|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$1,169.61
|
|
|
Service Code
|
NDC 53489064801
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$760.25 |
| Max. Negotiated Rate |
$1,052.65 |
| Rate for Payer: Aetna Commercial |
$994.17
|
| Rate for Payer: BCBS Trust/PPO |
$954.75
|
| Rate for Payer: BCN Commercial |
$903.87
|
| Rate for Payer: Cash Price |
$935.69
|
| Rate for Payer: Cofinity Commercial |
$1,005.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.69
|
| Rate for Payer: Healthscope Commercial |
$1,052.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$877.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$994.17
|
| Rate for Payer: Nomi Health Commercial |
$959.08
|
| Rate for Payer: PHP Commercial |
$994.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,017.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.26
|
| Rate for Payer: UHC Core |
$976.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$877.21
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$338.95
|
|
|
Service Code
|
NDC 68084054921
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.50 |
| 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 |
$135.58
|
| Rate for Payer: BCBS MAPPO |
$84.74
|
| Rate for Payer: BCBS Trust/PPO |
$278.65
|
| Rate for Payer: BCN Commercial |
$263.53
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.11
|
| Rate for Payer: Nomi Health Commercial |
$277.94
|
| 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 Cigna Priority Health |
$220.32
|
| Rate for Payer: Priority Health HMO/PPO |
$294.89
|
| Rate for Payer: Priority Health Medicare |
$85.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.10
|
| 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 Dual Complete DSNP |
$84.74
|
| Rate for Payer: UHC Exchange |
$84.74
|
| Rate for Payer: UHC Medicare Advantage |
$84.74
|
| Rate for Payer: VA VA |
$84.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.21
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$338.95
|
|
|
Service Code
|
NDC 68084054921
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.32 |
| Max. Negotiated Rate |
$305.06 |
| Rate for Payer: Aetna Commercial |
$288.11
|
| Rate for Payer: BCBS Trust/PPO |
$276.68
|
| Rate for Payer: BCN Commercial |
$261.94
|
| 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: PHP Commercial |
$288.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.32
|
| Rate for Payer: Priority Health HMO/PPO |
$294.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.10
|
| 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
|
IP
|
$11.30
|
|
|
Service Code
|
NDC 68084054911
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Aetna Commercial |
$9.61
|
| Rate for Payer: BCBS Trust/PPO |
$9.22
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| Rate for Payer: Nomi Health Commercial |
$9.27
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health HMO/PPO |
$9.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.94
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.47
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$1,169.61
|
|
|
Service Code
|
NDC 53489064801
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.78 |
| Max. Negotiated Rate |
$1,052.65 |
| Rate for Payer: Aetna Commercial |
$994.17
|
| Rate for Payer: Aetna Medicare |
$304.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$365.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$365.50
|
| Rate for Payer: BCBS Complete |
$467.84
|
| Rate for Payer: BCBS MAPPO |
$292.40
|
| Rate for Payer: BCBS Trust/PPO |
$961.54
|
| Rate for Payer: BCN Commercial |
$909.37
|
| Rate for Payer: BCN Medicare Advantage |
$292.40
|
| Rate for Payer: Cash Price |
$935.69
|
| Rate for Payer: Cofinity Commercial |
$1,005.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.40
|
| Rate for Payer: Healthscope Commercial |
$1,052.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$877.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$994.17
|
| Rate for Payer: Nomi Health Commercial |
$959.08
|
| Rate for Payer: PACE Senior Care Partners |
$277.78
|
| Rate for Payer: PACE SWMI |
$292.40
|
| Rate for Payer: PHP Commercial |
$994.17
|
| Rate for Payer: PHP Medicare Advantage |
$292.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$760.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,017.56
|
| Rate for Payer: Priority Health Medicare |
$295.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.64
|
| Rate for Payer: Railroad Medicare Medicare |
$292.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.26
|
| Rate for Payer: UHC Core |
$976.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$292.40
|
| Rate for Payer: UHC Exchange |
$292.40
|
| Rate for Payer: UHC Medicare Advantage |
$292.40
|
| Rate for Payer: VA VA |
$292.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$877.21
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$11.30
|
|
|
Service Code
|
NDC 68084054911
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Aetna Commercial |
$9.61
|
| Rate for Payer: Aetna Medicare |
$2.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.53
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS MAPPO |
$2.83
|
| Rate for Payer: BCBS Trust/PPO |
$9.29
|
| Rate for Payer: BCN Commercial |
$8.79
|
| Rate for Payer: BCN Medicare Advantage |
$2.83
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.83
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| Rate for Payer: Nomi Health Commercial |
$9.27
|
| Rate for Payer: PACE Senior Care Partners |
$2.68
|
| Rate for Payer: PACE SWMI |
$2.83
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Medicare Advantage |
$2.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health HMO/PPO |
$9.83
|
| Rate for Payer: Priority Health Medicare |
$2.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.57
|
| Rate for Payer: Railroad Medicare Medicare |
$2.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.94
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.83
|
| Rate for Payer: UHC Exchange |
$2.83
|
| Rate for Payer: UHC Medicare Advantage |
$2.83
|
| Rate for Payer: VA VA |
$2.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.47
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$2,127.84
|
|
|
Service Code
|
NDC 00378311001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,383.10 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,736.96
|
| Rate for Payer: BCN Commercial |
$1,644.39
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,595.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.66
|
| Rate for Payer: Nomi Health Commercial |
$1,744.83
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,851.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,872.50
|
| Rate for Payer: UHC Core |
$1,776.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,595.88
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$308.18
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.19 |
| Max. Negotiated Rate |
$277.36 |
| Rate for Payer: Aetna Commercial |
$261.95
|
| Rate for Payer: Aetna Medicare |
$80.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.31
|
| Rate for Payer: BCBS Complete |
$123.27
|
| Rate for Payer: BCBS MAPPO |
$77.05
|
| Rate for Payer: BCBS Trust/PPO |
$253.35
|
| Rate for Payer: BCN Commercial |
$239.61
|
| Rate for Payer: BCN Medicare Advantage |
$77.05
|
| Rate for Payer: Cash Price |
$246.54
|
| Rate for Payer: Cofinity Commercial |
$265.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.05
|
| Rate for Payer: Healthscope Commercial |
$277.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.95
|
| Rate for Payer: Nomi Health Commercial |
$252.71
|
| Rate for Payer: PACE Senior Care Partners |
$73.19
|
| Rate for Payer: PACE SWMI |
$77.05
|
| Rate for Payer: PHP Commercial |
$261.95
|
| Rate for Payer: PHP Medicare Advantage |
$77.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.32
|
| Rate for Payer: Priority Health HMO/PPO |
$268.12
|
| Rate for Payer: Priority Health Medicare |
$77.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.48
|
| Rate for Payer: Railroad Medicare Medicare |
$77.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.20
|
| Rate for Payer: UHC Core |
$257.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.05
|
| Rate for Payer: UHC Exchange |
$77.05
|
| Rate for Payer: UHC Medicare Advantage |
$77.05
|
| Rate for Payer: VA VA |
$77.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.13
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$308.18
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.32 |
| Max. Negotiated Rate |
$277.36 |
| Rate for Payer: Aetna Commercial |
$261.95
|
| Rate for Payer: BCBS Trust/PPO |
$251.57
|
| Rate for Payer: BCN Commercial |
$238.16
|
| Rate for Payer: Cash Price |
$246.54
|
| Rate for Payer: Cofinity Commercial |
$265.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.54
|
| Rate for Payer: Healthscope Commercial |
$277.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.95
|
| Rate for Payer: Nomi Health Commercial |
$252.71
|
| Rate for Payer: PHP Commercial |
$261.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.32
|
| Rate for Payer: Priority Health HMO/PPO |
$268.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.20
|
| Rate for Payer: UHC Core |
$257.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.13
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$2,127.84
|
|
|
Service Code
|
NDC 00378311001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$505.36 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: Aetna Medicare |
$553.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$664.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$664.95
|
| Rate for Payer: BCBS Complete |
$851.14
|
| Rate for Payer: BCBS MAPPO |
$531.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.30
|
| Rate for Payer: BCN Commercial |
$1,654.40
|
| Rate for Payer: BCN Medicare Advantage |
$531.96
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.96
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,595.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$611.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.66
|
| Rate for Payer: Nomi Health Commercial |
$1,744.83
|
| Rate for Payer: PACE Senior Care Partners |
$505.36
|
| Rate for Payer: PACE SWMI |
$531.96
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: PHP Medicare Advantage |
$531.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,851.22
|
| Rate for Payer: Priority Health Medicare |
$537.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.65
|
| Rate for Payer: Railroad Medicare Medicare |
$531.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,872.50
|
| Rate for Payer: UHC Core |
$1,776.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.96
|
| Rate for Payer: UHC Exchange |
$531.96
|
| Rate for Payer: UHC Medicare Advantage |
$531.96
|
| Rate for Payer: VA VA |
$531.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,595.88
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$1,215.03
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,157.10 |
| Max. Negotiated Rate |
$1,215.03 |
| Rate for Payer: BCBS Complete |
$1,215.03
|
| Rate for Payer: Mclaren Medicaid |
$1,157.10
|
| Rate for Payer: Meridian Medicaid |
$1,215.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,157.10
|
| Rate for Payer: UHCCP Medicaid |
$1,157.10
|
|
|
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 |
$124.52 |
| Max. Negotiated Rate |
$26,939.14 |
| Rate for Payer: Aetna Commercial |
$25,442.52
|
| Rate for Payer: Aetna Medicare |
$7,782.42
|
| 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: BCBS Complete |
$130.75
|
| Rate for Payer: BCBS MAPPO |
$7,483.10
|
| Rate for Payer: BCBS Trust/PPO |
$24,607.41
|
| Rate for Payer: BCN Commercial |
$23,272.43
|
| Rate for Payer: BCN Medicare Advantage |
$7,483.10
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cofinity Commercial |
$25,741.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,483.10
|
| Rate for Payer: Healthscope Commercial |
$26,939.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,449.28
|
| Rate for Payer: Mclaren Medicaid |
$124.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,857.25
|
| Rate for Payer: Meridian Medicaid |
$130.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,605.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.52
|
| Rate for Payer: Nomi Health Commercial |
$24,544.55
|
| Rate for Payer: PACE Senior Care Partners |
$7,108.94
|
| Rate for Payer: PACE SWMI |
$7,483.10
|
| Rate for Payer: PHP Commercial |
$25,442.52
|
| Rate for Payer: PHP Medicare Advantage |
$7,483.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,456.05
|
| Rate for Payer: Priority Health HMO/PPO |
$26,041.17
|
| Rate for Payer: Priority Health Medicare |
$7,557.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,054.69
|
| Rate for Payer: Railroad Medicare Medicare |
$7,483.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,340.49
|
| Rate for Payer: UHC Core |
$24,993.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,483.10
|
| Rate for Payer: UHC Exchange |
$7,483.10
|
| Rate for Payer: UHC Medicare Advantage |
$7,483.10
|
| Rate for Payer: UHCCP Medicaid |
$124.52
|
| Rate for Payer: VA VA |
$7,483.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,449.28
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29,932.38
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,456.05 |
| Max. Negotiated Rate |
$26,939.14 |
| Rate for Payer: Aetna Commercial |
$25,442.52
|
| Rate for Payer: BCBS Trust/PPO |
$24,433.80
|
| Rate for Payer: BCN Commercial |
$23,131.74
|
| Rate for Payer: Cash Price |
$23,945.90
|
| Rate for Payer: Cofinity Commercial |
$25,741.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,945.90
|
| Rate for Payer: Healthscope Commercial |
$26,939.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,449.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,442.52
|
| Rate for Payer: Nomi Health Commercial |
$24,544.55
|
| Rate for Payer: PHP Commercial |
$25,442.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,456.05
|
| Rate for Payer: Priority Health HMO/PPO |
$26,041.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20,054.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,340.49
|
| Rate for Payer: UHC Core |
$24,993.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,449.28
|
|
|
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
|
Facility
|
OP
|
$2,463.31
|
|
|
Service Code
|
CPT 25295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,345.85 |
| Max. Negotiated Rate |
$2,463.31 |
| Rate for Payer: BCBS Complete |
$2,463.31
|
| Rate for Payer: Mclaren Medicaid |
$2,345.85
|
| Rate for Payer: Meridian Medicaid |
$2,463.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,345.85
|
| Rate for Payer: UHCCP Medicaid |
$2,345.85
|
|
|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN
|
Facility
|
OP
|
$2,463.31
|
|
|
Service Code
|
CPT 24358
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,345.85 |
| Max. Negotiated Rate |
$2,463.31 |
| Rate for Payer: BCBS Complete |
$2,463.31
|
| Rate for Payer: Mclaren Medicaid |
$2,345.85
|
| Rate for Payer: Meridian Medicaid |
$2,463.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,345.85
|
| Rate for Payer: UHCCP Medicaid |
$2,345.85
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$30.03
|
|
|
Service Code
|
NDC 00067399842
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$25.53
|
| Rate for Payer: BCBS Trust/PPO |
$24.51
|
| Rate for Payer: BCN Commercial |
$23.21
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.02
|
| Rate for Payer: Healthscope Commercial |
$27.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.53
|
| Rate for Payer: Nomi Health Commercial |
$24.62
|
| Rate for Payer: PHP Commercial |
$25.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.52
|
| Rate for Payer: Priority Health HMO/PPO |
$26.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.43
|
| Rate for Payer: UHC Core |
$25.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.52
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$30.03
|
|
|
Service Code
|
NDC 00067399842
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$27.03 |
| Rate for Payer: Aetna Commercial |
$25.53
|
| Rate for Payer: Aetna Medicare |
$7.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.38
|
| Rate for Payer: BCBS Complete |
$12.01
|
| Rate for Payer: BCBS MAPPO |
$7.51
|
| Rate for Payer: BCBS Trust/PPO |
$24.69
|
| Rate for Payer: BCN Commercial |
$23.35
|
| Rate for Payer: BCN Medicare Advantage |
$7.51
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.51
|
| Rate for Payer: Healthscope Commercial |
$27.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.53
|
| Rate for Payer: Nomi Health Commercial |
$24.62
|
| Rate for Payer: PACE Senior Care Partners |
$7.13
|
| Rate for Payer: PACE SWMI |
$7.51
|
| Rate for Payer: PHP Commercial |
$25.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.52
|
| Rate for Payer: Priority Health HMO/PPO |
$26.13
|
| Rate for Payer: Priority Health Medicare |
$7.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.12
|
| Rate for Payer: Railroad Medicare Medicare |
$7.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.43
|
| Rate for Payer: UHC Core |
$25.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.51
|
| Rate for Payer: UHC Exchange |
$7.51
|
| Rate for Payer: UHC Medicare Advantage |
$7.51
|
| Rate for Payer: VA VA |
$7.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.52
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$23.90
|
|
|
Service Code
|
NDC 51672208001
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$21.51 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$6.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.47
|
| Rate for Payer: BCBS Complete |
$9.56
|
| Rate for Payer: BCBS MAPPO |
$5.97
|
| Rate for Payer: BCBS Trust/PPO |
$19.65
|
| Rate for Payer: BCN Commercial |
$18.58
|
| Rate for Payer: BCN Medicare Advantage |
$5.97
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.97
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Nomi Health Commercial |
$19.60
|
| Rate for Payer: PACE Senior Care Partners |
$5.68
|
| Rate for Payer: PACE SWMI |
$5.97
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: PHP Medicare Advantage |
$5.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health HMO/PPO |
$20.79
|
| Rate for Payer: Priority Health Medicare |
$6.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.01
|
| Rate for Payer: Railroad Medicare Medicare |
$5.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.03
|
| Rate for Payer: UHC Core |
$19.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.97
|
| Rate for Payer: UHC Exchange |
$5.97
|
| Rate for Payer: UHC Medicare Advantage |
$5.97
|
| Rate for Payer: VA VA |
$5.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.93
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$23.90
|
|
|
Service Code
|
NDC 51672208001
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$21.51 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: BCBS Trust/PPO |
$19.51
|
| Rate for Payer: BCN Commercial |
$18.47
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Nomi Health Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health HMO/PPO |
$20.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.03
|
| Rate for Payer: UHC Core |
$19.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.93
|
|
|
TERCONAZOLE 0.4 % VAGINAL CREAM
|
Facility
|
IP
|
$74.34
|
|
|
Service Code
|
NDC 51672130406
|
| Hospital Charge Code |
11510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$66.91 |
| Rate for Payer: Aetna Commercial |
$63.19
|
| Rate for Payer: BCBS Trust/PPO |
$60.68
|
| Rate for Payer: BCN Commercial |
$57.45
|
| Rate for Payer: Cash Price |
$59.47
|
| Rate for Payer: Cofinity Commercial |
$63.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.47
|
| Rate for Payer: Healthscope Commercial |
$66.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.19
|
| Rate for Payer: Nomi Health Commercial |
$60.96
|
| Rate for Payer: PHP Commercial |
$63.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.32
|
| Rate for Payer: Priority Health HMO/PPO |
$64.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.42
|
| Rate for Payer: UHC Core |
$62.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.76
|
|
|
TERCONAZOLE 0.4 % VAGINAL CREAM
|
Facility
|
OP
|
$74.34
|
|
|
Service Code
|
NDC 51672130406
|
| Hospital Charge Code |
11510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$66.91 |
| Rate for Payer: Aetna Commercial |
$63.19
|
| Rate for Payer: Aetna Medicare |
$19.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.23
|
| Rate for Payer: BCBS Complete |
$29.74
|
| Rate for Payer: BCBS MAPPO |
$18.59
|
| Rate for Payer: BCBS Trust/PPO |
$61.11
|
| Rate for Payer: BCN Commercial |
$57.80
|
| Rate for Payer: BCN Medicare Advantage |
$18.59
|
| Rate for Payer: Cash Price |
$59.47
|
| Rate for Payer: Cofinity Commercial |
$63.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.59
|
| Rate for Payer: Healthscope Commercial |
$66.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.19
|
| Rate for Payer: Nomi Health Commercial |
$60.96
|
| Rate for Payer: PACE Senior Care Partners |
$17.66
|
| Rate for Payer: PACE SWMI |
$18.59
|
| Rate for Payer: PHP Commercial |
$63.19
|
| Rate for Payer: PHP Medicare Advantage |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.32
|
| Rate for Payer: Priority Health HMO/PPO |
$64.68
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.81
|
| Rate for Payer: Railroad Medicare Medicare |
$18.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.42
|
| Rate for Payer: UHC Core |
$62.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.59
|
| Rate for Payer: UHC Exchange |
$18.59
|
| Rate for Payer: UHC Medicare Advantage |
$18.59
|
| Rate for Payer: VA VA |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.76
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.19 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna Commercial |
$93.84
|
| Rate for Payer: Aetna Medicare |
$25.39
|
| Rate for Payer: Aetna Medicare |
$28.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.50
|
| Rate for Payer: BCBS Complete |
$44.16
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS MAPPO |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$24.41
|
| Rate for Payer: BCBS Trust/PPO |
$80.28
|
| Rate for Payer: BCBS Trust/PPO |
$90.76
|
| Rate for Payer: BCN Commercial |
$75.92
|
| Rate for Payer: BCN Commercial |
$85.84
|
| Rate for Payer: BCN Medicare Advantage |
$24.41
|
| Rate for Payer: BCN Medicare Advantage |
$27.60
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cash Price |
$88.32
|
| Rate for Payer: Cofinity Commercial |
$94.94
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.41
|
| Rate for Payer: Healthscope Commercial |
$99.36
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.84
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Nomi Health Commercial |
$90.53
|
| Rate for Payer: PACE Senior Care Partners |
$23.19
|
| Rate for Payer: PACE Senior Care Partners |
$26.22
|
| Rate for Payer: PACE SWMI |
$24.41
|
| Rate for Payer: PACE SWMI |
$27.60
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: PHP Commercial |
$93.84
|
| Rate for Payer: PHP Medicare Advantage |
$27.60
|
| Rate for Payer: PHP Medicare Advantage |
$24.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.76
|
| Rate for Payer: Priority Health HMO/PPO |
$96.05
|
| Rate for Payer: Priority Health HMO/PPO |
$84.96
|
| Rate for Payer: Priority Health Medicare |
$24.66
|
| Rate for Payer: Priority Health Medicare |
$27.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.97
|
| Rate for Payer: Railroad Medicare Medicare |
$27.60
|
| Rate for Payer: Railroad Medicare Medicare |
$24.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.93
|
| Rate for Payer: UHC Core |
$81.54
|
| Rate for Payer: UHC Core |
$92.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.60
|
| Rate for Payer: UHC Exchange |
$27.60
|
| Rate for Payer: UHC Exchange |
$24.41
|
| Rate for Payer: UHC Medicare Advantage |
$27.60
|
| Rate for Payer: UHC Medicare Advantage |
$24.41
|
| Rate for Payer: VA VA |
$27.60
|
| Rate for Payer: VA VA |
$24.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.80
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$110.40
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$99.36 |
| Rate for Payer: Aetna Commercial |
$93.84
|
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: BCBS Trust/PPO |
$90.12
|
| Rate for Payer: BCBS Trust/PPO |
$79.71
|
| Rate for Payer: BCN Commercial |
$85.32
|
| Rate for Payer: BCN Commercial |
$75.46
|
| Rate for Payer: Cash Price |
$88.32
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Cofinity Commercial |
$94.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.32
|
| Rate for Payer: Healthscope Commercial |
$99.36
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$90.53
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: PHP Commercial |
$93.84
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.76
|
| Rate for Payer: Priority Health HMO/PPO |
$84.96
|
| Rate for Payer: Priority Health HMO/PPO |
$96.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.93
|
| Rate for Payer: UHC Core |
$92.18
|
| Rate for Payer: UHC Core |
$81.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.24
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,678.15
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,090.80 |
| Max. Negotiated Rate |
$1,510.34 |
| Rate for Payer: Aetna Commercial |
$1,426.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,369.87
|
| Rate for Payer: BCN Commercial |
$1,296.87
|
| Rate for Payer: Cash Price |
$1,342.52
|
| Rate for Payer: Cofinity Commercial |
$1,443.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,342.52
|
| Rate for Payer: Healthscope Commercial |
$1,510.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,258.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,426.43
|
| Rate for Payer: Nomi Health Commercial |
$1,376.08
|
| Rate for Payer: PHP Commercial |
$1,426.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,459.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,124.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,476.77
|
| Rate for Payer: UHC Core |
$1,401.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,258.61
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,678.15
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$398.56 |
| Max. Negotiated Rate |
$1,510.34 |
| Rate for Payer: Aetna Commercial |
$1,426.43
|
| Rate for Payer: Aetna Medicare |
$436.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$524.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$524.42
|
| Rate for Payer: BCBS Complete |
$450.21
|
| Rate for Payer: BCBS MAPPO |
$419.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,379.61
|
| Rate for Payer: BCN Commercial |
$1,304.76
|
| Rate for Payer: BCN Medicare Advantage |
$419.54
|
| Rate for Payer: Cash Price |
$1,342.52
|
| Rate for Payer: Cash Price |
$1,342.52
|
| Rate for Payer: Cofinity Commercial |
$1,443.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,342.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$419.54
|
| Rate for Payer: Healthscope Commercial |
$1,510.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,258.61
|
| Rate for Payer: Mclaren Medicaid |
$428.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$440.51
|
| Rate for Payer: Meridian Medicaid |
$450.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$482.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,426.43
|
| Rate for Payer: Nomi Health Commercial |
$1,376.08
|
| Rate for Payer: PACE Senior Care Partners |
$398.56
|
| Rate for Payer: PACE SWMI |
$419.54
|
| Rate for Payer: PHP Commercial |
$1,426.43
|
| Rate for Payer: PHP Medicare Advantage |
$419.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,459.99
|
| Rate for Payer: Priority Health Medicare |
$423.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,124.36
|
| Rate for Payer: Railroad Medicare Medicare |
$419.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,476.77
|
| Rate for Payer: UHC Core |
$1,401.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$419.54
|
| Rate for Payer: UHC Exchange |
$419.54
|
| Rate for Payer: UHC Medicare Advantage |
$419.54
|
| Rate for Payer: UHCCP Medicaid |
$428.74
|
| Rate for Payer: VA VA |
$419.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,258.61
|
|
