|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$122.08
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.72 |
| Max. Negotiated Rate |
$109.87 |
| Rate for Payer: Aetna American Axle |
$79.35
|
| Rate for Payer: Aetna Commercial |
$103.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.35
|
| Rate for Payer: Cash Price |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$104.99
|
| Rate for Payer: Cofinity Commercial |
$85.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$109.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.77
|
| Rate for Payer: PHP Commercial |
$103.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.35
|
| Rate for Payer: Priority Health SBD |
$76.91
|
| Rate for Payer: UMR Bronson Commercial |
$53.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.56
|
|
|
ATROPINE 1 % EYE OINTMENT
|
Facility
|
IP
|
$56.98
|
|
|
Service Code
|
NDC 24208082555
|
| Hospital Charge Code |
735
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$51.28 |
| Rate for Payer: Aetna American Axle |
$37.04
|
| Rate for Payer: Aetna Commercial |
$48.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.04
|
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.58
|
| Rate for Payer: Healthscope Commercial |
$51.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.43
|
| Rate for Payer: PHP Commercial |
$48.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.04
|
| Rate for Payer: Priority Health SBD |
$35.90
|
| Rate for Payer: UMR Bronson Commercial |
$25.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.74
|
|
|
ATROPINE 1 % EYE OINTMENT
|
Facility
|
OP
|
$56.98
|
|
|
Service Code
|
NDC 24208082555
|
| Hospital Charge Code |
735
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.08 |
| Max. Negotiated Rate |
$51.28 |
| Rate for Payer: Aetna American Axle |
$37.04
|
| Rate for Payer: Aetna Commercial |
$48.43
|
| Rate for Payer: Aetna Medicare |
$28.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.04
|
| Rate for Payer: BCBS Complete |
$22.79
|
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.58
|
| Rate for Payer: Healthscope Commercial |
$51.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.43
|
| Rate for Payer: PHP Commercial |
$48.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.04
|
| Rate for Payer: Priority Health SBD |
$35.90
|
| Rate for Payer: UMR Bronson Commercial |
$21.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.74
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
734
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna American Axle |
$19.69
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: BCBS Complete |
$12.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$11.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
734
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna American Axle |
$19.69
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$13.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna American Axle |
$19.69
|
| Rate for Payer: Aetna American Axle |
$28.84
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: UMR Bronson Commercial |
$13.33
|
| Rate for Payer: UMR Bronson Commercial |
$19.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.28
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna American Axle |
$19.69
|
| Rate for Payer: Aetna American Axle |
$28.84
|
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna Medicare |
$15.14
|
| Rate for Payer: Aetna Medicare |
$22.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: BCBS Complete |
$17.75
|
| Rate for Payer: BCBS Complete |
$12.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$11.21
|
| Rate for Payer: UMR Bronson Commercial |
$16.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
|
|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$44.37
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$39.93 |
| Rate for Payer: Aetna American Axle |
$28.84
|
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna Medicare |
$22.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: BCBS Complete |
$17.75
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Commercial |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.84
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: UMR Bronson Commercial |
$16.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.28
|
|
|
AUGMENTATION, MANDIBULAR BODY OR ANGLE; PROSTHETIC MATERIAL
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 21125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,174.78
|
| Rate for Payer: BCN Commercial |
$3,174.78
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$701.22
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$637.47
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCESS, OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
CPT 20936
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$371.34 |
| Max. Negotiated Rate |
$5,042.00 |
| Rate for Payer: BCBS Trust/PPO |
$371.34
|
| Rate for Payer: BCN Commercial |
$371.34
|
| Rate for Payer: UHC Core |
$5,042.00
|
|
|
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); MORSELIZED (THROUGH SEPARATE SKIN OR FASCIAL INCISION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
CPT 20937
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$163.55 |
| Max. Negotiated Rate |
$5,042.00 |
| Rate for Payer: BCBS Trust/PPO |
$642.46
|
| Rate for Payer: BCN Commercial |
$642.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.90
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Exchange |
$163.55
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,231.68
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
198019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,741.94 |
| Max. Negotiated Rate |
$5,608.51 |
| Rate for Payer: Aetna American Axle |
$4,050.59
|
| Rate for Payer: Aetna Commercial |
$5,296.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,050.59
|
| Rate for Payer: Cash Price |
$4,985.34
|
| Rate for Payer: Cofinity Commercial |
$4,362.18
|
| Rate for Payer: Cofinity Commercial |
$5,359.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,362.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,985.34
|
| Rate for Payer: Healthscope Commercial |
$5,608.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,362.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,673.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,296.93
|
| Rate for Payer: PHP Commercial |
$5,296.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,050.59
|
| Rate for Payer: Priority Health SBD |
$3,925.96
|
| Rate for Payer: UMR Bronson Commercial |
$2,741.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,673.76
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,231.68
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
198019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.73 |
| Max. Negotiated Rate |
$5,608.51 |
| Rate for Payer: Aetna American Axle |
$4,050.59
|
| Rate for Payer: Aetna Commercial |
$5,296.93
|
| Rate for Payer: Aetna Medicare |
$80.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,050.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.32
|
| Rate for Payer: BCBS Complete |
$43.82
|
| Rate for Payer: BCBS MAPPO |
$77.86
|
| Rate for Payer: BCBS Trust/PPO |
$209.94
|
| Rate for Payer: BCN Commercial |
$209.94
|
| Rate for Payer: BCN Medicare Advantage |
$77.86
|
| Rate for Payer: Cash Price |
$4,985.34
|
| Rate for Payer: Cash Price |
$4,985.34
|
| Rate for Payer: Cofinity Commercial |
$5,359.24
|
| Rate for Payer: Cofinity Commercial |
$4,362.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,362.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,985.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.86
|
| Rate for Payer: Healthscope Commercial |
$5,608.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,362.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,673.76
|
| Rate for Payer: Mclaren Medicaid |
$41.73
|
| Rate for Payer: Mclaren Medicare |
$77.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.75
|
| Rate for Payer: Meridian Medicaid |
$43.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,296.93
|
| Rate for Payer: Nomi Health Commercial |
$233.58
|
| Rate for Payer: PACE Medicare |
$73.97
|
| Rate for Payer: PACE SWMI |
$77.86
|
| Rate for Payer: PHP Commercial |
$5,296.93
|
| Rate for Payer: PHP Medicare Advantage |
$77.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,050.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.78
|
| Rate for Payer: Priority Health Medicare |
$77.86
|
| Rate for Payer: Priority Health Narrow Network |
$179.02
|
| Rate for Payer: Priority Health SBD |
$3,925.96
|
| Rate for Payer: Railroad Medicare Medicare |
$77.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.86
|
| Rate for Payer: UHC Exchange |
$148.80
|
| Rate for Payer: UHC Medicare Advantage |
$77.86
|
| Rate for Payer: UHCCP Medicaid |
$41.73
|
| Rate for Payer: UMR Bronson Commercial |
$2,305.72
|
| Rate for Payer: VA VA |
$77.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,673.76
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,680.20
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
182436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,259.29 |
| Max. Negotiated Rate |
$8,712.18 |
| Rate for Payer: Aetna American Axle |
$6,292.13
|
| Rate for Payer: Aetna Commercial |
$8,228.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,292.13
|
| Rate for Payer: Cash Price |
$7,744.16
|
| Rate for Payer: Cofinity Commercial |
$6,776.14
|
| Rate for Payer: Cofinity Commercial |
$8,324.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,776.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,744.16
|
| Rate for Payer: Healthscope Commercial |
$8,712.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,776.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,260.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,228.17
|
| Rate for Payer: PHP Commercial |
$8,228.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,292.13
|
| Rate for Payer: Priority Health SBD |
$6,098.53
|
| Rate for Payer: UMR Bronson Commercial |
$4,259.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,260.15
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,680.20
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
182436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$8,712.18 |
| Rate for Payer: Aetna American Axle |
$6,292.13
|
| Rate for Payer: Aetna Commercial |
$8,228.17
|
| Rate for Payer: Aetna Medicare |
$100.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,292.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.19
|
| Rate for Payer: BCBS Complete |
$54.56
|
| Rate for Payer: BCBS MAPPO |
$96.95
|
| Rate for Payer: BCBS Trust/PPO |
$261.38
|
| Rate for Payer: BCN Commercial |
$261.38
|
| Rate for Payer: BCN Medicare Advantage |
$96.95
|
| Rate for Payer: Cash Price |
$7,744.16
|
| Rate for Payer: Cash Price |
$7,744.16
|
| Rate for Payer: Cofinity Commercial |
$8,324.97
|
| Rate for Payer: Cofinity Commercial |
$6,776.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,776.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,744.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.95
|
| Rate for Payer: Healthscope Commercial |
$8,712.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,776.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,260.15
|
| Rate for Payer: Mclaren Medicaid |
$51.97
|
| Rate for Payer: Mclaren Medicare |
$96.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.80
|
| Rate for Payer: Meridian Medicaid |
$54.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,228.17
|
| Rate for Payer: Nomi Health Commercial |
$290.85
|
| Rate for Payer: PACE Medicare |
$92.10
|
| Rate for Payer: PACE SWMI |
$96.95
|
| Rate for Payer: PHP Commercial |
$8,228.17
|
| Rate for Payer: PHP Medicare Advantage |
$96.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,292.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.93
|
| Rate for Payer: Priority Health Medicare |
$96.95
|
| Rate for Payer: Priority Health Narrow Network |
$219.14
|
| Rate for Payer: Priority Health SBD |
$6,098.53
|
| Rate for Payer: Railroad Medicare Medicare |
$96.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.95
|
| Rate for Payer: UHC Exchange |
$185.28
|
| Rate for Payer: UHC Medicare Advantage |
$96.95
|
| Rate for Payer: UHCCP Medicaid |
$51.97
|
| Rate for Payer: UMR Bronson Commercial |
$3,581.67
|
| Rate for Payer: VA VA |
$96.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,260.15
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11732
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$113.71
|
| Rate for Payer: BCN Commercial |
$113.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.91
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$16.28
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$51.56 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$173.65
|
| Rate for Payer: BCN Commercial |
$173.65
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.72
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$51.56
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$51.56 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$173.65
|
| Rate for Payer: BCN Commercial |
$173.65
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.72
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$51.56
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
AXILLARY LYMPHADENECTOMY; COMPLETE
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 38745
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$864.35 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,704.89
|
| Rate for Payer: BCN Commercial |
$3,704.89
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$950.78
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$864.35
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
AXILLARY LYMPHADENECTOMY; SUPERFICIAL
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 38740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$686.57 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,704.89
|
| Rate for Payer: BCN Commercial |
$3,704.89
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$755.23
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$686.57
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
|
IP
|
$267.38
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.65 |
| Max. Negotiated Rate |
$240.64 |
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna American Axle |
$173.10
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$226.36
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$186.41
|
| Rate for Payer: Cofinity Commercial |
$229.02
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.04
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$239.67
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$226.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$167.77
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: UMR Bronson Commercial |
$117.65
|
| Rate for Payer: UMR Bronson Commercial |
$201.42
|
| Rate for Payer: UMR Bronson Commercial |
$117.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.54
|
|
|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
|
OP
|
$457.77
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$411.99 |
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$173.10
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$226.36
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: Aetna Medicare |
$133.15
|
| Rate for Payer: Aetna Medicare |
$1,313.86
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.10
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: BCBS Complete |
$106.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$229.02
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$186.41
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$239.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$226.36
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$167.77
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: UMR Bronson Commercial |
$972.26
|
| Rate for Payer: UMR Bronson Commercial |
$98.93
|
| Rate for Payer: UMR Bronson Commercial |
$169.37
|
| Rate for Payer: UMR Bronson Commercial |
$98.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$327.39
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$144.05 |
| Max. Negotiated Rate |
$294.65 |
| Rate for Payer: Aetna American Axle |
$212.80
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$173.10
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna Commercial |
$278.28
|
| Rate for Payer: Aetna Commercial |
$226.36
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.10
|
| Rate for Payer: Cash Price |
$261.91
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$281.56
|
| Rate for Payer: Cofinity Commercial |
$229.17
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$186.41
|
| Rate for Payer: Cofinity Commercial |
$229.02
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$239.67
|
| Rate for Payer: Healthscope Commercial |
$294.65
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$278.28
|
| Rate for Payer: PHP Commercial |
$226.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$167.77
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$206.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.20
|
| Rate for Payer: UMR Bronson Commercial |
$117.17
|
| Rate for Payer: UMR Bronson Commercial |
$144.05
|
| Rate for Payer: UMR Bronson Commercial |
$201.42
|
| Rate for Payer: UMR Bronson Commercial |
$117.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.54
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$333.64
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$300.28 |
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$198.35
|
| Rate for Payer: Aetna American Axle |
$212.80
|
| Rate for Payer: Aetna American Axle |
$180.29
|
| Rate for Payer: Aetna American Axle |
$281.50
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$173.10
|
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna American Axle |
$186.36
|
| Rate for Payer: Aetna Commercial |
$243.70
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$259.38
|
| Rate for Payer: Aetna Commercial |
$235.76
|
| Rate for Payer: Aetna Commercial |
$278.28
|
| Rate for Payer: Aetna Commercial |
$226.36
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$368.11
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: Aetna Medicare |
$163.70
|
| Rate for Payer: Aetna Medicare |
$143.35
|
| Rate for Payer: Aetna Medicare |
$152.58
|
| Rate for Payer: Aetna Medicare |
$1,313.86
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna Medicare |
$133.15
|
| Rate for Payer: Aetna Medicare |
$216.54
|
| Rate for Payer: Aetna Medicare |
$138.68
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.80
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Complete |
$106.52
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: BCBS Complete |
$110.95
|
| Rate for Payer: BCBS Complete |
$173.23
|
| Rate for Payer: BCBS Complete |
$130.96
|
| Rate for Payer: BCBS Complete |
$114.68
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Complete |
$122.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$346.46
|
| Rate for Payer: Cash Price |
$346.46
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$261.91
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$244.12
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Cash Price |
$244.12
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: Cash Price |
$261.91
|
| Rate for Payer: Cofinity Commercial |
$229.02
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$186.41
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$194.16
|
| Rate for Payer: Cofinity Commercial |
$238.54
|
| Rate for Payer: Cofinity Commercial |
$200.69
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Cofinity Commercial |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$262.43
|
| Rate for Payer: Cofinity Commercial |
$229.17
|
| Rate for Payer: Cofinity Commercial |
$281.56
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Cofinity Commercial |
$372.44
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$239.67
|
| Rate for Payer: Healthscope Commercial |
$249.63
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Healthscope Commercial |
$274.64
|
| Rate for Payer: Healthscope Commercial |
$389.76
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$294.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.70
|
| Rate for Payer: PHP Commercial |
$278.28
|
| Rate for Payer: PHP Commercial |
$235.76
|
| Rate for Payer: PHP Commercial |
$368.11
|
| Rate for Payer: PHP Commercial |
$243.70
|
| Rate for Payer: PHP Commercial |
$259.38
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$226.36
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health SBD |
$272.83
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$180.62
|
| Rate for Payer: Priority Health SBD |
$167.77
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$206.26
|
| Rate for Payer: Priority Health SBD |
$192.24
|
| Rate for Payer: Priority Health SBD |
$174.74
|
| Rate for Payer: UMR Bronson Commercial |
$972.26
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$102.63
|
| Rate for Payer: UMR Bronson Commercial |
$160.24
|
| Rate for Payer: UMR Bronson Commercial |
$169.37
|
| Rate for Payer: UMR Bronson Commercial |
$98.93
|
| Rate for Payer: UMR Bronson Commercial |
$121.13
|
| Rate for Payer: UMR Bronson Commercial |
$112.91
|
| Rate for Payer: UMR Bronson Commercial |
$98.53
|
| Rate for Payer: UMR Bronson Commercial |
$106.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.72
|
|
|
AZATHIOPRINE 50 MG TABLET
|
Facility
|
OP
|
$254.60
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
9183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna American Axle |
$172.85
|
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna American Axle |
$266.76
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna Commercial |
$226.03
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$132.96
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: Aetna Medicare |
$110.68
|
| Rate for Payer: Aetna Medicare |
$205.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.85
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: BCBS Complete |
$88.54
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Complete |
$164.16
|
| Rate for Payer: BCBS Complete |
$106.37
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.34
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cash Price |
$212.74
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cash Price |
$212.74
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Cofinity Commercial |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$228.69
|
| Rate for Payer: Cofinity Commercial |
$186.14
|
| Rate for Payer: Cofinity Commercial |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Healthscope Commercial |
$239.33
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: PHP Commercial |
$226.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.49
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: Priority Health SBD |
$258.55
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: Priority Health SBD |
$167.53
|
| Rate for Payer: UMR Bronson Commercial |
$81.90
|
| Rate for Payer: UMR Bronson Commercial |
$98.39
|
| Rate for Payer: UMR Bronson Commercial |
$94.20
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: UMR Bronson Commercial |
$151.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
