|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); PERCUTANEOUS
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 24357
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$416.51 |
| 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 |
$1,746.73
|
| 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) |
$458.16
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$416.51
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENOTOMY, FLEXOR, FINGER, OPEN, EACH TENDON
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 26455
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$461.04 |
| 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 |
$1,377.10
|
| 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) |
$507.14
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$461.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
TENOTOMY, FLEXOR, PALM, OPEN, EACH TENDON
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$463.99 |
| 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 |
$1,810.03
|
| 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) |
$510.39
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$463.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 28234
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$268.50 |
| 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 |
$1,377.10
|
| 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) |
$295.35
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$268.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25290
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$438.77 |
| 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) |
$482.65
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$438.77
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENOTOMY, OPEN, TENDON FLEXOR; FOOT, SINGLE OR MULTIPLE TENDON(S) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 28230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$282.58 |
| 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 |
$355.40
|
| 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) |
$310.84
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$282.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,497.31
|
|
|
Service Code
|
CPT 28232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$239.69 |
| 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 |
$334.58
|
| 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) |
$263.66
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,428.61
|
| Rate for Payer: UHC Exchange |
$239.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 27606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$266.54 |
| 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 |
$1,810.03
|
| 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) |
$293.19
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$266.54
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
TENOTOMY, SHOULDER AREA; SINGLE TENDON
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 23405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$612.64 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,896.88
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$673.90
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$612.64
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$41,392.78
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,212.82 |
| Max. Negotiated Rate |
$37,253.50 |
| Rate for Payer: Aetna American Axle |
$26,905.31
|
| Rate for Payer: Aetna Commercial |
$35,183.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,905.31
|
| Rate for Payer: Cash Price |
$33,114.22
|
| Rate for Payer: Cofinity Commercial |
$28,974.95
|
| Rate for Payer: Cofinity Commercial |
$35,597.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,114.22
|
| Rate for Payer: Healthscope Commercial |
$37,253.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28,974.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,044.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35,183.86
|
| Rate for Payer: PHP Commercial |
$35,183.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,974.95
|
| Rate for Payer: Priority Health SBD |
$26,077.45
|
| Rate for Payer: UMR Bronson Commercial |
$18,212.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,044.58
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$41,392.78
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.41 |
| Max. Negotiated Rate |
$37,253.50 |
| Rate for Payer: Aetna American Axle |
$26,905.31
|
| Rate for Payer: Aetna Commercial |
$35,183.86
|
| Rate for Payer: Aetna Medicare |
$341.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,905.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.00
|
| Rate for Payer: BCBS Complete |
$188.40
|
| Rate for Payer: BCBS MAPPO |
$328.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.92
|
| Rate for Payer: BCN Medicare Advantage |
$328.00
|
| Rate for Payer: Cash Price |
$33,114.22
|
| Rate for Payer: Cash Price |
$33,114.22
|
| Rate for Payer: Cofinity Commercial |
$35,597.79
|
| Rate for Payer: Cofinity Commercial |
$28,974.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,114.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.00
|
| Rate for Payer: Healthscope Commercial |
$37,253.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28,974.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,044.58
|
| Rate for Payer: Mclaren Medicaid |
$179.41
|
| Rate for Payer: Mclaren Medicare |
$328.00
|
| Rate for Payer: Meridian Medicaid |
$188.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$344.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35,183.86
|
| Rate for Payer: PACE Medicare |
$311.60
|
| Rate for Payer: PACE SWMI |
$328.00
|
| Rate for Payer: PHP Commercial |
$35,183.86
|
| Rate for Payer: PHP Medicare Advantage |
$328.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,974.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$963.29
|
| Rate for Payer: Priority Health Medicare |
$328.00
|
| Rate for Payer: Priority Health Narrow Network |
$770.63
|
| Rate for Payer: Priority Health SBD |
$26,077.45
|
| Rate for Payer: Railroad Medicare Medicare |
$328.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.00
|
| Rate for Payer: UHC Medicare Advantage |
$337.84
|
| Rate for Payer: UMR Bronson Commercial |
$15,315.33
|
| Rate for Payer: VA VA |
$328.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,044.58
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
NDC 96295-13323
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.02
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$31.19
|
|
|
Service Code
|
NDC 51672-2080-2
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$28.07 |
| Rate for Payer: Aetna American Axle |
$20.27
|
| Rate for Payer: Aetna Commercial |
$26.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.27
|
| Rate for Payer: Cash Price |
$24.95
|
| Rate for Payer: Cofinity Commercial |
$21.83
|
| Rate for Payer: Cofinity Commercial |
$26.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.95
|
| Rate for Payer: Healthscope Commercial |
$28.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.51
|
| Rate for Payer: PHP Commercial |
$26.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.83
|
| Rate for Payer: Priority Health SBD |
$19.65
|
| Rate for Payer: UMR Bronson Commercial |
$13.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.39
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$23.22
|
|
|
Service Code
|
NDC 51672-2080-1
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$20.90 |
| Rate for Payer: Aetna American Axle |
$15.09
|
| Rate for Payer: Aetna Commercial |
$19.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.09
|
| Rate for Payer: Cash Price |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$20.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.74
|
| Rate for Payer: PHP Commercial |
$19.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health SBD |
$14.63
|
| Rate for Payer: UMR Bronson Commercial |
$10.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.42
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$68.39
|
|
|
Service Code
|
NDC 69097-731-02
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$61.55 |
| Rate for Payer: Aetna American Axle |
$44.45
|
| Rate for Payer: Aetna Commercial |
$58.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.45
|
| Rate for Payer: Cash Price |
$54.71
|
| Rate for Payer: Cofinity Commercial |
$58.82
|
| Rate for Payer: Cofinity Commercial |
$47.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.71
|
| Rate for Payer: Healthscope Commercial |
$61.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.13
|
| Rate for Payer: PHP Commercial |
$58.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.87
|
| Rate for Payer: Priority Health SBD |
$43.09
|
| Rate for Payer: UMR Bronson Commercial |
$30.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.29
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$80.37
|
|
|
Service Code
|
NDC 69097-859-02
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$72.33 |
| Rate for Payer: Aetna American Axle |
$52.24
|
| Rate for Payer: Aetna Commercial |
$68.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.24
|
| Rate for Payer: Cash Price |
$64.30
|
| Rate for Payer: Cofinity Commercial |
$56.26
|
| Rate for Payer: Cofinity Commercial |
$69.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.30
|
| Rate for Payer: Healthscope Commercial |
$72.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.31
|
| Rate for Payer: PHP Commercial |
$68.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.26
|
| Rate for Payer: Priority Health SBD |
$50.63
|
| Rate for Payer: UMR Bronson Commercial |
$35.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.28
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$90.24
|
|
|
Service Code
|
NDC 51991-526-33
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.71 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna American Axle |
$58.66
|
| Rate for Payer: Aetna Commercial |
$76.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.66
|
| Rate for Payer: Cash Price |
$72.19
|
| Rate for Payer: Cofinity Commercial |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$77.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.70
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.17
|
| Rate for Payer: Priority Health SBD |
$56.85
|
| Rate for Payer: UMR Bronson Commercial |
$39.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.68
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$21.32
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$19.19 |
| Rate for Payer: Aetna American Axle |
$13.86
|
| Rate for Payer: Aetna American Axle |
$10.99
|
| Rate for Payer: Aetna American Axle |
$15.63
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna Commercial |
$14.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$15.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.44
|
| Rate for Payer: PHP Commercial |
$14.37
|
| Rate for Payer: PHP Commercial |
$18.12
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: Priority Health SBD |
$13.43
|
| Rate for Payer: Priority Health SBD |
$10.65
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
| Rate for Payer: UMR Bronson Commercial |
$9.38
|
| Rate for Payer: UMR Bronson Commercial |
$7.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.04
|
|
|
TERBUTALINE 2.5 MG TABLET
|
Facility
|
IP
|
$1,530.32
|
|
|
Service Code
|
NDC 0527-1318-01
|
| Hospital Charge Code |
11508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$673.34 |
| Max. Negotiated Rate |
$1,377.29 |
| Rate for Payer: Aetna American Axle |
$994.71
|
| Rate for Payer: Aetna Commercial |
$1,300.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.71
|
| Rate for Payer: Cash Price |
$1,224.26
|
| Rate for Payer: Cofinity Commercial |
$1,071.22
|
| Rate for Payer: Cofinity Commercial |
$1,316.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.26
|
| Rate for Payer: Healthscope Commercial |
$1,377.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,071.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,147.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,300.77
|
| Rate for Payer: PHP Commercial |
$1,300.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.22
|
| Rate for Payer: Priority Health SBD |
$964.10
|
| Rate for Payer: UMR Bronson Commercial |
$673.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,147.74
|
|
|
TERBUTALINE 5 MG TABLET
|
Facility
|
IP
|
$2,322.49
|
|
|
Service Code
|
NDC 10135-580-01
|
| Hospital Charge Code |
11509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,021.90 |
| Max. Negotiated Rate |
$2,090.24 |
| Rate for Payer: Aetna American Axle |
$1,509.62
|
| Rate for Payer: Aetna Commercial |
$1,974.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.62
|
| Rate for Payer: Cash Price |
$1,857.99
|
| Rate for Payer: Cofinity Commercial |
$1,625.74
|
| Rate for Payer: Cofinity Commercial |
$1,997.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,857.99
|
| Rate for Payer: Healthscope Commercial |
$2,090.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,625.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,741.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,974.12
|
| Rate for Payer: PHP Commercial |
$1,974.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,625.74
|
| Rate for Payer: Priority Health SBD |
$1,463.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,021.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,741.87
|
|
|
TERBUTALINE 5 MG TABLET
|
Facility
|
IP
|
$1,868.87
|
|
|
Service Code
|
NDC 0527-1311-01
|
| Hospital Charge Code |
11509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$822.30 |
| Max. Negotiated Rate |
$1,681.98 |
| Rate for Payer: Aetna American Axle |
$1,214.77
|
| Rate for Payer: Aetna Commercial |
$1,588.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.77
|
| Rate for Payer: Cash Price |
$1,495.10
|
| Rate for Payer: Cofinity Commercial |
$1,308.21
|
| Rate for Payer: Cofinity Commercial |
$1,607.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,495.10
|
| Rate for Payer: Healthscope Commercial |
$1,681.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,308.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,401.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,588.54
|
| Rate for Payer: PHP Commercial |
$1,588.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,308.21
|
| Rate for Payer: Priority Health SBD |
$1,177.39
|
| Rate for Payer: UMR Bronson Commercial |
$822.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,401.65
|
|
|
TESTES PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$35,713.33
|
|
|
Service Code
|
MS-DRG 711
|
| Min. Negotiated Rate |
$16,027.92 |
| Max. Negotiated Rate |
$35,713.33 |
| Rate for Payer: Aetna Medicare |
$17,546.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,089.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,089.38
|
| Rate for Payer: BCBS MAPPO |
$16,871.50
|
| Rate for Payer: BCBS Trust/PPO |
$35,713.33
|
| Rate for Payer: BCN Medicare Advantage |
$16,871.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,871.50
|
| Rate for Payer: Mclaren Medicare |
$16,871.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,715.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,402.22
|
| Rate for Payer: PACE Medicare |
$16,027.92
|
| Rate for Payer: PACE SWMI |
$16,871.50
|
| Rate for Payer: PHP Medicare Advantage |
$16,871.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,463.45
|
| Rate for Payer: Priority Health Medicare |
$16,871.50
|
| Rate for Payer: Priority Health Narrow Network |
$24,370.76
|
| Rate for Payer: Railroad Medicare Medicare |
$16,871.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,382.72
|
| Rate for Payer: UHC Core |
$26,553.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,871.50
|
| Rate for Payer: UHC Exchange |
$21,110.12
|
| Rate for Payer: UHC Medicare Advantage |
$17,377.64
|
| Rate for Payer: VA VA |
$16,871.50
|
|
|
TESTES PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,686.06
|
|
|
Service Code
|
MS-DRG 712
|
| Min. Negotiated Rate |
$9,186.70 |
| Max. Negotiated Rate |
$19,686.06 |
| Rate for Payer: Aetna Medicare |
$10,057.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,087.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,087.76
|
| Rate for Payer: BCBS MAPPO |
$9,670.21
|
| Rate for Payer: BCBS Trust/PPO |
$19,686.06
|
| Rate for Payer: BCN Medicare Advantage |
$9,670.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,670.21
|
| Rate for Payer: Mclaren Medicare |
$9,670.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,153.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,120.74
|
| Rate for Payer: PACE Medicare |
$9,186.70
|
| Rate for Payer: PACE SWMI |
$9,670.21
|
| Rate for Payer: PHP Medicare Advantage |
$9,670.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,053.44
|
| Rate for Payer: Priority Health Medicare |
$9,670.21
|
| Rate for Payer: Priority Health Narrow Network |
$13,642.75
|
| Rate for Payer: Railroad Medicare Medicare |
$9,670.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,127.85
|
| Rate for Payer: UHC Core |
$14,864.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,670.21
|
| Rate for Payer: UHC Exchange |
$11,817.45
|
| Rate for Payer: UHC Medicare Advantage |
$9,960.32
|
| Rate for Payer: VA VA |
$9,670.21
|
|
|
TESTOSTERONE 1 % (25 MG/2.5 GRAM) TRANSDERMAL GEL PACKET
|
Facility
|
IP
|
$64.11
|
|
|
Service Code
|
NDC 0051-8425-30
|
| Hospital Charge Code |
109728
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$57.70 |
| Rate for Payer: Aetna American Axle |
$41.67
|
| Rate for Payer: Aetna Commercial |
$54.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.67
|
| Rate for Payer: Cash Price |
$51.29
|
| Rate for Payer: Cofinity Commercial |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$55.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.29
|
| Rate for Payer: Healthscope Commercial |
$57.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.49
|
| Rate for Payer: PHP Commercial |
$54.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.88
|
| Rate for Payer: Priority Health SBD |
$40.39
|
| Rate for Payer: UMR Bronson Commercial |
$28.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.08
|
|
|
TESTOSTERONE 1 % (50 MG/5 GRAM) TRANSDERMAL GEL PACKET
|
Facility
|
IP
|
$65.89
|
|
|
Service Code
|
NDC 0051-8450-30
|
| Hospital Charge Code |
36093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna American Axle |
$42.83
|
| Rate for Payer: Aetna Commercial |
$56.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.83
|
| Rate for Payer: Cash Price |
$52.71
|
| Rate for Payer: Cofinity Commercial |
$46.12
|
| Rate for Payer: Cofinity Commercial |
$56.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.71
|
| Rate for Payer: Healthscope Commercial |
$59.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.01
|
| Rate for Payer: PHP Commercial |
$56.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.12
|
| Rate for Payer: Priority Health SBD |
$41.51
|
| Rate for Payer: UMR Bronson Commercial |
$28.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.42
|
|
