|
TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,985.55
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
192875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$9,887.00 |
| Rate for Payer: Aetna American Axle |
$7,140.61
|
| Rate for Payer: Aetna Commercial |
$9,337.72
|
| Rate for Payer: Aetna Medicare |
$17.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,140.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.46
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$16.37
|
| Rate for Payer: BCBS Trust/PPO |
$35.24
|
| Rate for Payer: BCN Medicare Advantage |
$16.37
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cofinity Commercial |
$9,447.57
|
| Rate for Payer: Cofinity Commercial |
$7,689.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,788.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.37
|
| Rate for Payer: Healthscope Commercial |
$9,887.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,689.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,239.16
|
| Rate for Payer: Mclaren Medicaid |
$8.95
|
| Rate for Payer: Mclaren Medicare |
$16.37
|
| Rate for Payer: Meridian Medicaid |
$9.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,337.72
|
| Rate for Payer: PACE Medicare |
$15.55
|
| Rate for Payer: PACE SWMI |
$16.37
|
| Rate for Payer: PHP Commercial |
$9,337.72
|
| Rate for Payer: PHP Medicare Advantage |
$16.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,689.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.64
|
| Rate for Payer: Priority Health Medicare |
$16.37
|
| Rate for Payer: Priority Health Narrow Network |
$46.11
|
| Rate for Payer: Priority Health SBD |
$6,920.90
|
| Rate for Payer: Railroad Medicare Medicare |
$16.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.37
|
| Rate for Payer: UHC Medicare Advantage |
$16.86
|
| Rate for Payer: UMR Bronson Commercial |
$4,064.65
|
| Rate for Payer: VA VA |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,239.16
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$22,797.10
|
|
|
Service Code
|
MS-DRG 913
|
| Min. Negotiated Rate |
$11,427.57 |
| Max. Negotiated Rate |
$22,797.10 |
| Rate for Payer: Aetna Medicare |
$12,510.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,036.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,036.28
|
| Rate for Payer: BCBS MAPPO |
$12,029.02
|
| Rate for Payer: BCBS Trust/PPO |
$22,294.45
|
| Rate for Payer: BCN Medicare Advantage |
$12,029.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,029.02
|
| Rate for Payer: Mclaren Medicare |
$12,029.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,630.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,833.37
|
| Rate for Payer: PACE Medicare |
$11,427.57
|
| Rate for Payer: PACE SWMI |
$12,029.02
|
| Rate for Payer: PHP Medicare Advantage |
$12,029.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,445.96
|
| Rate for Payer: Priority Health Medicare |
$12,029.02
|
| Rate for Payer: Priority Health Narrow Network |
$17,156.77
|
| Rate for Payer: Railroad Medicare Medicare |
$12,029.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,797.10
|
| Rate for Payer: UHC Core |
$18,693.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,029.02
|
| Rate for Payer: UHC Exchange |
$14,861.31
|
| Rate for Payer: UHC Medicare Advantage |
$12,389.89
|
| Rate for Payer: VA VA |
$12,029.02
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$17,776.25
|
|
|
Service Code
|
MS-DRG 914
|
| Min. Negotiated Rate |
$7,131.75 |
| Max. Negotiated Rate |
$17,776.25 |
| Rate for Payer: Aetna Medicare |
$7,807.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,383.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,383.89
|
| Rate for Payer: BCBS MAPPO |
$7,507.11
|
| Rate for Payer: BCBS Trust/PPO |
$17,776.25
|
| Rate for Payer: BCN Medicare Advantage |
$7,507.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,507.11
|
| Rate for Payer: Mclaren Medicare |
$7,507.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,882.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,633.18
|
| Rate for Payer: PACE Medicare |
$7,131.75
|
| Rate for Payer: PACE SWMI |
$7,507.11
|
| Rate for Payer: PHP Medicare Advantage |
$7,507.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,025.42
|
| Rate for Payer: Priority Health Medicare |
$7,507.11
|
| Rate for Payer: Priority Health Narrow Network |
$10,420.34
|
| Rate for Payer: Railroad Medicare Medicare |
$7,507.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,846.06
|
| Rate for Payer: UHC Core |
$11,353.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,507.11
|
| Rate for Payer: UHC Exchange |
$9,026.17
|
| Rate for Payer: UHC Medicare Advantage |
$7,732.32
|
| Rate for Payer: VA VA |
$7,507.11
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
|
IP
|
$21,987.88
|
|
|
Service Code
|
MS-DRG 086
|
| Min. Negotiated Rate |
$10,128.87 |
| Max. Negotiated Rate |
$21,987.88 |
| Rate for Payer: Aetna Medicare |
$11,088.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,327.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,327.46
|
| Rate for Payer: BCBS MAPPO |
$10,661.97
|
| Rate for Payer: BCBS Trust/PPO |
$21,987.88
|
| Rate for Payer: BCN Medicare Advantage |
$10,661.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,661.97
|
| Rate for Payer: Mclaren Medicare |
$10,661.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,195.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,261.27
|
| Rate for Payer: PACE Medicare |
$10,128.87
|
| Rate for Payer: PACE SWMI |
$10,661.97
|
| Rate for Payer: PHP Medicare Advantage |
$10,661.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,900.28
|
| Rate for Payer: Priority Health Medicare |
$10,661.97
|
| Rate for Payer: Priority Health Narrow Network |
$15,120.22
|
| Rate for Payer: Railroad Medicare Medicare |
$10,661.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,091.04
|
| Rate for Payer: UHC Core |
$16,474.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,661.97
|
| Rate for Payer: UHC Exchange |
$13,097.24
|
| Rate for Payer: UHC Medicare Advantage |
$10,981.83
|
| Rate for Payer: VA VA |
$10,661.97
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
|
IP
|
$27,199.63
|
|
|
Service Code
|
MS-DRG 083
|
| Min. Negotiated Rate |
$10,416.57 |
| Max. Negotiated Rate |
$27,199.63 |
| Rate for Payer: Aetna Medicare |
$11,403.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,706.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,706.01
|
| Rate for Payer: BCBS MAPPO |
$10,964.81
|
| Rate for Payer: BCBS Trust/PPO |
$27,199.63
|
| Rate for Payer: BCN Medicare Advantage |
$10,964.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,964.81
|
| Rate for Payer: Mclaren Medicare |
$10,964.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,513.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,609.53
|
| Rate for Payer: PACE Medicare |
$10,416.57
|
| Rate for Payer: PACE SWMI |
$10,964.81
|
| Rate for Payer: PHP Medicare Advantage |
$10,964.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,464.23
|
| Rate for Payer: Priority Health Medicare |
$10,964.81
|
| Rate for Payer: Priority Health Narrow Network |
$15,571.38
|
| Rate for Payer: Railroad Medicare Medicare |
$10,964.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,690.53
|
| Rate for Payer: UHC Core |
$16,965.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,964.81
|
| Rate for Payer: UHC Exchange |
$13,488.04
|
| Rate for Payer: UHC Medicare Advantage |
$11,293.75
|
| Rate for Payer: VA VA |
$10,964.81
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
|
IP
|
$41,219.10
|
|
|
Service Code
|
MS-DRG 085
|
| Min. Negotiated Rate |
$17,125.31 |
| Max. Negotiated Rate |
$41,219.10 |
| Rate for Payer: Aetna Medicare |
$18,747.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,533.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,533.30
|
| Rate for Payer: BCBS MAPPO |
$18,026.64
|
| Rate for Payer: BCBS Trust/PPO |
$41,219.10
|
| Rate for Payer: BCN Medicare Advantage |
$18,026.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,026.64
|
| Rate for Payer: Mclaren Medicare |
$18,026.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,927.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,730.64
|
| Rate for Payer: PACE Medicare |
$17,125.31
|
| Rate for Payer: PACE SWMI |
$18,026.64
|
| Rate for Payer: PHP Medicare Advantage |
$18,026.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,614.50
|
| Rate for Payer: Priority Health Medicare |
$18,026.64
|
| Rate for Payer: Priority Health Narrow Network |
$26,091.60
|
| Rate for Payer: Railroad Medicare Medicare |
$18,026.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,669.29
|
| Rate for Payer: UHC Core |
$28,428.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,026.64
|
| Rate for Payer: UHC Exchange |
$22,600.72
|
| Rate for Payer: UHC Medicare Advantage |
$18,567.44
|
| Rate for Payer: VA VA |
$18,026.64
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
|
IP
|
$50,222.82
|
|
|
Service Code
|
MS-DRG 082
|
| Min. Negotiated Rate |
$17,165.56 |
| Max. Negotiated Rate |
$50,222.82 |
| Rate for Payer: Aetna Medicare |
$18,791.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,586.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,586.26
|
| Rate for Payer: BCBS MAPPO |
$18,069.01
|
| Rate for Payer: BCBS Trust/PPO |
$50,222.82
|
| Rate for Payer: BCN Medicare Advantage |
$18,069.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,069.01
|
| Rate for Payer: Mclaren Medicare |
$18,069.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,972.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,779.36
|
| Rate for Payer: PACE Medicare |
$17,165.56
|
| Rate for Payer: PACE SWMI |
$18,069.01
|
| Rate for Payer: PHP Medicare Advantage |
$18,069.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,693.42
|
| Rate for Payer: Priority Health Medicare |
$18,069.01
|
| Rate for Payer: Priority Health Narrow Network |
$26,154.74
|
| Rate for Payer: Railroad Medicare Medicare |
$18,069.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,753.19
|
| Rate for Payer: UHC Core |
$28,496.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,069.01
|
| Rate for Payer: UHC Exchange |
$22,655.42
|
| Rate for Payer: UHC Medicare Advantage |
$18,611.08
|
| Rate for Payer: VA VA |
$18,069.01
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$15,331.20
|
|
|
Service Code
|
MS-DRG 087
|
| Min. Negotiated Rate |
$6,974.36 |
| Max. Negotiated Rate |
$15,331.20 |
| Rate for Payer: Aetna Medicare |
$7,635.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,176.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,176.79
|
| Rate for Payer: BCBS MAPPO |
$7,341.43
|
| Rate for Payer: BCBS Trust/PPO |
$15,331.20
|
| Rate for Payer: BCN Medicare Advantage |
$7,341.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,341.43
|
| Rate for Payer: Mclaren Medicare |
$7,341.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,708.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,442.64
|
| Rate for Payer: PACE Medicare |
$6,974.36
|
| Rate for Payer: PACE SWMI |
$7,341.43
|
| Rate for Payer: PHP Medicare Advantage |
$7,341.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,716.90
|
| Rate for Payer: Priority Health Medicare |
$7,341.43
|
| Rate for Payer: Priority Health Narrow Network |
$10,173.52
|
| Rate for Payer: Railroad Medicare Medicare |
$7,341.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,518.09
|
| Rate for Payer: UHC Core |
$11,084.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,341.43
|
| Rate for Payer: UHC Exchange |
$8,812.37
|
| Rate for Payer: UHC Medicare Advantage |
$7,561.67
|
| Rate for Payer: VA VA |
$7,341.43
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$17,419.42
|
|
|
Service Code
|
MS-DRG 084
|
| Min. Negotiated Rate |
$7,219.61 |
| Max. Negotiated Rate |
$17,419.42 |
| Rate for Payer: Aetna Medicare |
$7,903.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,499.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,499.49
|
| Rate for Payer: BCBS MAPPO |
$7,599.59
|
| Rate for Payer: BCBS Trust/PPO |
$17,419.42
|
| Rate for Payer: BCN Medicare Advantage |
$7,599.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,599.59
|
| Rate for Payer: Mclaren Medicare |
$7,599.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,979.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,739.53
|
| Rate for Payer: PACE Medicare |
$7,219.61
|
| Rate for Payer: PACE SWMI |
$7,599.59
|
| Rate for Payer: PHP Medicare Advantage |
$7,599.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,197.62
|
| Rate for Payer: Priority Health Medicare |
$7,599.59
|
| Rate for Payer: Priority Health Narrow Network |
$10,558.10
|
| Rate for Payer: Railroad Medicare Medicare |
$7,599.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,029.10
|
| Rate for Payer: UHC Core |
$11,503.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,599.59
|
| Rate for Payer: UHC Exchange |
$9,145.50
|
| Rate for Payer: UHC Medicare Advantage |
$7,827.58
|
| Rate for Payer: VA VA |
$7,599.59
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
|
IP
|
$22,975.57
|
|
|
Service Code
|
MS-DRG 604
|
| Min. Negotiated Rate |
$11,513.23 |
| Max. Negotiated Rate |
$22,975.57 |
| Rate for Payer: Aetna Medicare |
$12,603.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,148.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,148.99
|
| Rate for Payer: BCBS MAPPO |
$12,119.19
|
| Rate for Payer: BCBS Trust/PPO |
$16,539.91
|
| Rate for Payer: BCN Medicare Advantage |
$12,119.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,119.19
|
| Rate for Payer: Mclaren Medicare |
$12,119.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,725.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,937.07
|
| Rate for Payer: PACE Medicare |
$11,513.23
|
| Rate for Payer: PACE SWMI |
$12,119.19
|
| Rate for Payer: PHP Medicare Advantage |
$12,119.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,613.85
|
| Rate for Payer: Priority Health Medicare |
$12,119.19
|
| Rate for Payer: Priority Health Narrow Network |
$17,291.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12,119.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,975.57
|
| Rate for Payer: UHC Core |
$18,839.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,119.19
|
| Rate for Payer: UHC Exchange |
$14,977.65
|
| Rate for Payer: UHC Medicare Advantage |
$12,482.77
|
| Rate for Payer: VA VA |
$12,119.19
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
|
IP
|
$14,245.63
|
|
|
Service Code
|
MS-DRG 605
|
| Min. Negotiated Rate |
$7,139.82 |
| Max. Negotiated Rate |
$14,245.63 |
| Rate for Payer: Aetna Medicare |
$7,816.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,394.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,394.50
|
| Rate for Payer: BCBS MAPPO |
$7,515.60
|
| Rate for Payer: BCBS Trust/PPO |
$14,245.63
|
| Rate for Payer: BCN Medicare Advantage |
$7,515.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,515.60
|
| Rate for Payer: Mclaren Medicare |
$7,515.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,891.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,642.94
|
| Rate for Payer: PACE Medicare |
$7,139.82
|
| Rate for Payer: PACE SWMI |
$7,515.60
|
| Rate for Payer: PHP Medicare Advantage |
$7,515.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,041.21
|
| Rate for Payer: Priority Health Medicare |
$7,515.60
|
| Rate for Payer: Priority Health Narrow Network |
$10,432.97
|
| Rate for Payer: Railroad Medicare Medicare |
$7,515.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,862.84
|
| Rate for Payer: UHC Core |
$11,367.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,515.60
|
| Rate for Payer: UHC Exchange |
$9,037.11
|
| Rate for Payer: UHC Medicare Advantage |
$7,741.07
|
| Rate for Payer: VA VA |
$7,515.60
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
IP
|
$635.53
|
|
|
Service Code
|
NDC 0065-0260-25
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.63 |
| Max. Negotiated Rate |
$571.98 |
| Rate for Payer: Aetna American Axle |
$413.09
|
| Rate for Payer: Aetna Commercial |
$540.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.09
|
| Rate for Payer: Cash Price |
$508.42
|
| Rate for Payer: Cofinity Commercial |
$444.87
|
| Rate for Payer: Cofinity Commercial |
$546.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.42
|
| Rate for Payer: Healthscope Commercial |
$571.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$444.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$540.20
|
| Rate for Payer: PHP Commercial |
$540.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.87
|
| Rate for Payer: Priority Health SBD |
$400.38
|
| Rate for Payer: UMR Bronson Commercial |
$279.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.65
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
IP
|
$538.65
|
|
|
Service Code
|
NDC 0781-6185-56
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.01 |
| Max. Negotiated Rate |
$484.78 |
| Rate for Payer: Aetna American Axle |
$350.12
|
| Rate for Payer: Aetna Commercial |
$457.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.12
|
| Rate for Payer: Cash Price |
$430.92
|
| Rate for Payer: Cofinity Commercial |
$377.06
|
| Rate for Payer: Cofinity Commercial |
$463.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.92
|
| Rate for Payer: Healthscope Commercial |
$484.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$377.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$457.85
|
| Rate for Payer: PHP Commercial |
$457.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.06
|
| Rate for Payer: Priority Health SBD |
$339.35
|
| Rate for Payer: UMR Bronson Commercial |
$237.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.99
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
IP
|
$144.24
|
|
|
Service Code
|
NDC 42571-130-27
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$129.82 |
| Rate for Payer: Aetna American Axle |
$93.76
|
| Rate for Payer: Aetna Commercial |
$122.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.76
|
| Rate for Payer: Cash Price |
$115.39
|
| Rate for Payer: Cofinity Commercial |
$100.97
|
| Rate for Payer: Cofinity Commercial |
$124.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.39
|
| Rate for Payer: Healthscope Commercial |
$129.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PHP Commercial |
$122.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.97
|
| Rate for Payer: Priority Health SBD |
$90.87
|
| Rate for Payer: UMR Bronson Commercial |
$63.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.18
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
IP
|
$409.36
|
|
|
Service Code
|
NDC 60505-0593-4
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.12 |
| Max. Negotiated Rate |
$368.42 |
| Rate for Payer: Aetna American Axle |
$266.08
|
| Rate for Payer: Aetna Commercial |
$347.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.08
|
| Rate for Payer: Cash Price |
$327.49
|
| Rate for Payer: Cofinity Commercial |
$286.55
|
| Rate for Payer: Cofinity Commercial |
$352.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.49
|
| Rate for Payer: Healthscope Commercial |
$368.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.96
|
| Rate for Payer: PHP Commercial |
$347.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.55
|
| Rate for Payer: Priority Health SBD |
$257.90
|
| Rate for Payer: UMR Bronson Commercial |
$180.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.02
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 50111-450-01
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.07 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna American Axle |
$227.60
|
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.63
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.10
|
| Rate for Payer: Priority Health SBD |
$220.59
|
| Rate for Payer: UMR Bronson Commercial |
$154.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$299.25
|
|
|
Service Code
|
NDC 0904-7212-61
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna American Axle |
$194.51
|
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.51
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$209.48
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.36
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.48
|
| Rate for Payer: Priority Health SBD |
$188.53
|
| Rate for Payer: UMR Bronson Commercial |
$131.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.44
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$3.55
|
|
|
Service Code
|
NDC 68084-608-11
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna American Axle |
$2.31
|
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: Priority Health SBD |
$2.24
|
| Rate for Payer: UMR Bronson Commercial |
$1.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.66
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$354.35
|
|
|
Service Code
|
NDC 68084-608-01
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.91 |
| Max. Negotiated Rate |
$318.92 |
| Rate for Payer: Aetna American Axle |
$230.33
|
| Rate for Payer: Aetna Commercial |
$301.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.33
|
| Rate for Payer: Cash Price |
$283.48
|
| Rate for Payer: Cofinity Commercial |
$248.04
|
| Rate for Payer: Cofinity Commercial |
$304.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.48
|
| Rate for Payer: Healthscope Commercial |
$318.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$301.20
|
| Rate for Payer: PHP Commercial |
$301.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.04
|
| Rate for Payer: Priority Health SBD |
$223.24
|
| Rate for Payer: UMR Bronson Commercial |
$155.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.76
|
|
|
TRAZODONE 25 MG CUSTOM TAB
|
Facility
|
IP
|
$0.92
|
|
|
Service Code
|
NDC 9900-0003-14
|
| Hospital Charge Code |
155125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Aetna American Axle |
$0.60
|
| Rate for Payer: Aetna Commercial |
$0.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.60
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.64
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.78
|
| Rate for Payer: PHP Commercial |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.64
|
| Rate for Payer: Priority Health SBD |
$0.58
|
| Rate for Payer: UMR Bronson Commercial |
$0.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.69
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$242.05
|
|
|
Service Code
|
NDC 0904-6868-61
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna American Axle |
$157.33
|
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.33
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$169.44
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.74
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.44
|
| Rate for Payer: Priority Health SBD |
$152.49
|
| Rate for Payer: UMR Bronson Commercial |
$106.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.54
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 60687-443-01
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna American Axle |
$169.55
|
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$182.60
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.72
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: Priority Health SBD |
$164.34
|
| Rate for Payer: UMR Bronson Commercial |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 60687-443-11
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna American Axle |
$1.70
|
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.22
|
| Rate for Payer: PHP Commercial |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.96
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 50111-560-01
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.73 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Cofinity Commercial |
$83.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.87
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.90
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$52.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$145.70
|
|
|
Service Code
|
NDC 13668-330-01
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna American Axle |
$94.70
|
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Commercial |
$101.99
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.84
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.99
|
| Rate for Payer: Priority Health SBD |
$91.79
|
| Rate for Payer: UMR Bronson Commercial |
$64.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.28
|
|
