|
1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH SIMPLE MEATAL ADVANCEMENT (EG, MAGPI, V-FLAP)
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 54322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$750.96 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,416.64
|
| Rate for Payer: BCN Commercial |
$2,416.64
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.06
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$750.96
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH URETHROPLASTY BY LOCAL SKIN FLAPS AND MOBILIZATION OF URETHRA
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 54326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$905.67 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,162.27
|
| Rate for Payer: BCN Commercial |
$3,162.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$996.24
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$905.67
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH URETHROPLASTY BY LOCAL SKIN FLAPS (EG, FLIP-FLAP, PREPUCIAL FLAP)
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 54324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$930.40 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,935.34
|
| Rate for Payer: BCN Commercial |
$2,935.34
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,023.44
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$930.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
ABACAVIR 300 MG-LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
IP
|
$5,807.08
|
|
|
Service Code
|
NDC 49702021718
|
| Hospital Charge Code |
29167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,555.12 |
| Max. Negotiated Rate |
$5,226.37 |
| Rate for Payer: Aetna American Axle |
$3,774.60
|
| Rate for Payer: Aetna Commercial |
$4,936.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,774.60
|
| Rate for Payer: Cash Price |
$4,645.66
|
| Rate for Payer: Cofinity Commercial |
$4,064.96
|
| Rate for Payer: Cofinity Commercial |
$4,994.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,064.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,645.66
|
| Rate for Payer: Healthscope Commercial |
$5,226.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,064.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,355.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,936.02
|
| Rate for Payer: PHP Commercial |
$4,936.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,774.60
|
| Rate for Payer: Priority Health SBD |
$3,658.46
|
| Rate for Payer: UMR Bronson Commercial |
$2,555.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,355.31
|
|
|
ABACAVIR 300 MG-LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
|
OP
|
$5,807.08
|
|
|
Service Code
|
NDC 49702021718
|
| Hospital Charge Code |
29167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,148.62 |
| Max. Negotiated Rate |
$5,226.37 |
| Rate for Payer: Aetna American Axle |
$3,774.60
|
| Rate for Payer: Aetna Commercial |
$4,936.02
|
| Rate for Payer: Aetna Medicare |
$2,903.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,774.60
|
| Rate for Payer: BCBS Complete |
$2,322.83
|
| Rate for Payer: Cash Price |
$4,645.66
|
| Rate for Payer: Cofinity Commercial |
$4,064.96
|
| Rate for Payer: Cofinity Commercial |
$4,994.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,064.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,645.66
|
| Rate for Payer: Healthscope Commercial |
$5,226.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,064.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,355.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,936.02
|
| Rate for Payer: PHP Commercial |
$4,936.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,774.60
|
| Rate for Payer: Priority Health SBD |
$3,658.46
|
| Rate for Payer: UMR Bronson Commercial |
$2,148.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,355.31
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
IP
|
$630.15
|
|
|
Service Code
|
NDC 00904687404
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.27 |
| Max. Negotiated Rate |
$567.14 |
| Rate for Payer: Aetna American Axle |
$409.60
|
| Rate for Payer: Aetna Commercial |
$535.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.60
|
| Rate for Payer: Cash Price |
$504.12
|
| Rate for Payer: Cofinity Commercial |
$441.10
|
| Rate for Payer: Cofinity Commercial |
$541.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.12
|
| Rate for Payer: Healthscope Commercial |
$567.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.63
|
| Rate for Payer: PHP Commercial |
$535.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.60
|
| Rate for Payer: Priority Health SBD |
$396.99
|
| Rate for Payer: UMR Bronson Commercial |
$277.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.61
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
IP
|
$1,139.05
|
|
|
Service Code
|
NDC 00904687406
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$501.18 |
| Max. Negotiated Rate |
$1,025.14 |
| Rate for Payer: Aetna American Axle |
$740.38
|
| Rate for Payer: Aetna Commercial |
$968.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$740.38
|
| Rate for Payer: Cash Price |
$911.24
|
| Rate for Payer: Cofinity Commercial |
$797.34
|
| Rate for Payer: Cofinity Commercial |
$979.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$797.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.24
|
| Rate for Payer: Healthscope Commercial |
$1,025.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$797.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$854.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$968.19
|
| Rate for Payer: PHP Commercial |
$968.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.38
|
| Rate for Payer: Priority Health SBD |
$717.60
|
| Rate for Payer: UMR Bronson Commercial |
$501.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$854.29
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
OP
|
$1,139.05
|
|
|
Service Code
|
NDC 00904687406
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$421.45 |
| Max. Negotiated Rate |
$1,025.14 |
| Rate for Payer: Aetna American Axle |
$740.38
|
| Rate for Payer: Aetna Commercial |
$968.19
|
| Rate for Payer: Aetna Medicare |
$569.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$740.38
|
| Rate for Payer: BCBS Complete |
$455.62
|
| Rate for Payer: Cash Price |
$911.24
|
| Rate for Payer: Cofinity Commercial |
$797.34
|
| Rate for Payer: Cofinity Commercial |
$979.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$797.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.24
|
| Rate for Payer: Healthscope Commercial |
$1,025.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$797.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$854.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$968.19
|
| Rate for Payer: PHP Commercial |
$968.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.38
|
| Rate for Payer: Priority Health SBD |
$717.60
|
| Rate for Payer: UMR Bronson Commercial |
$421.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$854.29
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
IP
|
$23.25
|
|
|
Service Code
|
NDC 68084002111
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna American Axle |
$15.11
|
| Rate for Payer: Aetna Commercial |
$19.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.11
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.60
|
| Rate for Payer: Healthscope Commercial |
$20.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.76
|
| Rate for Payer: PHP Commercial |
$19.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.11
|
| Rate for Payer: Priority Health SBD |
$14.65
|
| Rate for Payer: UMR Bronson Commercial |
$10.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.44
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
OP
|
$630.15
|
|
|
Service Code
|
NDC 00904687404
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.16 |
| Max. Negotiated Rate |
$567.14 |
| Rate for Payer: Aetna American Axle |
$409.60
|
| Rate for Payer: Aetna Commercial |
$535.63
|
| Rate for Payer: Aetna Medicare |
$315.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.60
|
| Rate for Payer: BCBS Complete |
$252.06
|
| Rate for Payer: Cash Price |
$504.12
|
| Rate for Payer: Cofinity Commercial |
$441.10
|
| Rate for Payer: Cofinity Commercial |
$541.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.12
|
| Rate for Payer: Healthscope Commercial |
$567.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.63
|
| Rate for Payer: PHP Commercial |
$535.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.60
|
| Rate for Payer: Priority Health SBD |
$396.99
|
| Rate for Payer: UMR Bronson Commercial |
$233.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.61
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
OP
|
$697.31
|
|
|
Service Code
|
NDC 68084002121
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.00 |
| Max. Negotiated Rate |
$627.58 |
| Rate for Payer: Aetna American Axle |
$453.25
|
| Rate for Payer: Aetna Commercial |
$592.71
|
| Rate for Payer: Aetna Medicare |
$348.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.25
|
| Rate for Payer: BCBS Complete |
$278.92
|
| Rate for Payer: Cash Price |
$557.85
|
| Rate for Payer: Cofinity Commercial |
$488.12
|
| Rate for Payer: Cofinity Commercial |
$599.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$488.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.85
|
| Rate for Payer: Healthscope Commercial |
$627.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$488.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.71
|
| Rate for Payer: PHP Commercial |
$592.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.25
|
| Rate for Payer: Priority Health SBD |
$439.31
|
| Rate for Payer: UMR Bronson Commercial |
$258.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.98
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
IP
|
$527.25
|
|
|
Service Code
|
NDC 31722055760
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$474.52 |
| Rate for Payer: Aetna American Axle |
$342.71
|
| Rate for Payer: Aetna Commercial |
$448.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.71
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cofinity Commercial |
$369.08
|
| Rate for Payer: Cofinity Commercial |
$453.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$369.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.80
|
| Rate for Payer: Healthscope Commercial |
$474.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.16
|
| Rate for Payer: PHP Commercial |
$448.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.71
|
| Rate for Payer: Priority Health SBD |
$332.17
|
| Rate for Payer: UMR Bronson Commercial |
$231.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.44
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
OP
|
$527.25
|
|
|
Service Code
|
NDC 31722055760
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.08 |
| Max. Negotiated Rate |
$474.52 |
| Rate for Payer: Aetna American Axle |
$342.71
|
| Rate for Payer: Aetna Commercial |
$448.16
|
| Rate for Payer: Aetna Medicare |
$263.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.71
|
| Rate for Payer: BCBS Complete |
$210.90
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cofinity Commercial |
$369.08
|
| Rate for Payer: Cofinity Commercial |
$453.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$369.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.80
|
| Rate for Payer: Healthscope Commercial |
$474.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.16
|
| Rate for Payer: PHP Commercial |
$448.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.71
|
| Rate for Payer: Priority Health SBD |
$332.17
|
| Rate for Payer: UMR Bronson Commercial |
$195.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.44
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
OP
|
$23.25
|
|
|
Service Code
|
NDC 68084002111
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna American Axle |
$15.11
|
| Rate for Payer: Aetna Commercial |
$19.76
|
| Rate for Payer: Aetna Medicare |
$11.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.11
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.60
|
| Rate for Payer: Healthscope Commercial |
$20.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.76
|
| Rate for Payer: PHP Commercial |
$19.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.11
|
| Rate for Payer: Priority Health SBD |
$14.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.44
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
|
IP
|
$697.31
|
|
|
Service Code
|
NDC 68084002121
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.82 |
| Max. Negotiated Rate |
$627.58 |
| Rate for Payer: Aetna American Axle |
$453.25
|
| Rate for Payer: Aetna Commercial |
$592.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.25
|
| Rate for Payer: Cash Price |
$557.85
|
| Rate for Payer: Cofinity Commercial |
$488.12
|
| Rate for Payer: Cofinity Commercial |
$599.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$488.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.85
|
| Rate for Payer: Healthscope Commercial |
$627.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$488.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.71
|
| Rate for Payer: PHP Commercial |
$592.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.25
|
| Rate for Payer: Priority Health SBD |
$439.31
|
| Rate for Payer: UMR Bronson Commercial |
$306.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.98
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
IP
|
$4,659.90
|
|
|
Service Code
|
NDC 49702020613
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,050.36 |
| Max. Negotiated Rate |
$4,193.91 |
| Rate for Payer: Aetna American Axle |
$3,028.94
|
| Rate for Payer: Aetna Commercial |
$3,960.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,028.94
|
| Rate for Payer: Cash Price |
$3,727.92
|
| Rate for Payer: Cofinity Commercial |
$3,261.93
|
| Rate for Payer: Cofinity Commercial |
$4,007.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,261.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,727.92
|
| Rate for Payer: Healthscope Commercial |
$4,193.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,261.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,494.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,960.92
|
| Rate for Payer: PHP Commercial |
$3,960.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,028.94
|
| Rate for Payer: Priority Health SBD |
$2,935.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,050.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,494.92
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
OP
|
$254.45
|
|
|
Service Code
|
NDC 69097036202
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: Aetna American Axle |
$165.39
|
| Rate for Payer: Aetna Commercial |
$216.28
|
| Rate for Payer: Aetna Medicare |
$127.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.39
|
| Rate for Payer: BCBS Complete |
$101.78
|
| Rate for Payer: Cash Price |
$203.56
|
| Rate for Payer: Cofinity Commercial |
$178.12
|
| Rate for Payer: Cofinity Commercial |
$218.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.56
|
| Rate for Payer: Healthscope Commercial |
$229.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.28
|
| Rate for Payer: PHP Commercial |
$216.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.39
|
| Rate for Payer: Priority Health SBD |
$160.30
|
| Rate for Payer: UMR Bronson Commercial |
$94.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.84
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
OP
|
$4,659.90
|
|
|
Service Code
|
NDC 49702020613
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,724.16 |
| Max. Negotiated Rate |
$4,193.91 |
| Rate for Payer: Aetna American Axle |
$3,028.94
|
| Rate for Payer: Aetna Commercial |
$3,960.92
|
| Rate for Payer: Aetna Medicare |
$2,329.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,028.94
|
| Rate for Payer: BCBS Complete |
$1,863.96
|
| Rate for Payer: Cash Price |
$3,727.92
|
| Rate for Payer: Cofinity Commercial |
$3,261.93
|
| Rate for Payer: Cofinity Commercial |
$4,007.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,261.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,727.92
|
| Rate for Payer: Healthscope Commercial |
$4,193.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,261.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,494.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,960.92
|
| Rate for Payer: PHP Commercial |
$3,960.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,028.94
|
| Rate for Payer: Priority Health SBD |
$2,935.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,724.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,494.92
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
IP
|
$254.45
|
|
|
Service Code
|
NDC 69097036202
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.96 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: Aetna American Axle |
$165.39
|
| Rate for Payer: Aetna Commercial |
$216.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.39
|
| Rate for Payer: Cash Price |
$203.56
|
| Rate for Payer: Cofinity Commercial |
$178.12
|
| Rate for Payer: Cofinity Commercial |
$218.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.56
|
| Rate for Payer: Healthscope Commercial |
$229.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.28
|
| Rate for Payer: PHP Commercial |
$216.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.39
|
| Rate for Payer: Priority Health SBD |
$160.30
|
| Rate for Payer: UMR Bronson Commercial |
$111.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.84
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
OP
|
$340.66
|
|
|
Service Code
|
NDC 68180028806
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.04 |
| Max. Negotiated Rate |
$306.59 |
| Rate for Payer: Aetna American Axle |
$221.43
|
| Rate for Payer: Aetna Commercial |
$289.56
|
| Rate for Payer: Aetna Medicare |
$170.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.43
|
| Rate for Payer: BCBS Complete |
$136.26
|
| Rate for Payer: Cash Price |
$272.53
|
| Rate for Payer: Cofinity Commercial |
$238.46
|
| Rate for Payer: Cofinity Commercial |
$292.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.53
|
| Rate for Payer: Healthscope Commercial |
$306.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.56
|
| Rate for Payer: PHP Commercial |
$289.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.43
|
| Rate for Payer: Priority Health SBD |
$214.62
|
| Rate for Payer: UMR Bronson Commercial |
$126.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.50
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
|
IP
|
$340.66
|
|
|
Service Code
|
NDC 68180028806
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.89 |
| Max. Negotiated Rate |
$306.59 |
| Rate for Payer: Aetna American Axle |
$221.43
|
| Rate for Payer: Aetna Commercial |
$289.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.43
|
| Rate for Payer: Cash Price |
$272.53
|
| Rate for Payer: Cofinity Commercial |
$238.46
|
| Rate for Payer: Cofinity Commercial |
$292.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.53
|
| Rate for Payer: Healthscope Commercial |
$306.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.56
|
| Rate for Payer: PHP Commercial |
$289.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.43
|
| Rate for Payer: Priority Health SBD |
$214.62
|
| Rate for Payer: UMR Bronson Commercial |
$149.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.50
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,151.36
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
70287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$946.60 |
| Max. Negotiated Rate |
$1,936.22 |
| Rate for Payer: Aetna American Axle |
$1,398.38
|
| Rate for Payer: Aetna American Axle |
$3,069.73
|
| Rate for Payer: Aetna Commercial |
$1,828.66
|
| Rate for Payer: Aetna Commercial |
$4,014.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,069.73
|
| Rate for Payer: Cash Price |
$1,721.09
|
| Rate for Payer: Cash Price |
$3,778.13
|
| Rate for Payer: Cofinity Commercial |
$4,061.49
|
| Rate for Payer: Cofinity Commercial |
$3,305.86
|
| Rate for Payer: Cofinity Commercial |
$1,505.95
|
| Rate for Payer: Cofinity Commercial |
$1,850.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,505.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,305.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,778.13
|
| Rate for Payer: Healthscope Commercial |
$1,936.22
|
| Rate for Payer: Healthscope Commercial |
$4,250.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,505.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,305.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,613.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,542.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,014.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,828.66
|
| Rate for Payer: PHP Commercial |
$4,014.26
|
| Rate for Payer: PHP Commercial |
$1,828.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,069.73
|
| Rate for Payer: Priority Health SBD |
$1,355.36
|
| Rate for Payer: Priority Health SBD |
$2,975.28
|
| Rate for Payer: UMR Bronson Commercial |
$946.60
|
| Rate for Payer: UMR Bronson Commercial |
$2,077.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,613.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,542.00
|
|
|
ABATACEPT (WITH MALTOSE) 250 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,151.36
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
70287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$1,936.22 |
| Rate for Payer: Aetna American Axle |
$1,398.38
|
| Rate for Payer: Aetna American Axle |
$3,069.73
|
| Rate for Payer: Aetna Commercial |
$4,014.26
|
| Rate for Payer: Aetna Commercial |
$1,828.66
|
| Rate for Payer: Aetna Medicare |
$45.55
|
| Rate for Payer: Aetna Medicare |
$45.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,069.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.75
|
| Rate for Payer: BCBS Complete |
$24.65
|
| Rate for Payer: BCBS Complete |
$24.65
|
| Rate for Payer: BCBS MAPPO |
$43.80
|
| Rate for Payer: BCBS MAPPO |
$43.80
|
| Rate for Payer: BCBS Trust/PPO |
$146.29
|
| Rate for Payer: BCBS Trust/PPO |
$146.29
|
| Rate for Payer: BCN Commercial |
$146.29
|
| Rate for Payer: BCN Commercial |
$146.29
|
| Rate for Payer: BCN Medicare Advantage |
$43.80
|
| Rate for Payer: BCN Medicare Advantage |
$43.80
|
| Rate for Payer: Cash Price |
$3,778.13
|
| Rate for Payer: Cash Price |
$1,721.09
|
| Rate for Payer: Cash Price |
$3,778.13
|
| Rate for Payer: Cash Price |
$1,721.09
|
| Rate for Payer: Cofinity Commercial |
$3,305.86
|
| Rate for Payer: Cofinity Commercial |
$1,505.95
|
| Rate for Payer: Cofinity Commercial |
$1,850.17
|
| Rate for Payer: Cofinity Commercial |
$4,061.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,505.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,305.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,778.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.80
|
| Rate for Payer: Healthscope Commercial |
$1,936.22
|
| Rate for Payer: Healthscope Commercial |
$4,250.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,305.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,505.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,613.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,542.00
|
| Rate for Payer: Mclaren Medicaid |
$23.48
|
| Rate for Payer: Mclaren Medicaid |
$23.48
|
| Rate for Payer: Mclaren Medicare |
$43.80
|
| Rate for Payer: Mclaren Medicare |
$43.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.99
|
| Rate for Payer: Meridian Medicaid |
$24.65
|
| Rate for Payer: Meridian Medicaid |
$24.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,828.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,014.26
|
| Rate for Payer: Nomi Health Commercial |
$131.40
|
| Rate for Payer: Nomi Health Commercial |
$131.40
|
| Rate for Payer: PACE Medicare |
$41.61
|
| Rate for Payer: PACE Medicare |
$41.61
|
| Rate for Payer: PACE SWMI |
$43.80
|
| Rate for Payer: PACE SWMI |
$43.80
|
| Rate for Payer: PHP Commercial |
$1,828.66
|
| Rate for Payer: PHP Commercial |
$4,014.26
|
| Rate for Payer: PHP Medicare Advantage |
$43.80
|
| Rate for Payer: PHP Medicare Advantage |
$43.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,069.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.00
|
| Rate for Payer: Priority Health Medicare |
$43.80
|
| Rate for Payer: Priority Health Medicare |
$43.80
|
| Rate for Payer: Priority Health Narrow Network |
$100.00
|
| Rate for Payer: Priority Health Narrow Network |
$100.00
|
| Rate for Payer: Priority Health SBD |
$1,355.36
|
| Rate for Payer: Priority Health SBD |
$2,975.28
|
| Rate for Payer: Railroad Medicare Medicare |
$43.80
|
| Rate for Payer: Railroad Medicare Medicare |
$43.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.80
|
| Rate for Payer: UHC Exchange |
$83.71
|
| Rate for Payer: UHC Exchange |
$83.71
|
| Rate for Payer: UHC Medicare Advantage |
$43.80
|
| Rate for Payer: UHC Medicare Advantage |
$43.80
|
| Rate for Payer: UHCCP Medicaid |
$23.48
|
| Rate for Payer: UHCCP Medicaid |
$23.48
|
| Rate for Payer: UMR Bronson Commercial |
$796.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,747.38
|
| Rate for Payer: VA VA |
$43.80
|
| Rate for Payer: VA VA |
$43.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,613.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,542.00
|
|
|
ABDHR GEL TOPICAL SYRINGE
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
NDC 09900000392
|
| Hospital Charge Code |
151065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna American Axle |
$7.60
|
| Rate for Payer: Aetna Commercial |
$9.94
|
| Rate for Payer: Aetna Medicare |
$5.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.60
|
| Rate for Payer: BCBS Complete |
$4.68
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.94
|
| Rate for Payer: PHP Commercial |
$9.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.60
|
| Rate for Payer: Priority Health SBD |
$7.37
|
| Rate for Payer: UMR Bronson Commercial |
$4.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.78
|
|
|
ABDHR GEL TOPICAL SYRINGE
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
NDC 09900000392
|
| Hospital Charge Code |
151065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna American Axle |
$7.60
|
| Rate for Payer: Aetna Commercial |
$9.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.60
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$8.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.94
|
| Rate for Payer: PHP Commercial |
$9.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.60
|
| Rate for Payer: Priority Health SBD |
$7.37
|
| Rate for Payer: UMR Bronson Commercial |
$5.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.78
|
|
