|
AGALSIDASE BETA 5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,640.58
|
|
|
Service Code
|
HCPCS J0180
|
| Hospital Charge Code |
38494
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.81 |
| Max. Negotiated Rate |
$2,376.52 |
| Rate for Payer: Aetna American Axle |
$1,716.38
|
| Rate for Payer: Aetna Commercial |
$2,244.49
|
| Rate for Payer: Aetna Medicare |
$232.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.40
|
| Rate for Payer: BCBS Complete |
$125.80
|
| Rate for Payer: BCBS MAPPO |
$223.52
|
| Rate for Payer: BCBS Trust/PPO |
$602.66
|
| Rate for Payer: BCN Commercial |
$602.66
|
| Rate for Payer: BCN Medicare Advantage |
$223.52
|
| Rate for Payer: Cash Price |
$2,112.46
|
| Rate for Payer: Cash Price |
$2,112.46
|
| Rate for Payer: Cofinity Commercial |
$2,270.90
|
| Rate for Payer: Cofinity Commercial |
$1,848.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,848.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,112.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.52
|
| Rate for Payer: Healthscope Commercial |
$2,376.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,848.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,980.44
|
| Rate for Payer: Mclaren Medicaid |
$119.81
|
| Rate for Payer: Mclaren Medicare |
$223.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.70
|
| Rate for Payer: Meridian Medicaid |
$125.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,244.49
|
| Rate for Payer: Nomi Health Commercial |
$670.56
|
| Rate for Payer: PACE Medicare |
$212.34
|
| Rate for Payer: PACE SWMI |
$223.52
|
| Rate for Payer: PHP Commercial |
$2,244.49
|
| Rate for Payer: PHP Medicare Advantage |
$223.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,716.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$643.29
|
| Rate for Payer: Priority Health Medicare |
$223.52
|
| Rate for Payer: Priority Health Narrow Network |
$514.63
|
| Rate for Payer: Priority Health SBD |
$1,663.57
|
| Rate for Payer: Railroad Medicare Medicare |
$223.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.52
|
| Rate for Payer: UHC Exchange |
$427.17
|
| Rate for Payer: UHC Medicare Advantage |
$223.52
|
| Rate for Payer: UHCCP Medicaid |
$119.81
|
| Rate for Payer: UMR Bronson Commercial |
$977.01
|
| Rate for Payer: VA VA |
$223.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,980.44
|
|
|
ALBENDAZOLE 200 MG TABLET
|
Facility
|
OP
|
$206.46
|
|
|
Service Code
|
NDC 31722093502
|
| Hospital Charge Code |
8979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.39 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna Medicare |
$103.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: BCBS Complete |
$82.58
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UMR Bronson Commercial |
$76.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
ALBENDAZOLE 200 MG TABLET
|
Facility
|
IP
|
$205.61
|
|
|
Service Code
|
NDC 72205005108
|
| Hospital Charge Code |
8979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.47 |
| Max. Negotiated Rate |
$185.05 |
| Rate for Payer: Aetna American Axle |
$133.65
|
| Rate for Payer: Aetna Commercial |
$174.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.65
|
| Rate for Payer: Cash Price |
$164.49
|
| Rate for Payer: Cofinity Commercial |
$143.93
|
| Rate for Payer: Cofinity Commercial |
$176.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.49
|
| Rate for Payer: Healthscope Commercial |
$185.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.77
|
| Rate for Payer: PHP Commercial |
$174.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.65
|
| Rate for Payer: Priority Health SBD |
$129.53
|
| Rate for Payer: UMR Bronson Commercial |
$90.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.21
|
|
|
ALBENDAZOLE 200 MG TABLET
|
Facility
|
OP
|
$205.61
|
|
|
Service Code
|
NDC 72205005108
|
| Hospital Charge Code |
8979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$185.05 |
| Rate for Payer: Aetna American Axle |
$133.65
|
| Rate for Payer: Aetna Commercial |
$174.77
|
| Rate for Payer: Aetna Medicare |
$102.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.65
|
| Rate for Payer: BCBS Complete |
$82.24
|
| Rate for Payer: Cash Price |
$164.49
|
| Rate for Payer: Cofinity Commercial |
$143.93
|
| Rate for Payer: Cofinity Commercial |
$176.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.49
|
| Rate for Payer: Healthscope Commercial |
$185.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.77
|
| Rate for Payer: PHP Commercial |
$174.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.65
|
| Rate for Payer: Priority Health SBD |
$129.53
|
| Rate for Payer: UMR Bronson Commercial |
$76.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.21
|
|
|
ALBENDAZOLE 200 MG TABLET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 31722093502
|
| Hospital Charge Code |
8979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
ALBUMIN, HUMAN 25 % CONTINUOUS INFUSION
|
Facility
|
OP
|
$180.01
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
180016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$162.01 |
| Rate for Payer: Aetna American Axle |
$117.01
|
| Rate for Payer: Aetna Commercial |
$153.01
|
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCN Commercial |
$143.12
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cofinity Commercial |
$126.01
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.01
|
| Rate for Payer: Healthscope Commercial |
$162.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.01
|
| Rate for Payer: PHP Commercial |
$153.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.01
|
| Rate for Payer: Priority Health SBD |
$113.41
|
| Rate for Payer: UMR Bronson Commercial |
$66.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.01
|
|
|
ALBUMIN, HUMAN 25 % CONTINUOUS INFUSION
|
Facility
|
IP
|
$180.01
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
180016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$162.01 |
| Rate for Payer: Aetna American Axle |
$117.01
|
| Rate for Payer: Aetna Commercial |
$153.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cofinity Commercial |
$126.01
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.01
|
| Rate for Payer: Healthscope Commercial |
$162.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.01
|
| Rate for Payer: PHP Commercial |
$153.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.01
|
| Rate for Payer: Priority Health SBD |
$113.41
|
| Rate for Payer: UMR Bronson Commercial |
$79.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.01
|
|
|
ALBUMIN, HUMAN 25 % FOR PARACENTESIS INJECTION SOLUTION
|
Facility
|
OP
|
$180.01
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
300360
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$162.01 |
| Rate for Payer: Aetna American Axle |
$117.01
|
| Rate for Payer: Aetna American Axle |
$186.68
|
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna Commercial |
$153.01
|
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: Aetna Medicare |
$143.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: BCBS Complete |
$114.88
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCN Commercial |
$143.12
|
| Rate for Payer: BCN Commercial |
$143.12
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Commercial |
$126.01
|
| Rate for Payer: Cofinity Commercial |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.01
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Healthscope Commercial |
$162.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$153.01
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.68
|
| Rate for Payer: Priority Health SBD |
$180.94
|
| Rate for Payer: Priority Health SBD |
$113.41
|
| Rate for Payer: UMR Bronson Commercial |
$66.60
|
| Rate for Payer: UMR Bronson Commercial |
$106.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.01
|
|
|
ALBUMIN, HUMAN 25 % FOR PARACENTESIS INJECTION SOLUTION
|
Facility
|
IP
|
$287.20
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
300360
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.37 |
| Max. Negotiated Rate |
$258.48 |
| Rate for Payer: Aetna American Axle |
$186.68
|
| Rate for Payer: Aetna American Axle |
$117.01
|
| Rate for Payer: Aetna Commercial |
$153.01
|
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Commercial |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$126.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Healthscope Commercial |
$162.01
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$153.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.68
|
| Rate for Payer: Priority Health SBD |
$180.94
|
| Rate for Payer: Priority Health SBD |
$113.41
|
| Rate for Payer: UMR Bronson Commercial |
$79.20
|
| Rate for Payer: UMR Bronson Commercial |
$126.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.40
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$147.52
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.91 |
| Max. Negotiated Rate |
$132.77 |
| Rate for Payer: Aetna American Axle |
$95.89
|
| Rate for Payer: Aetna American Axle |
$117.01
|
| Rate for Payer: Aetna American Axle |
$186.68
|
| Rate for Payer: Aetna Commercial |
$153.01
|
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cofinity Commercial |
$126.87
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$126.01
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Commercial |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$103.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.01
|
| Rate for Payer: Healthscope Commercial |
$162.01
|
| Rate for Payer: Healthscope Commercial |
$132.77
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.01
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$153.01
|
| Rate for Payer: PHP Commercial |
$125.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health SBD |
$180.94
|
| Rate for Payer: Priority Health SBD |
$113.41
|
| Rate for Payer: Priority Health SBD |
$92.94
|
| Rate for Payer: UMR Bronson Commercial |
$64.91
|
| Rate for Payer: UMR Bronson Commercial |
$126.37
|
| Rate for Payer: UMR Bronson Commercial |
$79.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.01
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$114.01
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.18 |
| Max. Negotiated Rate |
$143.12 |
| Rate for Payer: Aetna American Axle |
$74.11
|
| Rate for Payer: Aetna American Axle |
$95.89
|
| Rate for Payer: Aetna American Axle |
$184.60
|
| Rate for Payer: Aetna American Axle |
$186.68
|
| Rate for Payer: Aetna American Axle |
$110.06
|
| Rate for Payer: Aetna American Axle |
$152.99
|
| Rate for Payer: Aetna American Axle |
$117.01
|
| Rate for Payer: Aetna Commercial |
$153.01
|
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna Commercial |
$200.06
|
| Rate for Payer: Aetna Commercial |
$241.40
|
| Rate for Payer: Aetna Commercial |
$143.93
|
| Rate for Payer: Aetna Commercial |
$96.91
|
| Rate for Payer: Aetna Commercial |
$125.39
|
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: Aetna Medicare |
$117.68
|
| Rate for Payer: Aetna Medicare |
$73.76
|
| Rate for Payer: Aetna Medicare |
$142.00
|
| Rate for Payer: Aetna Medicare |
$84.66
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: Aetna Medicare |
$143.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.60
|
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: BCBS Complete |
$59.01
|
| Rate for Payer: BCBS Complete |
$67.73
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS Complete |
$114.88
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCBS Trust/PPO |
$143.12
|
| Rate for Payer: BCN Commercial |
$143.12
|
| Rate for Payer: BCN Commercial |
$143.12
|
| Rate for Payer: BCN Commercial |
$143.12
|
| Rate for Payer: BCN Commercial |
$143.12
|
| Rate for Payer: BCN Commercial |
$143.12
|
| Rate for Payer: BCN Commercial |
$143.12
|
| Rate for Payer: BCN Commercial |
$143.12
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$91.21
|
| Rate for Payer: Cash Price |
$118.02
|
| Rate for Payer: Cash Price |
$91.21
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cash Price |
$144.01
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$229.76
|
| Rate for Payer: Cofinity Commercial |
$103.26
|
| Rate for Payer: Cofinity Commercial |
$246.99
|
| Rate for Payer: Cofinity Commercial |
$164.76
|
| Rate for Payer: Cofinity Commercial |
$98.05
|
| Rate for Payer: Cofinity Commercial |
$145.62
|
| Rate for Payer: Cofinity Commercial |
$201.04
|
| Rate for Payer: Cofinity Commercial |
$79.81
|
| Rate for Payer: Cofinity Commercial |
$202.42
|
| Rate for Payer: Cofinity Commercial |
$118.53
|
| Rate for Payer: Cofinity Commercial |
$244.24
|
| Rate for Payer: Cofinity Commercial |
$198.80
|
| Rate for Payer: Cofinity Commercial |
$126.87
|
| Rate for Payer: Cofinity Commercial |
$126.01
|
| Rate for Payer: Cofinity Commercial |
$154.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Healthscope Commercial |
$162.01
|
| Rate for Payer: Healthscope Commercial |
$258.48
|
| Rate for Payer: Healthscope Commercial |
$211.83
|
| Rate for Payer: Healthscope Commercial |
$102.61
|
| Rate for Payer: Healthscope Commercial |
$132.77
|
| Rate for Payer: Healthscope Commercial |
$152.40
|
| Rate for Payer: Healthscope Commercial |
$255.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$125.39
|
| Rate for Payer: PHP Commercial |
$153.01
|
| Rate for Payer: PHP Commercial |
$244.12
|
| Rate for Payer: PHP Commercial |
$143.93
|
| Rate for Payer: PHP Commercial |
$96.91
|
| Rate for Payer: PHP Commercial |
$200.06
|
| Rate for Payer: PHP Commercial |
$241.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.68
|
| Rate for Payer: Priority Health SBD |
$113.41
|
| Rate for Payer: Priority Health SBD |
$148.28
|
| Rate for Payer: Priority Health SBD |
$180.94
|
| Rate for Payer: Priority Health SBD |
$178.92
|
| Rate for Payer: Priority Health SBD |
$92.94
|
| Rate for Payer: Priority Health SBD |
$106.68
|
| Rate for Payer: Priority Health SBD |
$71.83
|
| Rate for Payer: UMR Bronson Commercial |
$87.09
|
| Rate for Payer: UMR Bronson Commercial |
$62.65
|
| Rate for Payer: UMR Bronson Commercial |
$42.18
|
| Rate for Payer: UMR Bronson Commercial |
$54.58
|
| Rate for Payer: UMR Bronson Commercial |
$66.60
|
| Rate for Payer: UMR Bronson Commercial |
$105.08
|
| Rate for Payer: UMR Bronson Commercial |
$106.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.00
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$176.32
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
8982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.63 |
| Max. Negotiated Rate |
$158.69 |
| Rate for Payer: Aetna American Axle |
$114.61
|
| Rate for Payer: Aetna American Axle |
$122.15
|
| Rate for Payer: Aetna American Axle |
$120.64
|
| Rate for Payer: Aetna American Axle |
$100.28
|
| Rate for Payer: Aetna American Axle |
$241.28
|
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Aetna Commercial |
$131.14
|
| Rate for Payer: Aetna Commercial |
$315.52
|
| Rate for Payer: Aetna Commercial |
$157.76
|
| Rate for Payer: Aetna Commercial |
$159.73
|
| Rate for Payer: Aetna Medicare |
$92.80
|
| Rate for Payer: Aetna Medicare |
$93.96
|
| Rate for Payer: Aetna Medicare |
$88.16
|
| Rate for Payer: Aetna Medicare |
$77.14
|
| Rate for Payer: Aetna Medicare |
$185.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.64
|
| Rate for Payer: BCBS Complete |
$70.53
|
| Rate for Payer: BCBS Complete |
$61.71
|
| Rate for Payer: BCBS Complete |
$75.17
|
| Rate for Payer: BCBS Complete |
$148.48
|
| Rate for Payer: BCBS Complete |
$74.24
|
| Rate for Payer: BCBS Trust/PPO |
$28.63
|
| Rate for Payer: BCBS Trust/PPO |
$28.63
|
| Rate for Payer: BCBS Trust/PPO |
$28.63
|
| Rate for Payer: BCBS Trust/PPO |
$28.63
|
| Rate for Payer: BCBS Trust/PPO |
$28.63
|
| Rate for Payer: BCN Commercial |
$28.63
|
| Rate for Payer: BCN Commercial |
$28.63
|
| Rate for Payer: BCN Commercial |
$28.63
|
| Rate for Payer: BCN Commercial |
$28.63
|
| Rate for Payer: BCN Commercial |
$28.63
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$148.48
|
| Rate for Payer: Cash Price |
$123.42
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$123.42
|
| Rate for Payer: Cash Price |
$148.48
|
| Rate for Payer: Cash Price |
$296.96
|
| Rate for Payer: Cash Price |
$296.96
|
| Rate for Payer: Cash Price |
$150.34
|
| Rate for Payer: Cash Price |
$150.34
|
| Rate for Payer: Cofinity Commercial |
$123.42
|
| Rate for Payer: Cofinity Commercial |
$319.23
|
| Rate for Payer: Cofinity Commercial |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$159.62
|
| Rate for Payer: Cofinity Commercial |
$129.92
|
| Rate for Payer: Cofinity Commercial |
$259.84
|
| Rate for Payer: Cofinity Commercial |
$161.61
|
| Rate for Payer: Cofinity Commercial |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$151.64
|
| Rate for Payer: Cofinity Commercial |
$132.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.34
|
| Rate for Payer: Healthscope Commercial |
$169.13
|
| Rate for Payer: Healthscope Commercial |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$158.69
|
| Rate for Payer: Healthscope Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$334.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.14
|
| Rate for Payer: PHP Commercial |
$315.52
|
| Rate for Payer: PHP Commercial |
$159.73
|
| Rate for Payer: PHP Commercial |
$149.87
|
| Rate for Payer: PHP Commercial |
$131.14
|
| Rate for Payer: PHP Commercial |
$157.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.61
|
| Rate for Payer: Priority Health SBD |
$111.08
|
| Rate for Payer: Priority Health SBD |
$233.86
|
| Rate for Payer: Priority Health SBD |
$118.39
|
| Rate for Payer: Priority Health SBD |
$97.20
|
| Rate for Payer: Priority Health SBD |
$116.93
|
| Rate for Payer: UMR Bronson Commercial |
$57.08
|
| Rate for Payer: UMR Bronson Commercial |
$68.67
|
| Rate for Payer: UMR Bronson Commercial |
$65.24
|
| Rate for Payer: UMR Bronson Commercial |
$69.53
|
| Rate for Payer: UMR Bronson Commercial |
$137.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.71
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$187.92
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
8982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.68 |
| Max. Negotiated Rate |
$169.13 |
| Rate for Payer: Aetna American Axle |
$122.15
|
| Rate for Payer: Aetna American Axle |
$100.28
|
| Rate for Payer: Aetna American Axle |
$114.61
|
| Rate for Payer: Aetna American Axle |
$241.28
|
| Rate for Payer: Aetna American Axle |
$120.64
|
| Rate for Payer: Aetna Commercial |
$159.73
|
| Rate for Payer: Aetna Commercial |
$149.87
|
| Rate for Payer: Aetna Commercial |
$131.14
|
| Rate for Payer: Aetna Commercial |
$315.52
|
| Rate for Payer: Aetna Commercial |
$157.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.61
|
| Rate for Payer: Cash Price |
$150.34
|
| Rate for Payer: Cash Price |
$296.96
|
| Rate for Payer: Cash Price |
$141.06
|
| Rate for Payer: Cash Price |
$148.48
|
| Rate for Payer: Cash Price |
$123.42
|
| Rate for Payer: Cofinity Commercial |
$259.84
|
| Rate for Payer: Cofinity Commercial |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$161.61
|
| Rate for Payer: Cofinity Commercial |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$129.92
|
| Rate for Payer: Cofinity Commercial |
$123.42
|
| Rate for Payer: Cofinity Commercial |
$151.64
|
| Rate for Payer: Cofinity Commercial |
$159.62
|
| Rate for Payer: Cofinity Commercial |
$132.68
|
| Rate for Payer: Cofinity Commercial |
$319.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$259.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.48
|
| Rate for Payer: Healthscope Commercial |
$158.69
|
| Rate for Payer: Healthscope Commercial |
$169.13
|
| Rate for Payer: Healthscope Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$334.08
|
| Rate for Payer: Healthscope Commercial |
$138.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.14
|
| Rate for Payer: PHP Commercial |
$131.14
|
| Rate for Payer: PHP Commercial |
$315.52
|
| Rate for Payer: PHP Commercial |
$157.76
|
| Rate for Payer: PHP Commercial |
$159.73
|
| Rate for Payer: PHP Commercial |
$149.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.28
|
| Rate for Payer: Priority Health SBD |
$233.86
|
| Rate for Payer: Priority Health SBD |
$116.93
|
| Rate for Payer: Priority Health SBD |
$111.08
|
| Rate for Payer: Priority Health SBD |
$97.20
|
| Rate for Payer: Priority Health SBD |
$118.39
|
| Rate for Payer: UMR Bronson Commercial |
$67.88
|
| Rate for Payer: UMR Bronson Commercial |
$77.58
|
| Rate for Payer: UMR Bronson Commercial |
$82.68
|
| Rate for Payer: UMR Bronson Commercial |
$163.33
|
| Rate for Payer: UMR Bronson Commercial |
$81.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.94
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.53
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$1.93
|
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna American Axle |
$2.19
|
| Rate for Payer: Aetna American Axle |
$1.67
|
| Rate for Payer: Aetna American Axle |
$1.54
|
| Rate for Payer: Aetna American Axle |
$1.37
|
| Rate for Payer: Aetna American Axle |
$1.39
|
| Rate for Payer: Aetna American Axle |
$1.65
|
| Rate for Payer: Aetna American Axle |
$2.85
|
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Commercial |
$2.01
|
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Commercial |
$1.82
|
| Rate for Payer: Aetna Commercial |
$1.79
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.48
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Commercial |
$1.84
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.01
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$1.79
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$1.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.54
|
| Rate for Payer: Priority Health SBD |
$1.49
|
| Rate for Payer: Priority Health SBD |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.60
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: Priority Health SBD |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.04
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$1.93
|
| Rate for Payer: UMR Bronson Commercial |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Aetna Medicare |
$2.19
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Aetna American Axle |
$2.85
|
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna American Axle |
$1.67
|
| Rate for Payer: Aetna American Axle |
$1.65
|
| Rate for Payer: Aetna American Axle |
$2.19
|
| Rate for Payer: Aetna American Axle |
$1.37
|
| Rate for Payer: Aetna American Axle |
$1.54
|
| Rate for Payer: Aetna American Axle |
$1.39
|
| Rate for Payer: Aetna Commercial |
$1.82
|
| Rate for Payer: Aetna Commercial |
$2.01
|
| Rate for Payer: Aetna Commercial |
$1.79
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS Complete |
$0.95
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: BCBS Complete |
$1.03
|
| 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: BCBS Trust/PPO |
$0.19
|
| 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: 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: BCN Commercial |
$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: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cash Price |
$1.90
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$1.84
|
| Rate for Payer: Cofinity Commercial |
$1.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$1.79
|
| Rate for Payer: PHP Commercial |
$2.01
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: PHP Commercial |
$1.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.07
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.06
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.60
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: Priority Health SBD |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.49
|
| Rate for Payer: Priority Health SBD |
$1.35
|
| Rate for Payer: Priority Health SBD |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: UMR Bronson Commercial |
$0.79
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: UMR Bronson Commercial |
$0.78
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.58
|
|
|
ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$500.20
|
|
|
Service Code
|
NDC 70752010212
|
| Hospital Charge Code |
252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.07 |
| Max. Negotiated Rate |
$450.18 |
| Rate for Payer: Aetna American Axle |
$325.13
|
| Rate for Payer: Aetna Commercial |
$425.17
|
| Rate for Payer: Aetna Medicare |
$250.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.13
|
| Rate for Payer: BCBS Complete |
$200.08
|
| Rate for Payer: Cash Price |
$400.16
|
| Rate for Payer: Cofinity Commercial |
$350.14
|
| Rate for Payer: Cofinity Commercial |
$430.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.16
|
| Rate for Payer: Healthscope Commercial |
$450.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.17
|
| Rate for Payer: PHP Commercial |
$425.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.13
|
| Rate for Payer: Priority Health SBD |
$315.13
|
| Rate for Payer: UMR Bronson Commercial |
$185.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.15
|
|
|
ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$533.55
|
|
|
Service Code
|
NDC 00472082516
|
| Hospital Charge Code |
252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$480.20 |
| Rate for Payer: Aetna American Axle |
$346.81
|
| Rate for Payer: Aetna Commercial |
$453.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.81
|
| Rate for Payer: Cash Price |
$426.84
|
| Rate for Payer: Cofinity Commercial |
$373.48
|
| Rate for Payer: Cofinity Commercial |
$458.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$373.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$426.84
|
| Rate for Payer: Healthscope Commercial |
$480.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.52
|
| Rate for Payer: PHP Commercial |
$453.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.81
|
| Rate for Payer: Priority Health SBD |
$336.14
|
| Rate for Payer: UMR Bronson Commercial |
$234.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.16
|
|
|
ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$500.20
|
|
|
Service Code
|
NDC 70752010212
|
| Hospital Charge Code |
252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.09 |
| Max. Negotiated Rate |
$450.18 |
| Rate for Payer: Aetna American Axle |
$325.13
|
| Rate for Payer: Aetna Commercial |
$425.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.13
|
| Rate for Payer: Cash Price |
$400.16
|
| Rate for Payer: Cofinity Commercial |
$350.14
|
| Rate for Payer: Cofinity Commercial |
$430.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.16
|
| Rate for Payer: Healthscope Commercial |
$450.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.17
|
| Rate for Payer: PHP Commercial |
$425.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.13
|
| Rate for Payer: Priority Health SBD |
$315.13
|
| Rate for Payer: UMR Bronson Commercial |
$220.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.15
|
|
|
ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$533.55
|
|
|
Service Code
|
NDC 00472082516
|
| Hospital Charge Code |
252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.41 |
| Max. Negotiated Rate |
$480.20 |
| Rate for Payer: Aetna American Axle |
$346.81
|
| Rate for Payer: Aetna Commercial |
$453.52
|
| Rate for Payer: Aetna Medicare |
$266.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.81
|
| Rate for Payer: BCBS Complete |
$213.42
|
| Rate for Payer: Cash Price |
$426.84
|
| Rate for Payer: Cofinity Commercial |
$373.48
|
| Rate for Payer: Cofinity Commercial |
$458.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$373.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$426.84
|
| Rate for Payer: Healthscope Commercial |
$480.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$373.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.52
|
| Rate for Payer: PHP Commercial |
$453.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.81
|
| Rate for Payer: Priority Health SBD |
$336.14
|
| Rate for Payer: UMR Bronson Commercial |
$197.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.16
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna American Axle |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.16
|
| Rate for Payer: Priority Health Narrow Network |
$0.13
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna American Axle |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna American Axle |
$24.05
|
| Rate for Payer: Aetna American Axle |
$107.36
|
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna Commercial |
$31.45
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: Aetna Medicare |
$82.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.36
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Complete |
$66.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$132.14
|
| Rate for Payer: Cash Price |
$132.14
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$142.05
|
| Rate for Payer: Cofinity Commercial |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$115.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.60
|
| Rate for Payer: Healthscope Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$148.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.45
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: PHP Commercial |
$31.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.16
|
| Rate for Payer: Priority Health Narrow Network |
$0.13
|
| Rate for Payer: Priority Health Narrow Network |
$0.13
|
| Rate for Payer: Priority Health SBD |
$104.06
|
| Rate for Payer: Priority Health SBD |
$23.31
|
| Rate for Payer: UMR Bronson Commercial |
$13.69
|
| Rate for Payer: UMR Bronson Commercial |
$61.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.88
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$165.17
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.67 |
| Max. Negotiated Rate |
$148.65 |
| Rate for Payer: Aetna American Axle |
$107.36
|
| Rate for Payer: Aetna American Axle |
$24.05
|
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna Commercial |
$31.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.05
|
| Rate for Payer: Cash Price |
$132.14
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$115.62
|
| Rate for Payer: Cofinity Commercial |
$142.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.60
|
| Rate for Payer: Healthscope Commercial |
$148.65
|
| Rate for Payer: Healthscope Commercial |
$33.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.39
|
| Rate for Payer: PHP Commercial |
$31.45
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health SBD |
$104.06
|
| Rate for Payer: Priority Health SBD |
$23.31
|
| Rate for Payer: UMR Bronson Commercial |
$72.67
|
| Rate for Payer: UMR Bronson Commercial |
$16.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.75
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$109.20
|
|
|
Service Code
|
NDC 09900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$98.28 |
| Rate for Payer: Aetna American Axle |
$70.98
|
| Rate for Payer: Aetna Commercial |
$92.82
|
| Rate for Payer: Aetna Medicare |
$54.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.98
|
| Rate for Payer: BCBS Complete |
$43.68
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Commercial |
$76.44
|
| Rate for Payer: Cofinity Commercial |
$93.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$98.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: PHP Commercial |
$92.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.98
|
| Rate for Payer: Priority Health SBD |
$68.80
|
| Rate for Payer: UMR Bronson Commercial |
$40.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.90
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$109.20
|
|
|
Service Code
|
NDC 09900001169
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.05 |
| Max. Negotiated Rate |
$98.28 |
| Rate for Payer: Aetna American Axle |
$70.98
|
| Rate for Payer: Aetna Commercial |
$92.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.98
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Commercial |
$76.44
|
| Rate for Payer: Cofinity Commercial |
$93.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$98.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.82
|
| Rate for Payer: PHP Commercial |
$92.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.98
|
| Rate for Payer: Priority Health SBD |
$68.80
|
| Rate for Payer: UMR Bronson Commercial |
$48.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.90
|
|
