|
1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH SIMPLE MEATAL ADVANCEMENT (EG, MAGPI, V-FLAP)
|
Facility
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 54322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$763.59 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,304.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$839.95
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$763.59
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH URETHROPLASTY BY LOCAL SKIN FLAPS AND MOBILIZATION OF URETHRA
|
Facility
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 54326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$920.11 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,015.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,012.12
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$920.11
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH URETHROPLASTY BY LOCAL SKIN FLAPS (EG, FLIP-FLAP, PREPUCIAL FLAP)
|
Facility
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 54324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,798.73
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.50
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$945.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
ABACAVIR 300 MG-LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
IP
|
$4,779.89
|
|
|
Service Code
|
NDC 68180-286-07
|
| Hospital Charge Code |
29167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,103.15 |
| Max. Negotiated Rate |
$4,301.90 |
| Rate for Payer: Aetna American Axle |
$3,106.93
|
| Rate for Payer: Aetna Commercial |
$4,062.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,106.93
|
| Rate for Payer: Cash Price |
$3,823.91
|
| Rate for Payer: Cofinity Commercial |
$3,345.92
|
| Rate for Payer: Cofinity Commercial |
$4,110.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,823.91
|
| Rate for Payer: Healthscope Commercial |
$4,301.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,345.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,584.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,062.91
|
| Rate for Payer: PHP Commercial |
$4,062.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,345.92
|
| Rate for Payer: Priority Health SBD |
$3,011.33
|
| Rate for Payer: UMR Bronson Commercial |
$2,103.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,584.92
|
|
|
ABACAVIR 300 MG-LAMIVUDINE 150 MG-ZIDOVUDINE 300 MG TABLET
|
Facility
IP
|
$5,807.08
|
|
|
Service Code
|
NDC 49702-217-18
|
| 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: 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 Multiplan/Beech St/PHCS |
$4,936.02
|
| Rate for Payer: PHP Commercial |
$4,936.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,064.96
|
| 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 TABLET
|
Facility
IP
|
$613.61
|
|
|
Service Code
|
NDC 0904-6874-04
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$552.25 |
| Rate for Payer: Aetna American Axle |
$398.85
|
| Rate for Payer: Aetna Commercial |
$521.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.85
|
| Rate for Payer: Cash Price |
$490.89
|
| Rate for Payer: Cofinity Commercial |
$429.53
|
| Rate for Payer: Cofinity Commercial |
$527.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$490.89
|
| Rate for Payer: Healthscope Commercial |
$552.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$429.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$460.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$521.57
|
| Rate for Payer: PHP Commercial |
$521.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.53
|
| Rate for Payer: Priority Health SBD |
$386.57
|
| Rate for Payer: UMR Bronson Commercial |
$269.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$460.21
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
IP
|
$527.25
|
|
|
Service Code
|
NDC 31722-557-60
|
| 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: 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 Multiplan/Beech St/PHCS |
$448.16
|
| Rate for Payer: PHP Commercial |
$448.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.08
|
| 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
IP
|
$776.78
|
|
|
Service Code
|
NDC 68084-021-21
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$341.78 |
| Max. Negotiated Rate |
$699.10 |
| Rate for Payer: Aetna American Axle |
$504.91
|
| Rate for Payer: Aetna Commercial |
$660.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.91
|
| Rate for Payer: Cash Price |
$621.42
|
| Rate for Payer: Cofinity Commercial |
$543.75
|
| Rate for Payer: Cofinity Commercial |
$668.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$621.42
|
| Rate for Payer: Healthscope Commercial |
$699.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$543.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$582.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$660.26
|
| Rate for Payer: PHP Commercial |
$660.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.75
|
| Rate for Payer: Priority Health SBD |
$489.37
|
| Rate for Payer: UMR Bronson Commercial |
$341.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$582.58
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
IP
|
$25.90
|
|
|
Service Code
|
NDC 68084-021-11
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.02
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.13
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
|
|
ABACAVIR 300 MG TABLET
|
Facility
IP
|
$1,120.36
|
|
|
Service Code
|
NDC 0904-6874-06
|
| Hospital Charge Code |
24438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$492.96 |
| Max. Negotiated Rate |
$1,008.32 |
| Rate for Payer: Aetna American Axle |
$728.23
|
| Rate for Payer: Aetna Commercial |
$952.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.23
|
| Rate for Payer: Cash Price |
$896.29
|
| Rate for Payer: Cofinity Commercial |
$784.25
|
| Rate for Payer: Cofinity Commercial |
$963.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.29
|
| Rate for Payer: Healthscope Commercial |
$1,008.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$784.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$840.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$952.31
|
| Rate for Payer: PHP Commercial |
$952.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.25
|
| Rate for Payer: Priority Health SBD |
$705.83
|
| Rate for Payer: UMR Bronson Commercial |
$492.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$840.27
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
IP
|
$250.42
|
|
|
Service Code
|
NDC 69097-362-02
|
| Hospital Charge Code |
39301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.18 |
| Max. Negotiated Rate |
$225.38 |
| Rate for Payer: Aetna American Axle |
$162.77
|
| Rate for Payer: Aetna Commercial |
$212.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.77
|
| Rate for Payer: Cash Price |
$200.34
|
| Rate for Payer: Cofinity Commercial |
$175.29
|
| Rate for Payer: Cofinity Commercial |
$215.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.34
|
| Rate for Payer: Healthscope Commercial |
$225.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.86
|
| Rate for Payer: PHP Commercial |
$212.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.29
|
| Rate for Payer: Priority Health SBD |
$157.76
|
| Rate for Payer: UMR Bronson Commercial |
$110.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.82
|
|
|
ABACAVIR 600 MG-LAMIVUDINE 300 MG TABLET
|
Facility
IP
|
$4,659.90
|
|
|
Service Code
|
NDC 49702-206-13
|
| 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: 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 Multiplan/Beech St/PHCS |
$3,960.92
|
| Rate for Payer: PHP Commercial |
$3,960.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,261.93
|
| 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
IP
|
$340.66
|
|
|
Service Code
|
NDC 68180-288-06
|
| 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: 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 Multiplan/Beech St/PHCS |
$289.56
|
| Rate for Payer: PHP Commercial |
$289.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.46
|
| 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 INJECTION
|
Professional
|
$40.00
|
|
|
Service Code
|
HCPCS J0129
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$62.31 |
| Rate for Payer: Aetna Commercial |
$57.98
|
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.31
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$43.27
|
| Rate for Payer: BCBS Trust/PPO |
$52.16
|
| Rate for Payer: BCN Medicare Advantage |
$43.27
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Cofinity Commercial |
$57.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.43
|
| Rate for Payer: PACE SWMI |
$43.27
|
| Rate for Payer: PHP Commercial |
$60.58
|
| Rate for Payer: PHP Medicare Advantage |
$43.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health Medicare |
$43.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.27
|
| Rate for Payer: UHC Medicare Advantage |
$44.57
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
|
|
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 |
$2,896.40
|
| Rate for Payer: Aetna Commercial |
$1,828.66
|
| Rate for Payer: Aetna Commercial |
$3,787.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,896.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.38
|
| Rate for Payer: Cash Price |
$1,721.09
|
| Rate for Payer: Cash Price |
$3,564.80
|
| Rate for Payer: Cofinity Commercial |
$1,505.95
|
| Rate for Payer: Cofinity Commercial |
$1,850.17
|
| Rate for Payer: Cofinity Commercial |
$3,832.16
|
| Rate for Payer: Cofinity Commercial |
$3,119.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,564.80
|
| Rate for Payer: Healthscope Commercial |
$4,010.40
|
| Rate for Payer: Healthscope Commercial |
$1,936.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,119.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,505.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,342.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,613.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,787.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,828.66
|
| Rate for Payer: PHP Commercial |
$1,828.66
|
| Rate for Payer: PHP Commercial |
$3,787.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,119.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.95
|
| Rate for Payer: Priority Health SBD |
$1,355.36
|
| Rate for Payer: Priority Health SBD |
$2,807.28
|
| Rate for Payer: UMR Bronson Commercial |
$946.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,960.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,613.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,342.00
|
|
|
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 |
$23.61 |
| Max. Negotiated Rate |
$1,936.22 |
| Rate for Payer: Aetna American Axle |
$1,398.38
|
| Rate for Payer: Aetna American Axle |
$2,896.40
|
| Rate for Payer: Aetna Commercial |
$1,828.66
|
| Rate for Payer: Aetna Commercial |
$3,787.60
|
| Rate for Payer: Aetna Medicare |
$44.89
|
| Rate for Payer: Aetna Medicare |
$44.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,896.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.95
|
| Rate for Payer: BCBS Complete |
$24.79
|
| Rate for Payer: BCBS Complete |
$24.79
|
| Rate for Payer: BCBS MAPPO |
$43.16
|
| Rate for Payer: BCBS MAPPO |
$43.16
|
| Rate for Payer: BCBS Trust/PPO |
$165.44
|
| Rate for Payer: BCBS Trust/PPO |
$165.44
|
| Rate for Payer: BCN Medicare Advantage |
$43.16
|
| Rate for Payer: BCN Medicare Advantage |
$43.16
|
| Rate for Payer: Cash Price |
$3,564.80
|
| Rate for Payer: Cash Price |
$3,564.80
|
| Rate for Payer: Cash Price |
$1,721.09
|
| Rate for Payer: Cash Price |
$1,721.09
|
| Rate for Payer: Cofinity Commercial |
$3,119.20
|
| Rate for Payer: Cofinity Commercial |
$1,505.95
|
| Rate for Payer: Cofinity Commercial |
$1,850.17
|
| Rate for Payer: Cofinity Commercial |
$3,832.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,564.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.16
|
| Rate for Payer: Healthscope Commercial |
$1,936.22
|
| Rate for Payer: Healthscope Commercial |
$4,010.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,505.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,119.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,342.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,613.52
|
| Rate for Payer: Mclaren Medicaid |
$23.61
|
| Rate for Payer: Mclaren Medicaid |
$23.61
|
| Rate for Payer: Mclaren Medicare |
$43.16
|
| Rate for Payer: Mclaren Medicare |
$43.16
|
| Rate for Payer: Meridian Medicaid |
$24.79
|
| Rate for Payer: Meridian Medicaid |
$24.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,828.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,787.60
|
| Rate for Payer: PACE Medicare |
$41.00
|
| Rate for Payer: PACE Medicare |
$41.00
|
| Rate for Payer: PACE SWMI |
$43.16
|
| Rate for Payer: PACE SWMI |
$43.16
|
| Rate for Payer: PHP Commercial |
$1,828.66
|
| Rate for Payer: PHP Commercial |
$3,787.60
|
| Rate for Payer: PHP Medicare Advantage |
$43.16
|
| Rate for Payer: PHP Medicare Advantage |
$43.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,119.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.42
|
| Rate for Payer: Priority Health Medicare |
$43.16
|
| Rate for Payer: Priority Health Medicare |
$43.16
|
| Rate for Payer: Priority Health Narrow Network |
$100.34
|
| Rate for Payer: Priority Health Narrow Network |
$100.34
|
| Rate for Payer: Priority Health SBD |
$2,807.28
|
| Rate for Payer: Priority Health SBD |
$1,355.36
|
| Rate for Payer: Railroad Medicare Medicare |
$43.16
|
| Rate for Payer: Railroad Medicare Medicare |
$43.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.16
|
| Rate for Payer: UHC Medicare Advantage |
$44.46
|
| Rate for Payer: UHC Medicare Advantage |
$44.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,648.72
|
| Rate for Payer: UMR Bronson Commercial |
$796.00
|
| Rate for Payer: VA VA |
$43.16
|
| Rate for Payer: VA VA |
$43.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,613.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,342.00
|
|
|
ABDHR GEL TOPICAL SYRINGE
|
Facility
IP
|
$11.70
|
|
|
Service Code
|
NDC 9900-0003-92
|
| 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: 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 Multiplan/Beech St/PHCS |
$9.94
|
| Rate for Payer: PHP Commercial |
$9.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.19
|
| 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
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
|
Facility
OP
|
$4,267.42
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$200.39 |
| Max. Negotiated Rate |
$4,267.42 |
| Rate for Payer: Aetna Medicare |
$1,409.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,694.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,694.48
|
| Rate for Payer: BCBS Complete |
$778.65
|
| Rate for Payer: BCBS MAPPO |
$1,355.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.58
|
| Rate for Payer: Mclaren Medicaid |
$741.50
|
| Rate for Payer: Mclaren Medicare |
$1,355.58
|
| Rate for Payer: Meridian Medicaid |
$778.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,423.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,558.92
|
| Rate for Payer: PACE Medicare |
$1,287.80
|
| Rate for Payer: PACE SWMI |
$1,355.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,267.42
|
| Rate for Payer: Priority Health Medicare |
$1,355.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,413.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,355.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.43
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,355.58
|
| Rate for Payer: UHC Exchange |
$200.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,396.25
|
| Rate for Payer: VA VA |
$1,355.58
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); SUPERFICIAL
|
Facility
OP
|
$4,267.42
|
|
|
Service Code
|
CPT 30801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$150.62 |
| Max. Negotiated Rate |
$4,267.42 |
| Rate for Payer: Aetna Medicare |
$1,409.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,694.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,694.48
|
| Rate for Payer: BCBS Complete |
$778.65
|
| Rate for Payer: BCBS MAPPO |
$1,355.58
|
| Rate for Payer: BCBS Trust/PPO |
$833.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.58
|
| Rate for Payer: Mclaren Medicaid |
$741.50
|
| Rate for Payer: Mclaren Medicare |
$1,355.58
|
| Rate for Payer: Meridian Medicaid |
$778.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,423.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,558.92
|
| Rate for Payer: PACE Medicare |
$1,287.80
|
| Rate for Payer: PACE SWMI |
$1,355.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,267.42
|
| Rate for Payer: Priority Health Medicare |
$1,355.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,413.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,355.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.68
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,355.58
|
| Rate for Payer: UHC Exchange |
$150.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,396.25
|
| Rate for Payer: VA VA |
$1,355.58
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$15,135.20
|
|
|
Service Code
|
MS-DRG 770
|
| Min. Negotiated Rate |
$6,333.81 |
| Max. Negotiated Rate |
$15,135.20 |
| Rate for Payer: Aetna Medicare |
$6,933.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,333.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,333.96
|
| Rate for Payer: BCBS MAPPO |
$6,667.17
|
| Rate for Payer: BCBS Trust/PPO |
$15,135.20
|
| Rate for Payer: BCN Medicare Advantage |
$6,667.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,667.17
|
| Rate for Payer: Mclaren Medicare |
$6,667.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,000.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,667.25
|
| Rate for Payer: PACE Medicare |
$6,333.81
|
| Rate for Payer: PACE SWMI |
$6,667.17
|
| Rate for Payer: PHP Medicare Advantage |
$6,667.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,461.28
|
| Rate for Payer: Priority Health Medicare |
$6,667.17
|
| Rate for Payer: Priority Health Narrow Network |
$9,169.02
|
| Rate for Payer: Railroad Medicare Medicare |
$6,667.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,183.37
|
| Rate for Payer: UHC Core |
$9,990.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,667.17
|
| Rate for Payer: UHC Exchange |
$7,942.27
|
| Rate for Payer: UHC Medicare Advantage |
$6,867.19
|
| Rate for Payer: VA VA |
$6,667.17
|
|
|
ABORTION WITHOUT D&C
|
Facility
IP
|
$15,089.26
|
|
|
Service Code
|
MS-DRG 779
|
| Min. Negotiated Rate |
$7,728.41 |
| Max. Negotiated Rate |
$15,089.26 |
| Rate for Payer: Aetna Medicare |
$8,460.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,168.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,168.96
|
| Rate for Payer: BCBS MAPPO |
$8,135.17
|
| Rate for Payer: BCBS Trust/PPO |
$9,694.77
|
| Rate for Payer: BCN Medicare Advantage |
$8,135.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,135.17
|
| Rate for Payer: Mclaren Medicare |
$8,135.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,541.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,355.45
|
| Rate for Payer: PACE Medicare |
$7,728.41
|
| Rate for Payer: PACE SWMI |
$8,135.17
|
| Rate for Payer: PHP Medicare Advantage |
$8,135.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,194.94
|
| Rate for Payer: Priority Health Medicare |
$8,135.17
|
| Rate for Payer: Priority Health Narrow Network |
$11,355.95
|
| Rate for Payer: Railroad Medicare Medicare |
$8,135.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,089.26
|
| Rate for Payer: UHC Core |
$12,372.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,135.17
|
| Rate for Payer: UHC Exchange |
$9,836.60
|
| Rate for Payer: UHC Medicare Advantage |
$8,379.23
|
| Rate for Payer: VA VA |
$8,135.17
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$23.59
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna American Axle |
$21.40
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.40
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.51
|
| Rate for Payer: Priority Health SBD |
$20.75
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: UMR Bronson Commercial |
$14.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.70
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$1.55
|
|
|
Service Code
|
NDC 45802-732-00
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna American Axle |
$1.01
|
| Rate for Payer: Aetna Commercial |
$1.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.01
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Cofinity Commercial |
$1.08
|
| Rate for Payer: Cofinity Commercial |
$1.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.24
|
| Rate for Payer: Healthscope Commercial |
$1.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.32
|
| Rate for Payer: PHP Commercial |
$1.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.08
|
| Rate for Payer: Priority Health SBD |
$0.98
|
| Rate for Payer: UMR Bronson Commercial |
$0.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.16
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$18.57
|
|
|
Service Code
|
NDC 45802-732-30
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$16.71 |
| Rate for Payer: Aetna American Axle |
$12.07
|
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.07
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$13.00
|
| Rate for Payer: Cofinity Commercial |
$15.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$16.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.78
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health SBD |
$11.70
|
| Rate for Payer: UMR Bronson Commercial |
$8.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.93
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
IP
|
$14.30
|
|
|
Service Code
|
NDC 0121-0657-05
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$12.87 |
| Rate for Payer: Aetna American Axle |
$9.30
|
| Rate for Payer: Aetna Commercial |
$12.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.30
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cofinity Commercial |
$10.01
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Healthscope Commercial |
$12.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.16
|
| Rate for Payer: PHP Commercial |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health SBD |
$9.01
|
| Rate for Payer: UMR Bronson Commercial |
$6.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.72
|
|
