|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS
|
Facility
|
OP
|
$8,919.33
|
|
|
Service Code
|
CPT 37766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.24 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$477.66
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.26
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$320.24
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH OR WITHOUT USE OF FOREIGN MATERIAL;
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$912.91 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$5,749.50
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.20
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$912.91
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
STAVUDINE 30 MG CAPSULE
|
Facility
|
IP
|
$458.50
|
|
|
Service Code
|
NDC 65862-046-60
|
| Hospital Charge Code |
13310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.74 |
| Max. Negotiated Rate |
$412.65 |
| Rate for Payer: Aetna American Axle |
$298.02
|
| Rate for Payer: Aetna Commercial |
$389.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.02
|
| Rate for Payer: Cash Price |
$366.80
|
| Rate for Payer: Cofinity Commercial |
$320.95
|
| Rate for Payer: Cofinity Commercial |
$394.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.80
|
| Rate for Payer: Healthscope Commercial |
$412.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.72
|
| Rate for Payer: PHP Commercial |
$389.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.95
|
| Rate for Payer: Priority Health SBD |
$288.86
|
| Rate for Payer: UMR Bronson Commercial |
$201.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.88
|
|
|
STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING BURR HOLE(S), FOR INTRACRANIAL LESION;
|
Facility
|
OP
|
$4,977.70
|
|
|
Service Code
|
CPT 61750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,406.69 |
| Max. Negotiated Rate |
$4,977.70 |
| Rate for Payer: BCBS Trust/PPO |
$4,977.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,547.36
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$1,406.69
|
|
|
STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; CRANIAL, EXTRADURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 61782
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$167.98 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$610.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.78
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$167.98
|
|
|
STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; CRANIAL, INTRADURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$838.46
|
|
|
Service Code
|
CPT 61781
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$231.83 |
| Max. Negotiated Rate |
$838.46 |
| Rate for Payer: BCBS Trust/PPO |
$838.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.01
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$231.83
|
|
|
STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; SPINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$822.80
|
|
|
Service Code
|
CPT 61783
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$226.92 |
| Max. Negotiated Rate |
$822.80 |
| Rate for Payer: BCBS Trust/PPO |
$822.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.61
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$226.92
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
IP
|
$443.75
|
|
|
Service Code
|
NDC 62327-333-43
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna American Axle |
$288.44
|
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Commercial |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$377.19
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.62
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UMR Bronson Commercial |
$195.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.81
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
IP
|
$443.75
|
|
|
Service Code
|
NDC 62327-333-03
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna American Axle |
$288.44
|
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Commercial |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$377.19
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.62
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UMR Bronson Commercial |
$195.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.81
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC
|
Facility
|
IP
|
$48,529.12
|
|
|
Service Code
|
MS-DRG 327
|
| Min. Negotiated Rate |
$18,769.54 |
| Max. Negotiated Rate |
$48,529.12 |
| Rate for Payer: Aetna Medicare |
$20,547.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,696.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,696.76
|
| Rate for Payer: BCBS MAPPO |
$19,757.41
|
| Rate for Payer: BCBS Trust/PPO |
$48,529.12
|
| Rate for Payer: BCN Medicare Advantage |
$19,757.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,757.41
|
| Rate for Payer: Mclaren Medicare |
$19,757.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,745.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,721.02
|
| Rate for Payer: PACE Medicare |
$18,769.54
|
| Rate for Payer: PACE SWMI |
$19,757.41
|
| Rate for Payer: PHP Medicare Advantage |
$19,757.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,837.49
|
| Rate for Payer: Priority Health Medicare |
$19,757.41
|
| Rate for Payer: Priority Health Narrow Network |
$28,669.99
|
| Rate for Payer: Railroad Medicare Medicare |
$19,757.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,095.34
|
| Rate for Payer: UHC Core |
$31,237.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,757.41
|
| Rate for Payer: UHC Exchange |
$24,834.15
|
| Rate for Payer: UHC Medicare Advantage |
$20,350.13
|
| Rate for Payer: VA VA |
$19,757.41
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$90,956.93
|
|
|
Service Code
|
MS-DRG 326
|
| Min. Negotiated Rate |
$37,668.74 |
| Max. Negotiated Rate |
$90,956.93 |
| Rate for Payer: Aetna Medicare |
$41,237.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49,564.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49,564.12
|
| Rate for Payer: BCBS MAPPO |
$39,651.30
|
| Rate for Payer: BCBS Trust/PPO |
$90,956.93
|
| Rate for Payer: BCN Medicare Advantage |
$39,651.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,651.30
|
| Rate for Payer: Mclaren Medicare |
$39,651.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41,633.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45,599.00
|
| Rate for Payer: PACE Medicare |
$37,668.74
|
| Rate for Payer: PACE SWMI |
$39,651.30
|
| Rate for Payer: PHP Medicare Advantage |
$39,651.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72,883.24
|
| Rate for Payer: Priority Health Medicare |
$39,651.30
|
| Rate for Payer: Priority Health Narrow Network |
$58,306.59
|
| Rate for Payer: Railroad Medicare Medicare |
$39,651.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77,475.07
|
| Rate for Payer: UHC Core |
$63,528.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$39,651.30
|
| Rate for Payer: UHC Exchange |
$50,505.58
|
| Rate for Payer: UHC Medicare Advantage |
$40,840.84
|
| Rate for Payer: VA VA |
$39,651.30
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$32,016.86
|
|
|
Service Code
|
MS-DRG 328
|
| Min. Negotiated Rate |
$12,180.14 |
| Max. Negotiated Rate |
$32,016.86 |
| Rate for Payer: Aetna Medicare |
$13,334.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,026.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,026.50
|
| Rate for Payer: BCBS MAPPO |
$12,821.20
|
| Rate for Payer: BCBS Trust/PPO |
$32,016.86
|
| Rate for Payer: BCN Medicare Advantage |
$12,821.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,821.20
|
| Rate for Payer: Mclaren Medicare |
$12,821.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,462.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,744.38
|
| Rate for Payer: PACE Medicare |
$12,180.14
|
| Rate for Payer: PACE SWMI |
$12,821.20
|
| Rate for Payer: PHP Medicare Advantage |
$12,821.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,921.13
|
| Rate for Payer: Priority Health Medicare |
$12,821.20
|
| Rate for Payer: Priority Health Narrow Network |
$18,336.90
|
| Rate for Payer: Railroad Medicare Medicare |
$12,821.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,365.21
|
| Rate for Payer: UHC Core |
$19,979.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,821.20
|
| Rate for Payer: UHC Exchange |
$15,883.55
|
| Rate for Payer: UHC Medicare Advantage |
$13,205.84
|
| Rate for Payer: VA VA |
$12,821.20
|
|
|
STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$178.33
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
7508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.47 |
| Max. Negotiated Rate |
$160.50 |
| Rate for Payer: Aetna American Axle |
$115.91
|
| Rate for Payer: Aetna American Axle |
$161.38
|
| Rate for Payer: Aetna Commercial |
$211.04
|
| Rate for Payer: Aetna Commercial |
$151.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.38
|
| Rate for Payer: Cash Price |
$142.66
|
| Rate for Payer: Cash Price |
$198.62
|
| Rate for Payer: Cofinity Commercial |
$124.83
|
| Rate for Payer: Cofinity Commercial |
$153.36
|
| Rate for Payer: Cofinity Commercial |
$173.80
|
| Rate for Payer: Cofinity Commercial |
$213.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.66
|
| Rate for Payer: Healthscope Commercial |
$160.50
|
| Rate for Payer: Healthscope Commercial |
$223.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.58
|
| Rate for Payer: PHP Commercial |
$211.04
|
| Rate for Payer: PHP Commercial |
$151.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health SBD |
$156.42
|
| Rate for Payer: Priority Health SBD |
$112.35
|
| Rate for Payer: UMR Bronson Commercial |
$109.24
|
| Rate for Payer: UMR Bronson Commercial |
$78.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.21
|
|
|
STREPTOZOCIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,536.49
|
|
|
Service Code
|
HCPCS J9320
|
| Hospital Charge Code |
11436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$676.06 |
| Max. Negotiated Rate |
$1,382.84 |
| Rate for Payer: Aetna American Axle |
$998.72
|
| Rate for Payer: Aetna Commercial |
$1,306.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.72
|
| Rate for Payer: Cash Price |
$1,229.19
|
| Rate for Payer: Cofinity Commercial |
$1,075.54
|
| Rate for Payer: Cofinity Commercial |
$1,321.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.19
|
| Rate for Payer: Healthscope Commercial |
$1,382.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,075.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,152.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,306.02
|
| Rate for Payer: PHP Commercial |
$1,306.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.54
|
| Rate for Payer: Priority Health SBD |
$967.99
|
| Rate for Payer: UMR Bronson Commercial |
$676.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,152.37
|
|
|
STREPTOZOCIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,536.49
|
|
|
Service Code
|
HCPCS J9320
|
| Hospital Charge Code |
11436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.49 |
| Max. Negotiated Rate |
$1,382.84 |
| Rate for Payer: Aetna American Axle |
$998.72
|
| Rate for Payer: Aetna Commercial |
$1,306.02
|
| Rate for Payer: Aetna Medicare |
$384.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$462.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$462.73
|
| Rate for Payer: BCBS Complete |
$212.63
|
| Rate for Payer: BCBS MAPPO |
$370.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,097.25
|
| Rate for Payer: BCN Medicare Advantage |
$370.18
|
| Rate for Payer: Cash Price |
$1,229.19
|
| Rate for Payer: Cash Price |
$1,229.19
|
| Rate for Payer: Cofinity Commercial |
$1,075.54
|
| Rate for Payer: Cofinity Commercial |
$1,321.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.18
|
| Rate for Payer: Healthscope Commercial |
$1,382.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,075.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,152.37
|
| Rate for Payer: Mclaren Medicaid |
$202.49
|
| Rate for Payer: Mclaren Medicare |
$370.18
|
| Rate for Payer: Meridian Medicaid |
$212.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$388.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$425.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,306.02
|
| Rate for Payer: PACE Medicare |
$351.67
|
| Rate for Payer: PACE SWMI |
$370.18
|
| Rate for Payer: PHP Commercial |
$1,306.02
|
| Rate for Payer: PHP Medicare Advantage |
$370.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,087.19
|
| Rate for Payer: Priority Health Medicare |
$370.18
|
| Rate for Payer: Priority Health Narrow Network |
$869.75
|
| Rate for Payer: Priority Health SBD |
$967.99
|
| Rate for Payer: Railroad Medicare Medicare |
$370.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.18
|
| Rate for Payer: UHC Medicare Advantage |
$381.29
|
| Rate for Payer: UMR Bronson Commercial |
$568.50
|
| Rate for Payer: VA VA |
$370.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,152.37
|
|
|
SUBCONJUNCTIVAL INJECTION
|
Facility
|
OP
|
$1,114.93
|
|
|
Service Code
|
CPT 68200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$33.07 |
| Max. Negotiated Rate |
$1,114.93 |
| Rate for Payer: Aetna Medicare |
$368.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.70
|
| Rate for Payer: BCBS Complete |
$203.43
|
| Rate for Payer: BCBS MAPPO |
$354.16
|
| Rate for Payer: BCBS Trust/PPO |
$234.77
|
| Rate for Payer: BCN Medicare Advantage |
$354.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.16
|
| Rate for Payer: Mclaren Medicaid |
$193.73
|
| Rate for Payer: Mclaren Medicare |
$354.16
|
| Rate for Payer: Meridian Medicaid |
$203.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.28
|
| Rate for Payer: PACE Medicare |
$336.45
|
| Rate for Payer: PACE SWMI |
$354.16
|
| Rate for Payer: PHP Medicare Advantage |
$354.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,114.93
|
| Rate for Payer: Priority Health Medicare |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$891.94
|
| Rate for Payer: Railroad Medicare Medicare |
$354.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.38
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.16
|
| Rate for Payer: UHC Exchange |
$33.07
|
| Rate for Payer: UHC Medicare Advantage |
$364.78
|
| Rate for Payer: VA VA |
$354.16
|
|
|
SUBMUCOSAL INJECTABLE COMPOSITION (ELEVIEW)
|
Facility
|
IP
|
$287.55
|
|
|
Service Code
|
NDC 5391-5301-90
|
| Hospital Charge Code |
200133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$258.80 |
| Rate for Payer: Aetna American Axle |
$186.91
|
| Rate for Payer: Aetna Commercial |
$244.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.91
|
| Rate for Payer: Cash Price |
$230.04
|
| Rate for Payer: Cofinity Commercial |
$201.28
|
| Rate for Payer: Cofinity Commercial |
$247.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.04
|
| Rate for Payer: Healthscope Commercial |
$258.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$244.42
|
| Rate for Payer: PHP Commercial |
$244.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.28
|
| Rate for Payer: Priority Health SBD |
$181.16
|
| Rate for Payer: UMR Bronson Commercial |
$126.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.66
|
|
|
SUBMUCOUS RESECTION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 30140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.53 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,629.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.98
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$174.53
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
SUCCIMER 100 MG CAPSULE
|
Facility
|
IP
|
$8,152.95
|
|
|
Service Code
|
NDC 55292-201-11
|
| Hospital Charge Code |
11438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,587.30 |
| Max. Negotiated Rate |
$7,337.66 |
| Rate for Payer: Aetna American Axle |
$5,299.42
|
| Rate for Payer: Aetna Commercial |
$6,930.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,299.42
|
| Rate for Payer: Cash Price |
$6,522.36
|
| Rate for Payer: Cofinity Commercial |
$5,707.06
|
| Rate for Payer: Cofinity Commercial |
$7,011.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,522.36
|
| Rate for Payer: Healthscope Commercial |
$7,337.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,707.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,114.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,930.01
|
| Rate for Payer: PHP Commercial |
$6,930.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,707.06
|
| Rate for Payer: Priority Health SBD |
$5,136.36
|
| Rate for Payer: UMR Bronson Commercial |
$3,587.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,114.71
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna American Axle |
$51.58
|
| Rate for Payer: Aetna American Axle |
$18.05
|
| Rate for Payer: Aetna Commercial |
$23.60
|
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.05
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Cofinity Commercial |
$23.88
|
| Rate for Payer: Cofinity Commercial |
$55.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Healthscope Commercial |
$24.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.45
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$23.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.54
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: Priority Health SBD |
$17.50
|
| Rate for Payer: Priority Health SBD |
$49.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: UMR Bronson Commercial |
$34.91
|
| Rate for Payer: UMR Bronson Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.14
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$19.03 |
| Rate for Payer: Aetna American Axle |
$13.74
|
| Rate for Payer: Aetna American Axle |
$15.39
|
| Rate for Payer: Aetna American Axle |
$51.58
|
| Rate for Payer: Aetna American Axle |
$15.73
|
| Rate for Payer: Aetna American Axle |
$18.05
|
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna American Axle |
$20.20
|
| Rate for Payer: Aetna Commercial |
$26.41
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Commercial |
$20.57
|
| Rate for Payer: Aetna Commercial |
$20.13
|
| Rate for Payer: Aetna Commercial |
$23.60
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.39
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$22.22
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$16.58
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$26.72
|
| Rate for Payer: Cofinity Commercial |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$21.75
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Cofinity Commercial |
$55.54
|
| Rate for Payer: Cofinity Commercial |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$23.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.36
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Healthscope Commercial |
$27.96
|
| Rate for Payer: Healthscope Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$21.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.45
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: PHP Commercial |
$20.57
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Commercial |
$23.60
|
| Rate for Payer: PHP Commercial |
$20.13
|
| Rate for Payer: PHP Commercial |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.94
|
| Rate for Payer: Priority Health SBD |
$14.92
|
| Rate for Payer: Priority Health SBD |
$15.25
|
| Rate for Payer: Priority Health SBD |
$17.50
|
| Rate for Payer: Priority Health SBD |
$19.57
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: Priority Health SBD |
$49.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: UMR Bronson Commercial |
$13.67
|
| Rate for Payer: UMR Bronson Commercial |
$9.30
|
| Rate for Payer: UMR Bronson Commercial |
$10.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.65
|
| Rate for Payer: UMR Bronson Commercial |
$12.22
|
| Rate for Payer: UMR Bronson Commercial |
$34.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$33.32
|
|
|
Service Code
|
NDC 0121-0974-50
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$29.99 |
| Rate for Payer: Aetna American Axle |
$21.66
|
| Rate for Payer: Aetna Commercial |
$28.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.66
|
| Rate for Payer: Cash Price |
$26.66
|
| Rate for Payer: Cofinity Commercial |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$28.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.66
|
| Rate for Payer: Healthscope Commercial |
$29.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.32
|
| Rate for Payer: PHP Commercial |
$28.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.32
|
| Rate for Payer: Priority Health SBD |
$20.99
|
| Rate for Payer: UMR Bronson Commercial |
$14.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.99
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$46.47
|
|
|
Service Code
|
NDC 66689-790-01
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$41.82 |
| Rate for Payer: Aetna American Axle |
$30.21
|
| Rate for Payer: Aetna Commercial |
$39.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.21
|
| Rate for Payer: Cash Price |
$37.18
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Cofinity Commercial |
$39.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.18
|
| Rate for Payer: Healthscope Commercial |
$41.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.50
|
| Rate for Payer: PHP Commercial |
$39.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.53
|
| Rate for Payer: Priority Health SBD |
$29.28
|
| Rate for Payer: UMR Bronson Commercial |
$20.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.85
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$40.61
|
|
|
Service Code
|
NDC 68094-043-62
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.87 |
| Max. Negotiated Rate |
$36.55 |
| Rate for Payer: Aetna American Axle |
$26.40
|
| Rate for Payer: Aetna Commercial |
$34.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.40
|
| Rate for Payer: Cash Price |
$32.49
|
| Rate for Payer: Cofinity Commercial |
$28.43
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.49
|
| Rate for Payer: Healthscope Commercial |
$36.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.52
|
| Rate for Payer: PHP Commercial |
$34.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.43
|
| Rate for Payer: Priority Health SBD |
$25.58
|
| Rate for Payer: UMR Bronson Commercial |
$17.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.46
|
|
|
SUCRALFATE 100 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$29.91
|
|
|
Service Code
|
NDC 60687-738-08
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$26.92 |
| Rate for Payer: Aetna American Axle |
$19.44
|
| Rate for Payer: Aetna Commercial |
$25.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.44
|
| Rate for Payer: Cash Price |
$23.93
|
| Rate for Payer: Cofinity Commercial |
$20.94
|
| Rate for Payer: Cofinity Commercial |
$25.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.93
|
| Rate for Payer: Healthscope Commercial |
$26.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.42
|
| Rate for Payer: PHP Commercial |
$25.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.94
|
| Rate for Payer: Priority Health SBD |
$18.84
|
| Rate for Payer: UMR Bronson Commercial |
$13.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.43
|
|
