|
ACYCLOVIR 400 MG TABLET
|
Facility
|
IP
|
$262.20
|
|
|
Service Code
|
NDC 00904750761
|
| Hospital Charge Code |
8971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.37 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna American Axle |
$170.43
|
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
| Rate for Payer: UMR Bronson Commercial |
$115.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.65
|
|
|
ACYCLOVIR 400 MG TABLET
|
Facility
|
OP
|
$288.80
|
|
|
Service Code
|
NDC 60687085601
|
| Hospital Charge Code |
8971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.86 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna American Axle |
$187.72
|
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna Medicare |
$144.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: BCBS Complete |
$115.52
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Advantage |
$202.16
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$259.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.60
|
| Rate for Payer: PHP Commercial |
$245.48
|
| Rate for Payer: Priority Health SBD |
$181.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.72
|
| Rate for Payer: UHC Core |
$150.46
|
| Rate for Payer: UHC Exchange |
$113.50
|
| Rate for Payer: UMR Bronson Commercial |
$106.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.60
|
|
|
ACYCLOVIR 400 MG TABLET
|
Facility
|
IP
|
$288.80
|
|
|
Service Code
|
NDC 60687085601
|
| Hospital Charge Code |
8971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.07 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna American Axle |
$187.72
|
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Advantage |
$202.16
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$259.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.60
|
| Rate for Payer: PHP Commercial |
$245.48
|
| Rate for Payer: Priority Health SBD |
$181.94
|
| Rate for Payer: UMR Bronson Commercial |
$127.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.60
|
|
|
ACYCLOVIR 400 MG TABLET
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
NDC 60687085611
|
| Hospital Charge Code |
8971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna American Axle |
$1.88
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.88
|
| Rate for Payer: UHC Core |
$1.51
|
| Rate for Payer: UHC Exchange |
$1.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
ACYCLOVIR 400 MG TABLET
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 60687085611
|
| Hospital Charge Code |
8971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna American Axle |
$1.88
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
ACYCLOVIR 400 MG TABLET
|
Facility
|
OP
|
$262.20
|
|
|
Service Code
|
NDC 00904750761
|
| Hospital Charge Code |
8971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna American Axle |
$170.43
|
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna Medicare |
$131.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: BCBS Complete |
$104.88
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.43
|
| Rate for Payer: UHC Core |
$136.61
|
| Rate for Payer: UHC Exchange |
$103.04
|
| Rate for Payer: UMR Bronson Commercial |
$97.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.65
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.61
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Aetna American Axle |
$12.10
|
| Rate for Payer: Aetna American Axle |
$20.25
|
| Rate for Payer: Aetna American Axle |
$13.04
|
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: Aetna Commercial |
$15.82
|
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.04
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$14.89
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cofinity Advantage |
$21.80
|
| Rate for Payer: Cofinity Advantage |
$13.03
|
| Rate for Payer: Cofinity Advantage |
$14.04
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Cofinity Commercial |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Healthscope Commercial |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Healthscope Commercial |
$16.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.36
|
| Rate for Payer: PHP Commercial |
$17.05
|
| Rate for Payer: PHP Commercial |
$15.82
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: Priority Health SBD |
$11.72
|
| Rate for Payer: Priority Health SBD |
$12.64
|
| Rate for Payer: Priority Health SBD |
$19.62
|
| Rate for Payer: UMR Bronson Commercial |
$8.19
|
| Rate for Payer: UMR Bronson Commercial |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$8.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.36
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.06
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Aetna American Axle |
$13.04
|
| Rate for Payer: Aetna American Axle |
$12.10
|
| Rate for Payer: Aetna American Axle |
$20.25
|
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna Commercial |
$15.82
|
| Rate for Payer: Aetna Medicare |
$10.03
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Aetna Medicare |
$15.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS Complete |
$8.02
|
| Rate for Payer: BCBS Complete |
$12.46
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$14.89
|
| Rate for Payer: Cash Price |
$14.89
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cofinity Advantage |
$21.80
|
| Rate for Payer: Cofinity Advantage |
$14.04
|
| Rate for Payer: Cofinity Advantage |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$16.75
|
| Rate for Payer: Healthscope Commercial |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.36
|
| Rate for Payer: PHP Commercial |
$17.05
|
| Rate for Payer: PHP Commercial |
$15.82
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: Priority Health SBD |
$11.72
|
| Rate for Payer: Priority Health SBD |
$19.62
|
| Rate for Payer: Priority Health SBD |
$12.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UMR Bronson Commercial |
$11.53
|
| Rate for Payer: UMR Bronson Commercial |
$6.89
|
| Rate for Payer: UMR Bronson Commercial |
$7.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.36
|
|
|
ADALIMUMAB 40 MG/0.8 ML SUBCUTANEOUS PEN KIT
|
Facility
|
OP
|
$5,185.36
|
|
|
Service Code
|
HCPCS J0139
|
| Hospital Charge Code |
116603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$269.25 |
| Max. Negotiated Rate |
$4,666.82 |
| Rate for Payer: Aetna American Axle |
$3,370.48
|
| Rate for Payer: Aetna Commercial |
$4,407.56
|
| Rate for Payer: Aetna Medicare |
$2,592.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,370.48
|
| Rate for Payer: BCBS Complete |
$2,074.14
|
| Rate for Payer: Cash Price |
$4,148.29
|
| Rate for Payer: Cash Price |
$4,148.29
|
| Rate for Payer: Cofinity Advantage |
$3,629.75
|
| Rate for Payer: Cofinity Commercial |
$4,459.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,148.29
|
| Rate for Payer: Healthscope Commercial |
$4,666.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,629.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,889.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,148.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,407.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,889.02
|
| Rate for Payer: PHP Commercial |
$4,407.56
|
| Rate for Payer: Priority Health SBD |
$3,266.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.25
|
| Rate for Payer: UHC Core |
$269.25
|
| Rate for Payer: UHC Exchange |
$269.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,918.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,889.02
|
|
|
ADALIMUMAB 40 MG/0.8 ML SUBCUTANEOUS PEN KIT
|
Facility
|
IP
|
$5,185.36
|
|
|
Service Code
|
HCPCS J0139
|
| Hospital Charge Code |
116603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,281.56 |
| Max. Negotiated Rate |
$4,666.82 |
| Rate for Payer: Aetna American Axle |
$3,370.48
|
| Rate for Payer: Aetna Commercial |
$4,407.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,370.48
|
| Rate for Payer: Cash Price |
$4,148.29
|
| Rate for Payer: Cofinity Advantage |
$3,629.75
|
| Rate for Payer: Cofinity Commercial |
$4,459.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,148.29
|
| Rate for Payer: Healthscope Commercial |
$4,666.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,629.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,889.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,407.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,889.02
|
| Rate for Payer: PHP Commercial |
$4,407.56
|
| Rate for Payer: Priority Health SBD |
$3,266.78
|
| Rate for Payer: UMR Bronson Commercial |
$2,281.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,889.02
|
|
|
ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 42831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,359.14
|
| Rate for Payer: BCN Commercial |
$3,359.14
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 42830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,747.89
|
| Rate for Payer: BCN Commercial |
$2,747.89
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
ADENOIDECTOMY, SECONDARY; AGE 12 OR OVER
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 42836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.42
|
| Rate for Payer: BCN Commercial |
$2,064.42
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
ADENOIDECTOMY, SECONDARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 42835
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.42
|
| Rate for Payer: BCN Commercial |
$2,064.42
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
ADENOSINE 3 MG/250 ML NS IV
|
Facility
|
OP
|
$10.88
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
151056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Aetna American Axle |
$7.07
|
| Rate for Payer: Aetna Commercial |
$9.25
|
| Rate for Payer: Aetna Medicare |
$5.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.07
|
| Rate for Payer: BCBS Complete |
$4.35
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cofinity Advantage |
$7.62
|
| Rate for Payer: Cofinity Commercial |
$9.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.70
|
| Rate for Payer: Healthscope Commercial |
$9.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.16
|
| Rate for Payer: PHP Commercial |
$9.25
|
| Rate for Payer: Priority Health SBD |
$6.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$4.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.16
|
|
|
ADENOSINE 3 MG/250 ML NS IV
|
Facility
|
IP
|
$10.88
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
151056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Aetna American Axle |
$7.07
|
| Rate for Payer: Aetna Commercial |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.07
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cofinity Advantage |
$7.62
|
| Rate for Payer: Cofinity Commercial |
$9.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.70
|
| Rate for Payer: Healthscope Commercial |
$9.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.16
|
| Rate for Payer: PHP Commercial |
$9.25
|
| Rate for Payer: Priority Health SBD |
$6.85
|
| Rate for Payer: UMR Bronson Commercial |
$4.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.16
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.05
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna American Axle |
$11.73
|
| Rate for Payer: Aetna American Axle |
$16.42
|
| Rate for Payer: Aetna Commercial |
$15.34
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: Cash Price |
$14.44
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Advantage |
$17.68
|
| Rate for Payer: Cofinity Advantage |
$12.63
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$16.25
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.95
|
| Rate for Payer: PHP Commercial |
$15.34
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: Priority Health SBD |
$11.37
|
| Rate for Payer: UMR Bronson Commercial |
$7.94
|
| Rate for Payer: UMR Bronson Commercial |
$11.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.95
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.05
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna American Axle |
$11.73
|
| Rate for Payer: Aetna American Axle |
$16.42
|
| Rate for Payer: Aetna Commercial |
$15.34
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Medicare |
$9.03
|
| Rate for Payer: Aetna Medicare |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS Complete |
$7.22
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$14.44
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$14.44
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Advantage |
$12.63
|
| Rate for Payer: Cofinity Advantage |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$16.25
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.54
|
| Rate for Payer: PHP Commercial |
$15.34
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health SBD |
$11.37
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$6.68
|
| Rate for Payer: UMR Bronson Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.95
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$39.13
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
39477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$35.22 |
| Rate for Payer: Aetna American Axle |
$25.43
|
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Medicare |
$19.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: BCBS Complete |
$15.65
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cofinity Advantage |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.30
|
| Rate for Payer: Healthscope Commercial |
$35.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.35
|
| Rate for Payer: PHP Commercial |
$33.26
|
| Rate for Payer: Priority Health SBD |
$24.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$14.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.35
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$39.13
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
39477
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$35.22 |
| Rate for Payer: Aetna American Axle |
$25.43
|
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.43
|
| Rate for Payer: Cash Price |
$31.30
|
| Rate for Payer: Cofinity Advantage |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.30
|
| Rate for Payer: Healthscope Commercial |
$35.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.35
|
| Rate for Payer: PHP Commercial |
$33.26
|
| Rate for Payer: Priority Health SBD |
$24.65
|
| Rate for Payer: UMR Bronson Commercial |
$17.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.35
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
IP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna American Axle |
$16.42
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Advantage |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.95
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: UMR Bronson Commercial |
$11.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.95
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna American Axle |
$16.42
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Medicare |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Advantage |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.95
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.95
|
|
|
ADENOSINE 6 MG/500 ML NS IV
|
Facility
|
OP
|
$236.64
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
151053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$212.98 |
| Rate for Payer: Aetna American Axle |
$153.82
|
| Rate for Payer: Aetna Commercial |
$201.14
|
| Rate for Payer: Aetna Medicare |
$118.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.82
|
| Rate for Payer: BCBS Complete |
$94.66
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cofinity Advantage |
$165.65
|
| Rate for Payer: Cofinity Commercial |
$203.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
| Rate for Payer: Healthscope Commercial |
$212.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.48
|
| Rate for Payer: PHP Commercial |
$201.14
|
| Rate for Payer: Priority Health SBD |
$149.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UMR Bronson Commercial |
$87.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.48
|
|
|
ADENOSINE 6 MG/500 ML NS IV
|
Facility
|
IP
|
$236.64
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
151053
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.12 |
| Max. Negotiated Rate |
$212.98 |
| Rate for Payer: Aetna American Axle |
$153.82
|
| Rate for Payer: Aetna Commercial |
$201.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.82
|
| Rate for Payer: Cash Price |
$189.31
|
| Rate for Payer: Cofinity Advantage |
$165.65
|
| Rate for Payer: Cofinity Commercial |
$203.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.31
|
| Rate for Payer: Healthscope Commercial |
$212.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.48
|
| Rate for Payer: PHP Commercial |
$201.14
|
| Rate for Payer: Priority Health SBD |
$149.08
|
| Rate for Payer: UMR Bronson Commercial |
$104.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.48
|
|
|
ADENOSINE (DIAGNOSTIC) 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$114.90
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
15330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.56 |
| Max. Negotiated Rate |
$103.41 |
| Rate for Payer: Aetna American Axle |
$74.69
|
| Rate for Payer: Aetna American Axle |
$49.55
|
| Rate for Payer: Aetna American Axle |
$46.98
|
| Rate for Payer: Aetna Commercial |
$61.43
|
| Rate for Payer: Aetna Commercial |
$97.67
|
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.98
|
| Rate for Payer: Cash Price |
$57.82
|
| Rate for Payer: Cash Price |
$91.92
|
| Rate for Payer: Cash Price |
$60.98
|
| Rate for Payer: Cofinity Advantage |
$53.36
|
| Rate for Payer: Cofinity Advantage |
$80.43
|
| Rate for Payer: Cofinity Advantage |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$65.56
|
| Rate for Payer: Cofinity Commercial |
$98.81
|
| Rate for Payer: Cofinity Commercial |
$62.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.98
|
| Rate for Payer: Healthscope Commercial |
$65.04
|
| Rate for Payer: Healthscope Commercial |
$68.61
|
| Rate for Payer: Healthscope Commercial |
$103.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.17
|
| Rate for Payer: PHP Commercial |
$61.43
|
| Rate for Payer: PHP Commercial |
$97.67
|
| Rate for Payer: PHP Commercial |
$64.80
|
| Rate for Payer: Priority Health SBD |
$72.39
|
| Rate for Payer: Priority Health SBD |
$45.53
|
| Rate for Payer: Priority Health SBD |
$48.02
|
| Rate for Payer: UMR Bronson Commercial |
$50.56
|
| Rate for Payer: UMR Bronson Commercial |
$33.54
|
| Rate for Payer: UMR Bronson Commercial |
$31.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.17
|
|
