| Rate for Payer: Mclaren Medicaid |
$3.49
|
| Rate for Payer: Mclaren Medicaid |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$3.67
|
| Rate for Payer: Meridian Medicaid |
$4.33
|
| Rate for Payer: Meridian Medicaid |
$4.45
|
| Rate for Payer: Meridian Medicaid |
$3.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Nomi Health Commercial |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$16.25
|
| Rate for Payer: Nomi Health Commercial |
$16.76
|
| Rate for Payer: Nomi Health Commercial |
$19.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: PACE Senior Care Partners |
$5.56
|
| Rate for Payer: PACE Senior Care Partners |
$5.71
|
| Rate for Payer: PACE Senior Care Partners |
$4.71
|
| Rate for Payer: PACE Senior Care Partners |
$4.85
|
| Rate for Payer: PACE SWMI |
$4.96
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PACE SWMI |
$5.11
|
| Rate for Payer: PACE SWMI |
$5.85
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: PHP Medicare Advantage |
$4.96
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: PHP Medicare Advantage |
$5.11
|
| Rate for Payer: PHP Medicare Advantage |
$5.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.24
|
| Rate for Payer: Priority Health Medicare |
$5.16
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health Medicare |
$5.91
|
| Rate for Payer: Priority Health Medicare |
$6.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.79
|
| Rate for Payer: Railroad Medicare Medicare |
$5.85
|
| Rate for Payer: Railroad Medicare Medicare |
$4.96
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: Railroad Medicare Medicare |
$5.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.16
|
| Rate for Payer: UHC Core |
$16.55
|
| Rate for Payer: UHC Core |
$19.54
|
| Rate for Payer: UHC Core |
$17.07
|
| Rate for Payer: UHC Core |
$20.07
|
| Rate for Payer: UHC Exchange |
$5.85
|
| Rate for Payer: UHC Exchange |
$5.11
|
| Rate for Payer: UHC Exchange |
$6.01
|
| Rate for Payer: UHC Exchange |
$4.96
|
| Rate for Payer: UHC Medicaid |
$3.49
|
| Rate for Payer: UHC Medicaid |
$3.60
|
| Rate for Payer: UHC Medicaid |
$4.13
|
| Rate for Payer: UHC Medicaid |
$4.24
|
| Rate for Payer: UHC Medicare Advantage |
$5.11
|
| Rate for Payer: UHC Medicare Advantage |
$4.96
|
| Rate for Payer: UHC Medicare Advantage |
$6.01
|
| Rate for Payer: UHC Medicare Advantage |
$5.85
|
| Rate for Payer: UHCCP Medicaid |
$4.13
|
| Rate for Payer: UHCCP Medicaid |
$4.24
|
| Rate for Payer: UHCCP Medicaid |
$3.60
|
| Rate for Payer: UHCCP Medicaid |
$3.49
|
| Rate for Payer: VA VA |
$4.96
|
| Rate for Payer: VA VA |
$6.01
|
| Rate for Payer: VA VA |
$5.85
|
| Rate for Payer: VA VA |
$5.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.03
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 79854020010
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.05
|
| Rate for Payer: BCBS Complete |
$19.57
|
| Rate for Payer: BCBS MAPPO |
$26.44
|
| Rate for Payer: BCBS Trust/PPO |
$86.94
|
| Rate for Payer: BCN Commercial |
$86.94
|
| Rate for Payer: BCN Medicare Advantage |
$26.44
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.44
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.76
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: Nomi Health Commercial |
$86.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.31
|
| Rate for Payer: PACE Senior Care Partners |
$25.12
|
| Rate for Payer: PACE SWMI |
$26.44
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: PHP Medicare Advantage |
$26.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.00
|
| Rate for Payer: Priority Health Medicare |
$26.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.60
|
| Rate for Payer: Railroad Medicare Medicare |
$26.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.06
|
| Rate for Payer: UHC Core |
$88.30
|
| Rate for Payer: UHC Exchange |
$26.44
|
| Rate for Payer: UHC Medicaid |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$26.44
|
| Rate for Payer: UHCCP Medicaid |
$18.64
|
| Rate for Payer: VA VA |
$26.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 79854020010
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: BCBS Trust/PPO |
$87.34
|
| Rate for Payer: BCN Commercial |
$87.34
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: Nomi Health Commercial |
$86.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.31
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.06
|
| Rate for Payer: UHC Core |
$88.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 77333093410
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.87 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: BCBS Trust/PPO |
$320.24
|
| Rate for Payer: BCN Commercial |
$320.24
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Nomi Health Commercial |
$317.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.81
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$337.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.22
|
| Rate for Payer: UHC Core |
$323.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 77333093425
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.21
|
| Rate for Payer: BCBS Complete |
$0.72
|
| Rate for Payer: BCBS MAPPO |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$3.19
|
| Rate for Payer: BCN Commercial |
$3.19
|
| Rate for Payer: BCN Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.97
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Mclaren Medicaid |
$0.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.02
|
| Rate for Payer: Meridian Medicaid |
$0.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.91
|
| Rate for Payer: PACE Senior Care Partners |
$0.92
|
| Rate for Payer: PACE SWMI |
$0.97
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.38
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.70
|
| Rate for Payer: Railroad Medicare Medicare |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.24
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Medicaid |
$0.68
|
| Rate for Payer: UHC Medicare Advantage |
$0.97
|
| Rate for Payer: UHCCP Medicaid |
$0.68
|
| Rate for Payer: VA VA |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 77333093425
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: BCBS Trust/PPO |
$3.20
|
| Rate for Payer: BCN Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.91
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$387.75
|
|
|
Service Code
|
NDC 77333093410
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.36 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna Medicare |
$100.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.17
|
| Rate for Payer: BCBS Complete |
$71.77
|
| Rate for Payer: BCBS MAPPO |
$96.94
|
| Rate for Payer: BCBS Trust/PPO |
$318.77
|
| Rate for Payer: BCN Commercial |
$318.77
|
| Rate for Payer: BCN Medicare Advantage |
$96.94
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.94
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.81
|
| Rate for Payer: Mclaren Medicaid |
$68.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.78
|
| Rate for Payer: Meridian Medicaid |
$71.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$106.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Nomi Health Commercial |
$317.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.81
|
| Rate for Payer: PACE Senior Care Partners |
$92.09
|
| Rate for Payer: PACE SWMI |
$96.94
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: PHP Medicare Advantage |
$96.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$337.34
|
| Rate for Payer: Priority Health Medicare |
$97.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.87
|
| Rate for Payer: Railroad Medicare Medicare |
$96.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.22
|
| Rate for Payer: UHC Core |
$323.77
|
| Rate for Payer: UHC Exchange |
$96.94
|
| Rate for Payer: UHC Medicaid |
$68.36
|
| Rate for Payer: UHC Medicare Advantage |
$96.94
|
| Rate for Payer: UHCCP Medicaid |
$68.36
|
| Rate for Payer: VA VA |
$96.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.81
|
|
|
THIOGLYCOLIC ACID SALT BODY CREAM (NAIR)
|
Facility
|
IP
|
$21.96
|
|
|
Service Code
|
NDC 09900002059
|
| Hospital Charge Code |
302081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: BCBS Trust/PPO |
$18.14
|
| Rate for Payer: BCN Commercial |
$18.14
|
| Rate for Payer: Cash Price |
$17.57
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.57
|
| Rate for Payer: Healthscope Commercial |
$19.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.67
|
| Rate for Payer: Nomi Health Commercial |
$18.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.47
|
| Rate for Payer: PHP Commercial |
$18.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.32
|
| Rate for Payer: UHC Core |
$18.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.47
|
|
|
THIOGLYCOLIC ACID SALT BODY CREAM (NAIR)
|
Facility
|
OP
|
$21.96
|
|
|
Service Code
|
NDC 09900002059
|
| Hospital Charge Code |
302081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Aetna Medicare |
$5.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.86
|
| Rate for Payer: BCBS Complete |
$4.06
|
| Rate for Payer: BCBS MAPPO |
$5.49
|
| Rate for Payer: BCBS Trust/PPO |
$18.05
|
| Rate for Payer: BCN Commercial |
$18.05
|
| Rate for Payer: BCN Medicare Advantage |
$5.49
|
| Rate for Payer: Cash Price |
$17.57
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.49
|
| Rate for Payer: Healthscope Commercial |
$19.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.47
|
| Rate for Payer: Mclaren Medicaid |
$3.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.76
|
| Rate for Payer: Meridian Medicaid |
$4.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.67
|
| Rate for Payer: Nomi Health Commercial |
$18.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.47
|
| Rate for Payer: PACE Senior Care Partners |
$5.22
|
| Rate for Payer: PACE SWMI |
$5.49
|
| Rate for Payer: PHP Commercial |
$18.67
|
| Rate for Payer: PHP Medicare Advantage |
$5.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.11
|
| Rate for Payer: Priority Health Medicare |
$5.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.28
|
| Rate for Payer: Railroad Medicare Medicare |
$5.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.32
|
| Rate for Payer: UHC Core |
$18.34
|
| Rate for Payer: UHC Exchange |
$5.49
|
| Rate for Payer: UHC Medicaid |
$3.87
|
| Rate for Payer: UHC Medicare Advantage |
$5.49
|
| Rate for Payer: UHCCP Medicaid |
$3.87
|
| Rate for Payer: VA VA |
$5.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.47
|
|
|
THIORIDAZINE 50 MG TABLET
|
Facility
|
OP
|
$373.44
|
|
|
Service Code
|
NDC 00378061601
|
| Hospital Charge Code |
7900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.84 |
| Max. Negotiated Rate |
$336.10 |
| Rate for Payer: Aetna Commercial |
$317.42
|
| Rate for Payer: Aetna Medicare |
$97.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.70
|
| Rate for Payer: BCBS Complete |
$69.12
|
| Rate for Payer: BCBS MAPPO |
$93.36
|
| Rate for Payer: BCBS Trust/PPO |
$307.01
|
| Rate for Payer: BCN Commercial |
$307.01
|
| Rate for Payer: BCN Medicare Advantage |
$93.36
|
| Rate for Payer: Cash Price |
$298.75
|
| Rate for Payer: Cofinity Commercial |
$321.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.36
|
| Rate for Payer: Healthscope Commercial |
$336.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.08
|
| Rate for Payer: Mclaren Medicaid |
$65.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.03
|
| Rate for Payer: Meridian Medicaid |
$69.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.42
|
| Rate for Payer: Nomi Health Commercial |
$306.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.08
|
| Rate for Payer: PACE Senior Care Partners |
$88.69
|
| Rate for Payer: PACE SWMI |
$93.36
|
| Rate for Payer: PHP Commercial |
$317.42
|
| Rate for Payer: PHP Medicare Advantage |
$93.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$324.89
|
| Rate for Payer: Priority Health Medicare |
$94.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.91
|
| Rate for Payer: Railroad Medicare Medicare |
$93.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.63
|
| Rate for Payer: UHC Core |
$311.82
|
| Rate for Payer: UHC Exchange |
$93.36
|
| Rate for Payer: UHC Medicaid |
$65.84
|
| Rate for Payer: UHC Medicare Advantage |
$93.36
|
| Rate for Payer: UHCCP Medicaid |
$65.84
|
| Rate for Payer: VA VA |
$93.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.08
|
|
|
THIORIDAZINE 50 MG TABLET
|
Facility
|
IP
|
$373.44
|
|
|
Service Code
|
NDC 00378061601
|
| Hospital Charge Code |
7900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.91 |
| Max. Negotiated Rate |
$336.10 |
| Rate for Payer: Aetna Commercial |
$317.42
|
| Rate for Payer: BCBS Trust/PPO |
$308.42
|
| Rate for Payer: BCN Commercial |
$308.42
|
| Rate for Payer: Cash Price |
$298.75
|
| Rate for Payer: Cofinity Commercial |
$321.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.75
|
| Rate for Payer: Healthscope Commercial |
$336.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.42
|
| Rate for Payer: Nomi Health Commercial |
$306.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.08
|
| Rate for Payer: PHP Commercial |
$317.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$324.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.63
|
| Rate for Payer: UHC Core |
$311.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.08
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
IP
|
$876.13
|
|
|
Service Code
|
NDC 60793021721
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$609.79 |
| Max. Negotiated Rate |
$788.52 |
| Rate for Payer: Aetna Commercial |
$744.71
|
| Rate for Payer: BCBS Trust/PPO |
$723.60
|
| Rate for Payer: BCN Commercial |
$723.60
|
| Rate for Payer: Cash Price |
$700.90
|
| Rate for Payer: Cofinity Commercial |
$753.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.90
|
| Rate for Payer: Healthscope Commercial |
$788.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.71
|
| Rate for Payer: Nomi Health Commercial |
$718.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.10
|
| Rate for Payer: PHP Commercial |
$744.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$762.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$609.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.99
|
| Rate for Payer: UHC Core |
$731.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.10
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
OP
|
$876.13
|
|
|
Service Code
|
NDC 60793021721
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.46 |
| Max. Negotiated Rate |
$788.52 |
| Rate for Payer: Aetna Commercial |
$744.71
|
| Rate for Payer: Aetna Medicare |
$227.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.79
|
| Rate for Payer: BCBS Complete |
$162.17
|
| Rate for Payer: BCBS MAPPO |
$219.03
|
| Rate for Payer: BCBS Trust/PPO |
$720.27
|
| Rate for Payer: BCN Commercial |
$720.27
|
| Rate for Payer: BCN Medicare Advantage |
$219.03
|
| Rate for Payer: Cash Price |
$700.90
|
| Rate for Payer: Cofinity Commercial |
$753.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.03
|
| Rate for Payer: Healthscope Commercial |
$788.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.10
|
| Rate for Payer: Mclaren Medicaid |
$154.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.98
|
| Rate for Payer: Meridian Medicaid |
$162.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.71
|
| Rate for Payer: Nomi Health Commercial |
$718.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.10
|
| Rate for Payer: PACE Senior Care Partners |
$208.08
|
| Rate for Payer: PACE SWMI |
$219.03
|
| Rate for Payer: PHP Commercial |
$744.71
|
| Rate for Payer: PHP Medicare Advantage |
$219.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$762.23
|
| Rate for Payer: Priority Health Medicare |
$221.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$609.79
|
| Rate for Payer: Railroad Medicare Medicare |
$219.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.99
|
| Rate for Payer: UHC Core |
$731.57
|
| Rate for Payer: UHC Exchange |
$219.03
|
| Rate for Payer: UHC Medicaid |
$154.46
|
| Rate for Payer: UHC Medicare Advantage |
$219.03
|
| Rate for Payer: UHCCP Medicaid |
$154.46
|
| Rate for Payer: VA VA |
$219.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.10
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE
|
Facility
|
OP
|
$207.08
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
87798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$186.37 |
| Rate for Payer: Aetna Commercial |
$176.02
|
| Rate for Payer: Aetna Medicare |
$53.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.71
|
| Rate for Payer: BCBS Complete |
$38.33
|
| Rate for Payer: BCBS MAPPO |
$51.77
|
| Rate for Payer: BCBS Trust/PPO |
$170.24
|
| Rate for Payer: BCN Commercial |
$170.24
|
| Rate for Payer: BCN Medicare Advantage |
$51.77
|
| Rate for Payer: Cash Price |
$165.66
|
| Rate for Payer: Cofinity Commercial |
$178.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.77
|
| Rate for Payer: Healthscope Commercial |
$186.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.31
|
| Rate for Payer: Mclaren Medicaid |
$36.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.36
|
| Rate for Payer: Meridian Medicaid |
$38.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.02
|
| Rate for Payer: Nomi Health Commercial |
$169.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.31
|
| Rate for Payer: PACE Senior Care Partners |
$49.18
|
| Rate for Payer: PACE SWMI |
$51.77
|
| Rate for Payer: PHP Commercial |
$176.02
|
| Rate for Payer: PHP Medicare Advantage |
$51.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.16
|
| Rate for Payer: Priority Health Medicare |
$52.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.13
|
| Rate for Payer: Railroad Medicare Medicare |
$51.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.23
|
| Rate for Payer: UHC Core |
$172.91
|
| Rate for Payer: UHC Exchange |
$51.77
|
| Rate for Payer: UHC Medicaid |
$36.51
|
| Rate for Payer: UHC Medicare Advantage |
$51.77
|
| Rate for Payer: UHCCP Medicaid |
$36.51
|
| Rate for Payer: VA VA |
$51.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.31
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE
|
Facility
|
IP
|
$207.08
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
87798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$144.13 |
| Max. Negotiated Rate |
$186.37 |
| Rate for Payer: Aetna Commercial |
$176.02
|
| Rate for Payer: BCBS Trust/PPO |
$171.03
|
| Rate for Payer: BCN Commercial |
$171.03
|
| Rate for Payer: Cash Price |
$165.66
|
| Rate for Payer: Cofinity Commercial |
$178.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.66
|
| Rate for Payer: Healthscope Commercial |
$186.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.02
|
| Rate for Payer: Nomi Health Commercial |
$169.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.31
|
| Rate for Payer: PHP Commercial |
$176.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.23
|
| Rate for Payer: UHC Core |
$172.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.31
|
|
|
THYROID DISORDERS
|
Facility
|
IP
|
$3,058.29
|
|
|
Service Code
|
APR-DRG 4271
|
| Min. Negotiated Rate |
$2,912.65 |
| Max. Negotiated Rate |
$3,058.29 |
| Rate for Payer: BCBS Complete |
$3,058.29
|
| Rate for Payer: Mclaren Medicaid |
$2,912.65
|
| Rate for Payer: Meridian Medicaid |
$3,058.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,912.65
|
| Rate for Payer: UHC Medicaid |
$2,912.65
|
| Rate for Payer: UHCCP Medicaid |
$2,912.65
|
|
|
THYROID DISORDERS
|
Facility
|
IP
|
$12,492.38
|
|
|
Service Code
|
APR-DRG 4274
|
| Min. Negotiated Rate |
$11,897.51 |
| Max. Negotiated Rate |
$12,492.38 |
| Rate for Payer: BCBS Complete |
$12,492.38
|
| Rate for Payer: Mclaren Medicaid |
$11,897.51
|
| Rate for Payer: Meridian Medicaid |
$12,492.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,897.51
|
| Rate for Payer: UHC Medicaid |
$11,897.51
|
| Rate for Payer: UHCCP Medicaid |
$11,897.51
|
|
|
THYROID DISORDERS
|
Facility
|
IP
|
$7,117.77
|
|
|
Service Code
|
APR-DRG 4273
|
| Min. Negotiated Rate |
$6,778.83 |
| Max. Negotiated Rate |
$7,117.77 |
| Rate for Payer: BCBS Complete |
$7,117.77
|
| Rate for Payer: Mclaren Medicaid |
$6,778.83
|
| Rate for Payer: Meridian Medicaid |
$7,117.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,778.83
|
| Rate for Payer: UHC Medicaid |
$6,778.83
|
| Rate for Payer: UHCCP Medicaid |
$6,778.83
|
|
