|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$2,014.85
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$886.53 |
| Max. Negotiated Rate |
$1,813.36 |
| Rate for Payer: Aetna American Axle |
$1,309.65
|
| Rate for Payer: Aetna Commercial |
$1,712.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,309.65
|
| Rate for Payer: Cash Price |
$1,611.88
|
| Rate for Payer: Cofinity Commercial |
$1,410.40
|
| Rate for Payer: Cofinity Commercial |
$1,732.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,611.88
|
| Rate for Payer: Healthscope Commercial |
$1,813.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,410.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,511.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,712.62
|
| Rate for Payer: PHP Commercial |
$1,712.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.40
|
| Rate for Payer: Priority Health SBD |
$1,269.36
|
| Rate for Payer: UMR Bronson Commercial |
$886.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,511.14
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$6,044.52
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.62 |
| Max. Negotiated Rate |
$5,440.07 |
| Rate for Payer: Aetna American Axle |
$3,928.94
|
| Rate for Payer: Aetna American Axle |
$5,320.43
|
| Rate for Payer: Aetna American Axle |
$1,309.65
|
| Rate for Payer: Aetna Commercial |
$1,712.62
|
| Rate for Payer: Aetna Commercial |
$5,137.84
|
| Rate for Payer: Aetna Commercial |
$6,957.48
|
| Rate for Payer: Aetna Medicare |
$301.58
|
| Rate for Payer: Aetna Medicare |
$301.58
|
| Rate for Payer: Aetna Medicare |
$301.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,309.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,928.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,320.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$362.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$362.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$362.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$362.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$362.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$362.47
|
| Rate for Payer: BCBS Complete |
$166.56
|
| Rate for Payer: BCBS Complete |
$166.56
|
| Rate for Payer: BCBS Complete |
$166.56
|
| Rate for Payer: BCBS MAPPO |
$289.98
|
| Rate for Payer: BCBS MAPPO |
$289.98
|
| Rate for Payer: BCBS MAPPO |
$289.98
|
| Rate for Payer: BCBS Trust/PPO |
$945.45
|
| Rate for Payer: BCBS Trust/PPO |
$945.45
|
| Rate for Payer: BCBS Trust/PPO |
$945.45
|
| Rate for Payer: BCN Medicare Advantage |
$289.98
|
| Rate for Payer: BCN Medicare Advantage |
$289.98
|
| Rate for Payer: BCN Medicare Advantage |
$289.98
|
| Rate for Payer: Cash Price |
$4,835.62
|
| Rate for Payer: Cash Price |
$1,611.88
|
| Rate for Payer: Cash Price |
$6,548.22
|
| Rate for Payer: Cash Price |
$1,611.88
|
| Rate for Payer: Cash Price |
$6,548.22
|
| Rate for Payer: Cash Price |
$4,835.62
|
| Rate for Payer: Cofinity Commercial |
$4,231.16
|
| Rate for Payer: Cofinity Commercial |
$1,410.40
|
| Rate for Payer: Cofinity Commercial |
$1,732.77
|
| Rate for Payer: Cofinity Commercial |
$7,039.33
|
| Rate for Payer: Cofinity Commercial |
$5,198.29
|
| Rate for Payer: Cofinity Commercial |
$5,729.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,548.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,835.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,611.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.98
|
| Rate for Payer: Healthscope Commercial |
$7,366.74
|
| Rate for Payer: Healthscope Commercial |
$5,440.07
|
| Rate for Payer: Healthscope Commercial |
$1,813.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,231.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,729.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,410.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,138.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,511.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,533.39
|
| Rate for Payer: Mclaren Medicaid |
$158.62
|
| Rate for Payer: Mclaren Medicaid |
$158.62
|
| Rate for Payer: Mclaren Medicaid |
$158.62
|
| Rate for Payer: Mclaren Medicare |
$289.98
|
| Rate for Payer: Mclaren Medicare |
$289.98
|
| Rate for Payer: Mclaren Medicare |
$289.98
|
| Rate for Payer: Meridian Medicaid |
$166.56
|
| Rate for Payer: Meridian Medicaid |
$166.56
|
| Rate for Payer: Meridian Medicaid |
$166.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$304.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$304.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$304.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,712.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,137.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,957.48
|
| Rate for Payer: PACE Medicare |
$275.48
|
| Rate for Payer: PACE Medicare |
$275.48
|
| Rate for Payer: PACE Medicare |
$275.48
|
| Rate for Payer: PACE SWMI |
$289.98
|
| Rate for Payer: PACE SWMI |
$289.98
|
| Rate for Payer: PACE SWMI |
$289.98
|
| Rate for Payer: PHP Commercial |
$5,137.84
|
| Rate for Payer: PHP Commercial |
$6,957.48
|
| Rate for Payer: PHP Commercial |
$1,712.62
|
| Rate for Payer: PHP Medicare Advantage |
$289.98
|
| Rate for Payer: PHP Medicare Advantage |
$289.98
|
| Rate for Payer: PHP Medicare Advantage |
$289.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,231.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,729.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,410.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$815.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$815.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$815.70
|
| Rate for Payer: Priority Health Medicare |
$289.98
|
| Rate for Payer: Priority Health Medicare |
$289.98
|
| Rate for Payer: Priority Health Medicare |
$289.98
|
| Rate for Payer: Priority Health Narrow Network |
$652.56
|
| Rate for Payer: Priority Health Narrow Network |
$652.56
|
| Rate for Payer: Priority Health Narrow Network |
$652.56
|
| Rate for Payer: Priority Health SBD |
$5,156.72
|
| Rate for Payer: Priority Health SBD |
$3,808.05
|
| Rate for Payer: Priority Health SBD |
$1,269.36
|
| Rate for Payer: Railroad Medicare Medicare |
$289.98
|
| Rate for Payer: Railroad Medicare Medicare |
$289.98
|
| Rate for Payer: Railroad Medicare Medicare |
$289.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.98
|
| Rate for Payer: UHC Medicare Advantage |
$298.68
|
| Rate for Payer: UHC Medicare Advantage |
$298.68
|
| Rate for Payer: UHC Medicare Advantage |
$298.68
|
| Rate for Payer: UMR Bronson Commercial |
$3,028.55
|
| Rate for Payer: UMR Bronson Commercial |
$2,236.47
|
| Rate for Payer: UMR Bronson Commercial |
$745.49
|
| Rate for Payer: VA VA |
$289.98
|
| Rate for Payer: VA VA |
$289.98
|
| Rate for Payer: VA VA |
$289.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,533.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,511.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,138.95
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
IP
|
$1,212.93
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$533.69 |
| Max. Negotiated Rate |
$1,091.64 |
| Rate for Payer: Aetna American Axle |
$788.40
|
| Rate for Payer: Aetna American Axle |
$660.98
|
| Rate for Payer: Aetna Commercial |
$1,030.99
|
| Rate for Payer: Aetna Commercial |
$864.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.98
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cofinity Commercial |
$849.05
|
| Rate for Payer: Cofinity Commercial |
$711.83
|
| Rate for Payer: Cofinity Commercial |
$874.53
|
| Rate for Payer: Cofinity Commercial |
$1,043.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Healthscope Commercial |
$1,091.64
|
| Rate for Payer: Healthscope Commercial |
$915.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$909.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$864.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,030.99
|
| Rate for Payer: PHP Commercial |
$864.36
|
| Rate for Payer: PHP Commercial |
$1,030.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.05
|
| Rate for Payer: Priority Health SBD |
$640.65
|
| Rate for Payer: Priority Health SBD |
$764.15
|
| Rate for Payer: UMR Bronson Commercial |
$533.69
|
| Rate for Payer: UMR Bronson Commercial |
$447.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$909.70
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
OP
|
$1,016.90
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$1,096.58 |
| Rate for Payer: Aetna American Axle |
$660.98
|
| Rate for Payer: Aetna American Axle |
$788.40
|
| Rate for Payer: Aetna Commercial |
$1,030.99
|
| Rate for Payer: Aetna Commercial |
$864.36
|
| Rate for Payer: Aetna Medicare |
$337.73
|
| Rate for Payer: Aetna Medicare |
$337.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$405.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$405.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$405.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$405.93
|
| Rate for Payer: BCBS Complete |
$186.53
|
| Rate for Payer: BCBS Complete |
$186.53
|
| Rate for Payer: BCBS MAPPO |
$324.74
|
| Rate for Payer: BCBS MAPPO |
$324.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.58
|
| Rate for Payer: BCN Medicare Advantage |
$324.74
|
| Rate for Payer: BCN Medicare Advantage |
$324.74
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cofinity Commercial |
$711.83
|
| Rate for Payer: Cofinity Commercial |
$849.05
|
| Rate for Payer: Cofinity Commercial |
$874.53
|
| Rate for Payer: Cofinity Commercial |
$1,043.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.74
|
| Rate for Payer: Healthscope Commercial |
$915.21
|
| Rate for Payer: Healthscope Commercial |
$1,091.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$909.70
|
| Rate for Payer: Mclaren Medicaid |
$177.63
|
| Rate for Payer: Mclaren Medicaid |
$177.63
|
| Rate for Payer: Mclaren Medicare |
$324.74
|
| Rate for Payer: Mclaren Medicare |
$324.74
|
| Rate for Payer: Meridian Medicaid |
$186.53
|
| Rate for Payer: Meridian Medicaid |
$186.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$340.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$340.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$864.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,030.99
|
| Rate for Payer: PACE Medicare |
$308.51
|
| Rate for Payer: PACE Medicare |
$308.51
|
| Rate for Payer: PACE SWMI |
$324.74
|
| Rate for Payer: PACE SWMI |
$324.74
|
| Rate for Payer: PHP Commercial |
$864.36
|
| Rate for Payer: PHP Commercial |
$1,030.99
|
| Rate for Payer: PHP Medicare Advantage |
$324.74
|
| Rate for Payer: PHP Medicare Advantage |
$324.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$964.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$964.90
|
| Rate for Payer: Priority Health Medicare |
$324.74
|
| Rate for Payer: Priority Health Medicare |
$324.74
|
| Rate for Payer: Priority Health Narrow Network |
$771.92
|
| Rate for Payer: Priority Health Narrow Network |
$771.92
|
| Rate for Payer: Priority Health SBD |
$640.65
|
| Rate for Payer: Priority Health SBD |
$764.15
|
| Rate for Payer: Railroad Medicare Medicare |
$324.74
|
| Rate for Payer: Railroad Medicare Medicare |
$324.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.74
|
| Rate for Payer: UHC Medicare Advantage |
$334.49
|
| Rate for Payer: UHC Medicare Advantage |
$334.49
|
| Rate for Payer: UMR Bronson Commercial |
$448.78
|
| Rate for Payer: UMR Bronson Commercial |
$376.25
|
| Rate for Payer: VA VA |
$324.74
|
| Rate for Payer: VA VA |
$324.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$909.70
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 0487-2784-01
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$6.69
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna American Axle |
$4.35
|
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.35
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.35
|
| Rate for Payer: Healthscope Commercial |
$6.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.69
|
| Rate for Payer: PHP Commercial |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.68
|
| Rate for Payer: Priority Health SBD |
$4.21
|
| Rate for Payer: UMR Bronson Commercial |
$2.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.02
|
|
|
RADIAL STYLOIDECTOMY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$435.83 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.41
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$435.83
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); EXTENSORS, WITH OR WITHOUT TRANSPOSITION OF DORSAL RETINACULUM
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$606.10 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.71
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$606.10
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); FLEXORS
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 25115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$755.08 |
| Max. Negotiated Rate |
$4,497.31 |
| Rate for Payer: Aetna Medicare |
$1,485.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,785.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,785.76
|
| Rate for Payer: BCBS Complete |
$820.59
|
| Rate for Payer: BCBS MAPPO |
$1,428.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,157.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,428.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,428.61
|
| Rate for Payer: Mclaren Medicaid |
$781.45
|
| Rate for Payer: Mclaren Medicare |
$1,428.61
|
| Rate for Payer: Meridian Medicaid |
$820.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,500.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,642.90
|
| Rate for Payer: PACE Medicare |
$1,357.18
|
| Rate for Payer: PACE SWMI |
$1,428.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,428.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$781.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,497.31
|
| Rate for Payer: Priority Health Medicare |
$1,428.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,597.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,428.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.59
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$755.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF BACK OR FLANK; 5 CM OR GREATER
|
Facility
|
OP
|
$7,951.14
|
|
|
Service Code
|
CPT 21936
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,381.58 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,157.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,157.18
|
| Rate for Payer: BCBS Complete |
$1,450.79
|
| Rate for Payer: BCBS MAPPO |
$2,525.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,787.02
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Mclaren Medicaid |
$1,381.58
|
| Rate for Payer: Mclaren Medicare |
$2,525.74
|
| Rate for Payer: Meridian Medicaid |
$1,450.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,652.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,904.60
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,951.14
|
| Rate for Payer: Priority Health Medicare |
$2,525.74
|
| Rate for Payer: Priority Health Narrow Network |
$6,360.91
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,532.23
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$1,392.94
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: VA VA |
$2,525.74
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF NECK OR ANTERIOR THORAX; 5 CM OR GREATER
|
Facility
|
OP
|
$7,951.14
|
|
|
Service Code
|
CPT 21558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,317.95 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,157.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,157.18
|
| Rate for Payer: BCBS Complete |
$1,450.79
|
| Rate for Payer: BCBS MAPPO |
$2,525.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,787.02
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Mclaren Medicaid |
$1,381.58
|
| Rate for Payer: Mclaren Medicare |
$2,525.74
|
| Rate for Payer: Meridian Medicaid |
$1,450.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,652.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,904.60
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,951.14
|
| Rate for Payer: Priority Health Medicare |
$2,525.74
|
| Rate for Payer: Priority Health Narrow Network |
$6,360.91
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,449.74
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$1,317.95
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: VA VA |
$2,525.74
|
|
|
RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED; 1 VIEW
|
Facility
|
OP
|
$254.27
|
|
|
Service Code
|
CPT 73501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$254.27 |
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.96
|
| Rate for Payer: BCBS Complete |
$46.39
|
| Rate for Payer: BCBS MAPPO |
$80.77
|
| Rate for Payer: BCBS Trust/PPO |
$45.61
|
| Rate for Payer: BCN Medicare Advantage |
$80.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.77
|
| Rate for Payer: Mclaren Medicaid |
$44.18
|
| Rate for Payer: Mclaren Medicare |
$80.77
|
| Rate for Payer: Meridian Medicaid |
$46.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.89
|
| Rate for Payer: PACE Medicare |
$76.73
|
| Rate for Payer: PACE SWMI |
$80.77
|
| Rate for Payer: PHP Medicare Advantage |
$80.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.27
|
| Rate for Payer: Priority Health Medicare |
$80.77
|
| Rate for Payer: Priority Health Narrow Network |
$203.42
|
| Rate for Payer: Railroad Medicare Medicare |
$80.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.77
|
| Rate for Payer: UHC Exchange |
$32.42
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.77
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE
|
Facility
|
IP
|
$473.13
|
|
|
Service Code
|
NDC 1085808110
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.18 |
| Max. Negotiated Rate |
$425.82 |
| Rate for Payer: Aetna American Axle |
$307.53
|
| Rate for Payer: Aetna Commercial |
$402.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.53
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cofinity Commercial |
$331.19
|
| Rate for Payer: Cofinity Commercial |
$406.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.50
|
| Rate for Payer: Healthscope Commercial |
$425.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.16
|
| Rate for Payer: PHP Commercial |
$402.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.19
|
| Rate for Payer: Priority Health SBD |
$298.07
|
| Rate for Payer: UMR Bronson Commercial |
$208.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.85
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE
|
Facility
|
IP
|
$4,731.27
|
|
|
Service Code
|
NDC 1085808107
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,081.76 |
| Max. Negotiated Rate |
$4,258.14 |
| Rate for Payer: Aetna American Axle |
$3,075.33
|
| Rate for Payer: Aetna Commercial |
$4,021.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,075.33
|
| Rate for Payer: Cash Price |
$3,785.02
|
| Rate for Payer: Cofinity Commercial |
$3,311.89
|
| Rate for Payer: Cofinity Commercial |
$4,068.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.02
|
| Rate for Payer: Healthscope Commercial |
$4,258.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,311.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,021.58
|
| Rate for Payer: PHP Commercial |
$4,021.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,311.89
|
| Rate for Payer: Priority Health SBD |
$2,980.70
|
| Rate for Payer: UMR Bronson Commercial |
$2,081.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,548.45
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$63,518.57
|
|
|
Service Code
|
MS-DRG 849
|
| Min. Negotiated Rate |
$20,189.75 |
| Max. Negotiated Rate |
$63,518.57 |
| Rate for Payer: Aetna Medicare |
$22,102.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,565.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,565.46
|
| Rate for Payer: BCBS MAPPO |
$21,252.37
|
| Rate for Payer: BCBS Trust/PPO |
$63,518.57
|
| Rate for Payer: BCN Medicare Advantage |
$21,252.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,252.37
|
| Rate for Payer: Mclaren Medicare |
$21,252.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,314.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,440.23
|
| Rate for Payer: PACE Medicare |
$20,189.75
|
| Rate for Payer: PACE SWMI |
$21,252.37
|
| Rate for Payer: PHP Medicare Advantage |
$21,252.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,621.37
|
| Rate for Payer: Priority Health Medicare |
$21,252.37
|
| Rate for Payer: Priority Health Narrow Network |
$30,897.10
|
| Rate for Payer: Railroad Medicare Medicare |
$21,252.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,054.62
|
| Rate for Payer: UHC Core |
$33,664.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,252.37
|
| Rate for Payer: UHC Exchange |
$26,763.28
|
| Rate for Payer: UHC Medicare Advantage |
$21,889.94
|
| Rate for Payer: VA VA |
$21,252.37
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$100.08
|
|
|
Service Code
|
NDC 66993-661-30
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.04 |
| Max. Negotiated Rate |
$90.07 |
| Rate for Payer: Aetna American Axle |
$65.05
|
| Rate for Payer: Aetna Commercial |
$85.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.05
|
| Rate for Payer: Cash Price |
$80.06
|
| Rate for Payer: Cofinity Commercial |
$70.06
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.06
|
| Rate for Payer: Healthscope Commercial |
$90.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.07
|
| Rate for Payer: PHP Commercial |
$85.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.06
|
| Rate for Payer: Priority Health SBD |
$63.05
|
| Rate for Payer: UMR Bronson Commercial |
$44.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.06
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$110.30
|
|
|
Service Code
|
NDC 69097-825-02
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.53 |
| Max. Negotiated Rate |
$99.27 |
| Rate for Payer: Aetna American Axle |
$71.70
|
| Rate for Payer: Aetna Commercial |
$93.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.70
|
| Rate for Payer: Cash Price |
$88.24
|
| Rate for Payer: Cofinity Commercial |
$77.21
|
| Rate for Payer: Cofinity Commercial |
$94.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.24
|
| Rate for Payer: Healthscope Commercial |
$99.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.76
|
| Rate for Payer: PHP Commercial |
$93.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.21
|
| Rate for Payer: Priority Health SBD |
$69.49
|
| Rate for Payer: UMR Bronson Commercial |
$48.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.72
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$87.12
|
|
|
Service Code
|
NDC 65162-057-03
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$78.41 |
| Rate for Payer: Aetna American Axle |
$56.63
|
| Rate for Payer: Aetna Commercial |
$74.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: Cash Price |
$69.70
|
| Rate for Payer: Cofinity Commercial |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$74.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.70
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.05
|
| Rate for Payer: PHP Commercial |
$74.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.98
|
| Rate for Payer: Priority Health SBD |
$54.89
|
| Rate for Payer: UMR Bronson Commercial |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.34
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$441.75
|
|
|
Service Code
|
NDC 69097-825-07
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$397.58 |
| Rate for Payer: Aetna American Axle |
$287.14
|
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$375.49
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.22
|
| Rate for Payer: Priority Health SBD |
$278.30
|
| Rate for Payer: UMR Bronson Commercial |
$194.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,203.46
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,169.52 |
| Max. Negotiated Rate |
$6,483.11 |
| Rate for Payer: Aetna American Axle |
$4,682.25
|
| Rate for Payer: Aetna Commercial |
$6,122.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,682.25
|
| Rate for Payer: Cash Price |
$5,762.77
|
| Rate for Payer: Cofinity Commercial |
$5,042.42
|
| Rate for Payer: Cofinity Commercial |
$6,194.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,762.77
|
| Rate for Payer: Healthscope Commercial |
$6,483.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,042.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,402.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,122.94
|
| Rate for Payer: PHP Commercial |
$6,122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,042.42
|
| Rate for Payer: Priority Health SBD |
$4,538.18
|
| Rate for Payer: UMR Bronson Commercial |
$3,169.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,402.60
|
|
|
RAMIPRIL 10 MG CAPSULE
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 65862-477-01
|
| Hospital Charge Code |
11259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.85
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.06
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$61.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$82.08
|
|
|
Service Code
|
NDC 68382-144-06
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna American Axle |
$53.35
|
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.35
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cofinity Commercial |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$70.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.66
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.77
|
| Rate for Payer: PHP Commercial |
$69.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.46
|
| Rate for Payer: Priority Health SBD |
$51.71
|
| Rate for Payer: UMR Bronson Commercial |
$36.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.56
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
IP
|
$79.90
|
|
|
Service Code
|
NDC 65862-475-01
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna American Axle |
$51.94
|
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.94
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.92
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.93
|
| Rate for Payer: Priority Health SBD |
$50.34
|
| Rate for Payer: UMR Bronson Commercial |
$35.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.02
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$32,063.77
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
170507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,108.06 |
| Max. Negotiated Rate |
$28,857.39 |
| Rate for Payer: Aetna American Axle |
$20,841.45
|
| Rate for Payer: Aetna American Axle |
$4,168.29
|
| Rate for Payer: Aetna Commercial |
$5,450.85
|
| Rate for Payer: Aetna Commercial |
$27,254.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,841.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,168.29
|
| Rate for Payer: Cash Price |
$25,651.02
|
| Rate for Payer: Cash Price |
$5,130.21
|
| Rate for Payer: Cofinity Commercial |
$27,574.84
|
| Rate for Payer: Cofinity Commercial |
$22,444.64
|
| Rate for Payer: Cofinity Commercial |
$4,488.93
|
| Rate for Payer: Cofinity Commercial |
$5,514.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,651.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,130.21
|
| Rate for Payer: Healthscope Commercial |
$5,771.48
|
| Rate for Payer: Healthscope Commercial |
$28,857.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,488.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22,444.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,047.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,809.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,450.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27,254.20
|
| Rate for Payer: PHP Commercial |
$27,254.20
|
| Rate for Payer: PHP Commercial |
$5,450.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,488.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22,444.64
|
| Rate for Payer: Priority Health SBD |
$20,200.18
|
| Rate for Payer: Priority Health SBD |
$4,040.04
|
| Rate for Payer: UMR Bronson Commercial |
$14,108.06
|
| Rate for Payer: UMR Bronson Commercial |
$2,821.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,809.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,047.83
|
|
