|
THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID; CERVICAL APPROACH
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 60271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,037.66 |
| 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 |
$7,432.00
|
| 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) |
$1,141.43
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,037.66
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
THYROIDECTOMY, REMOVAL OF ALL REMAINING THYROID TISSUE FOLLOWING PREVIOUS REMOVAL OF A PORTION OF THYROID
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 60260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,070.41 |
| 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 |
$5,882.22
|
| 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) |
$1,177.45
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,070.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
THYROIDECTOMY, TOTAL OR COMPLETE
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 60240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$903.41 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$7,014.23
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$993.75
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$903.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH LIMITED NECK DISSECTION
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 60252
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,297.98 |
| 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 |
$8,234.88
|
| 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) |
$1,427.78
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,297.98
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH RADICAL NECK DISSECTION
|
Facility
|
OP
|
$5,788.44
|
|
|
Service Code
|
CPT 60254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,637.54 |
| Max. Negotiated Rate |
$5,788.44 |
| Rate for Payer: BCBS Trust/PPO |
$5,788.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,801.29
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Exchange |
$1,637.54
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC
|
Facility
|
IP
|
$33,562.29
|
|
|
Service Code
|
MS-DRG 626
|
| Min. Negotiated Rate |
$11,408.54 |
| Max. Negotiated Rate |
$33,562.29 |
| Rate for Payer: Aetna Medicare |
$12,489.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,011.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,011.24
|
| Rate for Payer: BCBS MAPPO |
$12,008.99
|
| Rate for Payer: BCBS Trust/PPO |
$33,562.29
|
| Rate for Payer: BCN Medicare Advantage |
$12,008.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,008.99
|
| Rate for Payer: Mclaren Medicare |
$12,008.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,609.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,810.34
|
| Rate for Payer: PACE Medicare |
$11,408.54
|
| Rate for Payer: PACE SWMI |
$12,008.99
|
| Rate for Payer: PHP Medicare Advantage |
$12,008.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,408.65
|
| Rate for Payer: Priority Health Medicare |
$12,008.99
|
| Rate for Payer: Priority Health Narrow Network |
$17,126.92
|
| Rate for Payer: Railroad Medicare Medicare |
$12,008.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,757.44
|
| Rate for Payer: UHC Core |
$18,660.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,008.99
|
| Rate for Payer: UHC Exchange |
$14,835.45
|
| Rate for Payer: UHC Medicare Advantage |
$12,369.26
|
| Rate for Payer: VA VA |
$12,008.99
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$45,212.10
|
|
|
Service Code
|
MS-DRG 625
|
| Min. Negotiated Rate |
$21,872.06 |
| Max. Negotiated Rate |
$45,212.10 |
| Rate for Payer: Aetna Medicare |
$23,944.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,779.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,779.02
|
| Rate for Payer: BCBS MAPPO |
$23,023.22
|
| Rate for Payer: BCBS Trust/PPO |
$45,212.10
|
| Rate for Payer: BCN Medicare Advantage |
$23,023.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,023.22
|
| Rate for Payer: Mclaren Medicare |
$23,023.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,174.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,476.70
|
| Rate for Payer: PACE Medicare |
$21,872.06
|
| Rate for Payer: PACE SWMI |
$23,023.22
|
| Rate for Payer: PHP Medicare Advantage |
$23,023.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,918.99
|
| Rate for Payer: Priority Health Medicare |
$23,023.22
|
| Rate for Payer: Priority Health Narrow Network |
$33,535.19
|
| Rate for Payer: Railroad Medicare Medicare |
$23,023.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,559.98
|
| Rate for Payer: UHC Core |
$36,538.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,023.22
|
| Rate for Payer: UHC Exchange |
$29,048.41
|
| Rate for Payer: UHC Medicare Advantage |
$23,713.92
|
| Rate for Payer: VA VA |
$23,023.22
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$27,805.24
|
|
|
Service Code
|
MS-DRG 627
|
| Min. Negotiated Rate |
$9,535.16 |
| Max. Negotiated Rate |
$27,805.24 |
| Rate for Payer: Aetna Medicare |
$10,438.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,546.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,546.26
|
| Rate for Payer: BCBS MAPPO |
$10,037.01
|
| Rate for Payer: BCBS Trust/PPO |
$27,805.24
|
| Rate for Payer: BCN Medicare Advantage |
$10,037.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,037.01
|
| Rate for Payer: Mclaren Medicare |
$10,037.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,538.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,542.56
|
| Rate for Payer: PACE Medicare |
$9,535.16
|
| Rate for Payer: PACE SWMI |
$10,037.01
|
| Rate for Payer: PHP Medicare Advantage |
$10,037.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,736.50
|
| Rate for Payer: Priority Health Medicare |
$10,037.01
|
| Rate for Payer: Priority Health Narrow Network |
$14,189.20
|
| Rate for Payer: Railroad Medicare Medicare |
$10,037.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,853.94
|
| Rate for Payer: UHC Core |
$15,459.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,037.01
|
| Rate for Payer: UHC Exchange |
$12,290.78
|
| Rate for Payer: UHC Medicare Advantage |
$10,338.12
|
| Rate for Payer: VA VA |
$10,037.01
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
|
IP
|
$277.92
|
|
|
Service Code
|
NDC 62559-741-01
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.28 |
| Max. Negotiated Rate |
$250.13 |
| Rate for Payer: Aetna American Axle |
$180.65
|
| Rate for Payer: Aetna Commercial |
$236.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.65
|
| Rate for Payer: Cash Price |
$222.34
|
| Rate for Payer: Cofinity Commercial |
$194.54
|
| Rate for Payer: Cofinity Commercial |
$239.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.34
|
| Rate for Payer: Healthscope Commercial |
$250.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$236.23
|
| Rate for Payer: PHP Commercial |
$236.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.54
|
| Rate for Payer: Priority Health SBD |
$175.09
|
| Rate for Payer: UMR Bronson Commercial |
$122.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.44
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
|
IP
|
$429.60
|
|
|
Service Code
|
NDC 0456-0458-01
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.02 |
| Max. Negotiated Rate |
$386.64 |
| Rate for Payer: Aetna American Axle |
$279.24
|
| Rate for Payer: Aetna Commercial |
$365.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.24
|
| Rate for Payer: Cash Price |
$343.68
|
| Rate for Payer: Cofinity Commercial |
$300.72
|
| Rate for Payer: Cofinity Commercial |
$369.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.68
|
| Rate for Payer: Healthscope Commercial |
$386.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.16
|
| Rate for Payer: PHP Commercial |
$365.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.72
|
| Rate for Payer: Priority Health SBD |
$270.65
|
| Rate for Payer: UMR Bronson Commercial |
$189.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.20
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
|
IP
|
$307.20
|
|
|
Service Code
|
NDC 42192-329-01
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.17 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna American Axle |
$199.68
|
| Rate for Payer: Aetna Commercial |
$261.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.68
|
| Rate for Payer: Cash Price |
$245.76
|
| Rate for Payer: Cofinity Commercial |
$215.04
|
| Rate for Payer: Cofinity Commercial |
$264.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.76
|
| Rate for Payer: Healthscope Commercial |
$276.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.12
|
| Rate for Payer: PHP Commercial |
$261.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.04
|
| Rate for Payer: Priority Health SBD |
$193.54
|
| Rate for Payer: UMR Bronson Commercial |
$135.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.40
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
IP
|
$477.60
|
|
|
Service Code
|
NDC 0456-0459-01
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.14 |
| Max. Negotiated Rate |
$429.84 |
| Rate for Payer: Aetna American Axle |
$310.44
|
| Rate for Payer: Aetna Commercial |
$405.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.44
|
| Rate for Payer: Cash Price |
$382.08
|
| Rate for Payer: Cofinity Commercial |
$334.32
|
| Rate for Payer: Cofinity Commercial |
$410.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.08
|
| Rate for Payer: Healthscope Commercial |
$429.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$334.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$358.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.96
|
| Rate for Payer: PHP Commercial |
$405.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.32
|
| Rate for Payer: Priority Health SBD |
$300.89
|
| Rate for Payer: UMR Bronson Commercial |
$210.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$358.20
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
IP
|
$340.80
|
|
|
Service Code
|
NDC 42192-330-01
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.95 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: Aetna American Axle |
$221.52
|
| Rate for Payer: Aetna Commercial |
$289.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.52
|
| Rate for Payer: Cash Price |
$272.64
|
| Rate for Payer: Cofinity Commercial |
$293.09
|
| Rate for Payer: Cofinity Commercial |
$238.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.64
|
| Rate for Payer: Healthscope Commercial |
$306.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.68
|
| Rate for Payer: PHP Commercial |
$289.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.56
|
| Rate for Payer: Priority Health SBD |
$214.70
|
| Rate for Payer: UMR Bronson Commercial |
$149.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.60
|
|
|
THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$6,172.85
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
196901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,105.58 |
| Max. Negotiated Rate |
$6,531.48 |
| Rate for Payer: Aetna American Axle |
$4,012.35
|
| Rate for Payer: Aetna Commercial |
$5,246.92
|
| Rate for Payer: Aetna Medicare |
$2,102.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,012.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,526.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,526.46
|
| Rate for Payer: BCBS Complete |
$1,160.96
|
| Rate for Payer: BCBS MAPPO |
$2,021.17
|
| Rate for Payer: BCBS Trust/PPO |
$6,531.48
|
| Rate for Payer: BCN Medicare Advantage |
$2,021.17
|
| Rate for Payer: Cash Price |
$4,938.28
|
| Rate for Payer: Cash Price |
$4,938.28
|
| Rate for Payer: Cofinity Commercial |
$5,308.65
|
| Rate for Payer: Cofinity Commercial |
$4,321.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,938.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,021.17
|
| Rate for Payer: Healthscope Commercial |
$5,555.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,321.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,629.64
|
| Rate for Payer: Mclaren Medicaid |
$1,105.58
|
| Rate for Payer: Mclaren Medicare |
$2,021.17
|
| Rate for Payer: Meridian Medicaid |
$1,160.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,122.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,324.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,246.92
|
| Rate for Payer: PACE Medicare |
$1,920.11
|
| Rate for Payer: PACE SWMI |
$2,021.17
|
| Rate for Payer: PHP Commercial |
$5,246.92
|
| Rate for Payer: PHP Medicare Advantage |
$2,021.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,105.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,321.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,906.83
|
| Rate for Payer: Priority Health Medicare |
$2,021.17
|
| Rate for Payer: Priority Health Narrow Network |
$4,725.46
|
| Rate for Payer: Priority Health SBD |
$3,888.90
|
| Rate for Payer: Railroad Medicare Medicare |
$2,021.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,021.17
|
| Rate for Payer: UHC Medicare Advantage |
$2,081.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,283.95
|
| Rate for Payer: VA VA |
$2,021.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,629.64
|
|
|
THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$6,172.85
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
196901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,716.05 |
| Max. Negotiated Rate |
$5,555.56 |
| Rate for Payer: Aetna American Axle |
$4,012.35
|
| Rate for Payer: Aetna Commercial |
$5,246.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,012.35
|
| Rate for Payer: Cash Price |
$4,938.28
|
| Rate for Payer: Cofinity Commercial |
$5,308.65
|
| Rate for Payer: Cofinity Commercial |
$4,321.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,938.28
|
| Rate for Payer: Healthscope Commercial |
$5,555.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,321.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,629.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,246.92
|
| Rate for Payer: PHP Commercial |
$5,246.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,321.00
|
| Rate for Payer: Priority Health SBD |
$3,888.90
|
| Rate for Payer: UMR Bronson Commercial |
$2,716.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,629.64
|
|
|
TIAGABINE 4 MG TABLET
|
Facility
|
IP
|
$655.24
|
|
|
Service Code
|
NDC 0093-5031-56
|
| Hospital Charge Code |
21827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.31 |
| Max. Negotiated Rate |
$589.72 |
| Rate for Payer: Aetna American Axle |
$425.91
|
| Rate for Payer: Aetna Commercial |
$556.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.91
|
| Rate for Payer: Cash Price |
$524.19
|
| Rate for Payer: Cofinity Commercial |
$563.51
|
| Rate for Payer: Cofinity Commercial |
$458.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.19
|
| Rate for Payer: Healthscope Commercial |
$589.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$458.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$491.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$556.95
|
| Rate for Payer: PHP Commercial |
$556.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.67
|
| Rate for Payer: Priority Health SBD |
$412.80
|
| Rate for Payer: UMR Bronson Commercial |
$288.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$491.43
|
|
|
TIAGABINE 4 MG TABLET
|
Facility
|
IP
|
$1,229.44
|
|
|
Service Code
|
NDC 63459-404-30
|
| Hospital Charge Code |
21827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$540.95 |
| Max. Negotiated Rate |
$1,106.50 |
| Rate for Payer: Aetna American Axle |
$799.14
|
| Rate for Payer: Aetna Commercial |
$1,045.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$799.14
|
| Rate for Payer: Cash Price |
$983.55
|
| Rate for Payer: Cofinity Commercial |
$1,057.32
|
| Rate for Payer: Cofinity Commercial |
$860.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$983.55
|
| Rate for Payer: Healthscope Commercial |
$1,106.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$860.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$922.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,045.02
|
| Rate for Payer: PHP Commercial |
$1,045.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$860.61
|
| Rate for Payer: Priority Health SBD |
$774.55
|
| Rate for Payer: UMR Bronson Commercial |
$540.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$922.08
|
|
|
TIAGABINE 4 MG TABLET
|
Facility
|
IP
|
$655.24
|
|
|
Service Code
|
NDC 62756-224-83
|
| Hospital Charge Code |
21827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.31 |
| Max. Negotiated Rate |
$589.72 |
| Rate for Payer: Aetna American Axle |
$425.91
|
| Rate for Payer: Aetna Commercial |
$556.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.91
|
| Rate for Payer: Cash Price |
$524.19
|
| Rate for Payer: Cofinity Commercial |
$458.67
|
| Rate for Payer: Cofinity Commercial |
$563.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.19
|
| Rate for Payer: Healthscope Commercial |
$589.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$458.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$491.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$556.95
|
| Rate for Payer: PHP Commercial |
$556.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.67
|
| Rate for Payer: Priority Health SBD |
$412.80
|
| Rate for Payer: UMR Bronson Commercial |
$288.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$491.43
|
|
|
TICAGRELOR 60 MG TABLET
|
Facility
|
IP
|
$1,544.90
|
|
|
Service Code
|
NDC 0186-0776-60
|
| Hospital Charge Code |
175597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$679.76 |
| Max. Negotiated Rate |
$1,390.41 |
| Rate for Payer: Aetna American Axle |
$1,004.18
|
| Rate for Payer: Aetna Commercial |
$1,313.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.18
|
| Rate for Payer: Cash Price |
$1,235.92
|
| Rate for Payer: Cofinity Commercial |
$1,081.43
|
| Rate for Payer: Cofinity Commercial |
$1,328.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,235.92
|
| Rate for Payer: Healthscope Commercial |
$1,390.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,081.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,158.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,313.16
|
| Rate for Payer: PHP Commercial |
$1,313.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.43
|
| Rate for Payer: Priority Health SBD |
$973.29
|
| Rate for Payer: UMR Bronson Commercial |
$679.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,158.68
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$2,574.83
|
|
|
Service Code
|
NDC 0186-0777-39
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,132.93 |
| Max. Negotiated Rate |
$2,317.35 |
| Rate for Payer: Aetna American Axle |
$1,673.64
|
| Rate for Payer: Aetna Commercial |
$2,188.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,673.64
|
| Rate for Payer: Cash Price |
$2,059.86
|
| Rate for Payer: Cofinity Commercial |
$1,802.38
|
| Rate for Payer: Cofinity Commercial |
$2,214.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,059.86
|
| Rate for Payer: Healthscope Commercial |
$2,317.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,802.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,931.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,188.61
|
| Rate for Payer: PHP Commercial |
$2,188.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,802.38
|
| Rate for Payer: Priority Health SBD |
$1,622.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,132.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,931.12
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$1,544.90
|
|
|
Service Code
|
NDC 0186-0777-60
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$679.76 |
| Max. Negotiated Rate |
$1,390.41 |
| Rate for Payer: Aetna American Axle |
$1,004.18
|
| Rate for Payer: Aetna Commercial |
$1,313.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.18
|
| Rate for Payer: Cash Price |
$1,235.92
|
| Rate for Payer: Cofinity Commercial |
$1,081.43
|
| Rate for Payer: Cofinity Commercial |
$1,328.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,235.92
|
| Rate for Payer: Healthscope Commercial |
$1,390.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,081.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,158.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,313.16
|
| Rate for Payer: PHP Commercial |
$1,313.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.43
|
| Rate for Payer: Priority Health SBD |
$973.29
|
| Rate for Payer: UMR Bronson Commercial |
$679.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,158.68
|
|
|
TIGECYCLINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$95.68
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
41652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.10 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna American Axle |
$62.19
|
| Rate for Payer: Aetna Commercial |
$81.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.19
|
| Rate for Payer: Cash Price |
$76.54
|
| Rate for Payer: Cofinity Commercial |
$66.98
|
| Rate for Payer: Cofinity Commercial |
$82.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.54
|
| Rate for Payer: Healthscope Commercial |
$86.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.33
|
| Rate for Payer: PHP Commercial |
$81.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.98
|
| Rate for Payer: Priority Health SBD |
$60.28
|
| Rate for Payer: UMR Bronson Commercial |
$42.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.76
|
|
|
TILDRAKIZUMAB-ASMN 100 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$34,845.28
|
|
|
Service Code
|
HCPCS J3245
|
| Hospital Charge Code |
188045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.94 |
| Max. Negotiated Rate |
$31,360.75 |
| Rate for Payer: Aetna American Axle |
$22,649.43
|
| Rate for Payer: Aetna Commercial |
$29,618.49
|
| Rate for Payer: Aetna Medicare |
$146.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,649.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.82
|
| Rate for Payer: BCBS Complete |
$80.79
|
| Rate for Payer: BCBS MAPPO |
$140.66
|
| Rate for Payer: BCBS Trust/PPO |
$454.50
|
| Rate for Payer: BCN Medicare Advantage |
$140.66
|
| Rate for Payer: Cash Price |
$27,876.22
|
| Rate for Payer: Cash Price |
$27,876.22
|
| Rate for Payer: Cofinity Commercial |
$24,391.70
|
| Rate for Payer: Cofinity Commercial |
$29,966.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,876.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.66
|
| Rate for Payer: Healthscope Commercial |
$31,360.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24,391.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26,133.96
|
| Rate for Payer: Mclaren Medicaid |
$76.94
|
| Rate for Payer: Mclaren Medicare |
$140.66
|
| Rate for Payer: Meridian Medicaid |
$80.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29,618.49
|
| Rate for Payer: PACE Medicare |
$133.62
|
| Rate for Payer: PACE SWMI |
$140.66
|
| Rate for Payer: PHP Commercial |
$29,618.49
|
| Rate for Payer: PHP Medicare Advantage |
$140.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,391.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$417.69
|
| Rate for Payer: Priority Health Medicare |
$140.66
|
| Rate for Payer: Priority Health Narrow Network |
$334.15
|
| Rate for Payer: Priority Health SBD |
$21,952.53
|
| Rate for Payer: Railroad Medicare Medicare |
$140.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.66
|
| Rate for Payer: UHC Medicare Advantage |
$144.87
|
| Rate for Payer: UMR Bronson Commercial |
$12,892.75
|
| Rate for Payer: VA VA |
$140.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26,133.96
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
IP
|
$21.78
|
|
|
Service Code
|
NDC 64980-513-05
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna American Axle |
$14.16
|
| Rate for Payer: Aetna Commercial |
$18.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.16
|
| Rate for Payer: Cash Price |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$15.25
|
| Rate for Payer: Cofinity Commercial |
$18.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.42
|
| Rate for Payer: Healthscope Commercial |
$19.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.51
|
| Rate for Payer: PHP Commercial |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.25
|
| Rate for Payer: Priority Health SBD |
$13.72
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.34
|
|
|
TIMOLOL MALEATE 0.25 % EYE DROPS
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 61314-226-05
|
| Hospital Charge Code |
11561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna American Axle |
$6.44
|
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.44
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$6.93
|
| Rate for Payer: Cofinity Commercial |
$8.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$8.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.42
|
| Rate for Payer: PHP Commercial |
$8.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.93
|
| Rate for Payer: Priority Health SBD |
$6.24
|
| Rate for Payer: UMR Bronson Commercial |
$4.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.42
|
|
