|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, DEEP CERVICAL NODE(S)
|
Facility
|
OP
|
$10,512.58
|
|
|
Service Code
|
CPT 38510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,001.76 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$7,137.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, INGUINOFEMORAL NODE(S)
|
Facility
|
OP
|
$10,512.58
|
|
|
Service Code
|
CPT 38531
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,001.76 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$7,137.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
BIOPSY OR EXCISION OF LYMPH NODE(S); OPEN, SUPERFICIAL
|
Facility
|
OP
|
$10,512.58
|
|
|
Service Code
|
CPT 38500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,001.76 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$7,137.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH
|
Facility
|
OP
|
$5,623.80
|
|
|
Service Code
|
CPT 55700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH
|
Facility
|
OP
|
$5,623.80
|
|
|
Service Code
|
CPT 55700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; DEEP (SUBFASCIAL OR INTRAMUSCULAR)
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 24066
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
BIOPSY, VESTIBULE OF MOUTH
|
Facility
|
OP
|
$1,398.05
|
|
|
Service Code
|
CPT 40808
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$266.21 |
| Max. Negotiated Rate |
$1,398.05 |
| Rate for Payer: Aetna Medicare |
$516.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$620.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$620.83
|
| Rate for Payer: BCBS Complete |
$279.52
|
| Rate for Payer: BCBS MAPPO |
$496.66
|
| Rate for Payer: BCN Medicare Advantage |
$496.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.66
|
| Rate for Payer: Mclaren Medicaid |
$266.21
|
| Rate for Payer: Mclaren Medicare |
$496.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.49
|
| Rate for Payer: Meridian Medicaid |
$279.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.16
|
| Rate for Payer: PACE Medicare |
$471.83
|
| Rate for Payer: PACE SWMI |
$496.66
|
| Rate for Payer: PHP Medicare Advantage |
$496.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.21
|
| Rate for Payer: Priority Health Medicare |
$496.66
|
| Rate for Payer: Railroad Medicare Medicare |
$496.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,398.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.66
|
| Rate for Payer: UHC Exchange |
$949.17
|
| Rate for Payer: UHC Medicare Advantage |
$496.66
|
| Rate for Payer: UHCCP Medicaid |
$266.21
|
| Rate for Payer: VA VA |
$496.66
|
|
|
BIOTIN 5 MG CAPSULE
|
Facility
|
IP
|
$124.08
|
|
|
Service Code
|
NDC 40985027116
|
| Hospital Charge Code |
9277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$111.67 |
| Rate for Payer: Aetna American Axle |
$80.65
|
| Rate for Payer: Aetna Commercial |
$105.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.65
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cofinity Commercial |
$106.71
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.26
|
| Rate for Payer: Healthscope Commercial |
$111.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.47
|
| Rate for Payer: PHP Commercial |
$105.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.65
|
| Rate for Payer: Priority Health SBD |
$78.17
|
| Rate for Payer: UMR Bronson Commercial |
$54.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.06
|
|
|
BIOTIN 5 MG CAPSULE
|
Facility
|
OP
|
$124.08
|
|
|
Service Code
|
NDC 40985027116
|
| Hospital Charge Code |
9277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.91 |
| Max. Negotiated Rate |
$111.67 |
| Rate for Payer: Aetna American Axle |
$80.65
|
| Rate for Payer: Aetna Commercial |
$105.47
|
| Rate for Payer: Aetna Medicare |
$62.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.65
|
| Rate for Payer: BCBS Complete |
$49.63
|
| Rate for Payer: Cash Price |
$99.26
|
| Rate for Payer: Cofinity Commercial |
$106.71
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.26
|
| Rate for Payer: Healthscope Commercial |
$111.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.47
|
| Rate for Payer: PHP Commercial |
$105.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.65
|
| Rate for Payer: Priority Health SBD |
$78.17
|
| Rate for Payer: UMR Bronson Commercial |
$45.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.06
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$36.38
|
|
|
Service Code
|
NDC 68784010212
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$32.74 |
| Rate for Payer: Aetna American Axle |
$23.65
|
| Rate for Payer: Aetna Commercial |
$30.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.65
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cofinity Commercial |
$25.47
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.10
|
| Rate for Payer: Healthscope Commercial |
$32.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.92
|
| Rate for Payer: PHP Commercial |
$30.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health SBD |
$22.92
|
| Rate for Payer: UMR Bronson Commercial |
$16.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.29
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$26.94
|
|
|
Service Code
|
NDC 81421002101
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Aetna American Axle |
$17.51
|
| Rate for Payer: Aetna Commercial |
$22.90
|
| Rate for Payer: Aetna Medicare |
$13.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.51
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Cofinity Commercial |
$18.86
|
| Rate for Payer: Cofinity Commercial |
$23.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.55
|
| Rate for Payer: Healthscope Commercial |
$24.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.90
|
| Rate for Payer: PHP Commercial |
$22.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.51
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: UMR Bronson Commercial |
$9.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$45.55
|
|
|
Service Code
|
NDC 81421002102
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$40.99 |
| Rate for Payer: Aetna American Axle |
$29.61
|
| Rate for Payer: Aetna Commercial |
$38.72
|
| Rate for Payer: Aetna Medicare |
$22.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.61
|
| Rate for Payer: BCBS Complete |
$18.22
|
| Rate for Payer: Cash Price |
$36.44
|
| Rate for Payer: Cofinity Commercial |
$31.89
|
| Rate for Payer: Cofinity Commercial |
$39.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.44
|
| Rate for Payer: Healthscope Commercial |
$40.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.72
|
| Rate for Payer: PHP Commercial |
$38.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.61
|
| Rate for Payer: Priority Health SBD |
$28.70
|
| Rate for Payer: UMR Bronson Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.16
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$191.53
|
|
|
Service Code
|
NDC 00574705050
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.87 |
| Max. Negotiated Rate |
$172.38 |
| Rate for Payer: Aetna American Axle |
$124.49
|
| Rate for Payer: Aetna Commercial |
$162.80
|
| Rate for Payer: Aetna Medicare |
$95.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.49
|
| Rate for Payer: BCBS Complete |
$76.61
|
| Rate for Payer: Cash Price |
$153.22
|
| Rate for Payer: Cofinity Commercial |
$134.07
|
| Rate for Payer: Cofinity Commercial |
$164.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.22
|
| Rate for Payer: Healthscope Commercial |
$172.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.80
|
| Rate for Payer: PHP Commercial |
$162.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.49
|
| Rate for Payer: Priority Health SBD |
$120.66
|
| Rate for Payer: UMR Bronson Commercial |
$70.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.65
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$38.42
|
|
|
Service Code
|
NDC 00904714212
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$34.58 |
| Rate for Payer: Aetna American Axle |
$24.97
|
| Rate for Payer: Aetna Commercial |
$32.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.97
|
| Rate for Payer: Cash Price |
$30.74
|
| Rate for Payer: Cofinity Commercial |
$26.89
|
| Rate for Payer: Cofinity Commercial |
$33.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.74
|
| Rate for Payer: Healthscope Commercial |
$34.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.66
|
| Rate for Payer: PHP Commercial |
$32.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.97
|
| Rate for Payer: Priority Health SBD |
$24.20
|
| Rate for Payer: UMR Bronson Commercial |
$16.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.82
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$45.55
|
|
|
Service Code
|
NDC 81421002102
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$40.99 |
| Rate for Payer: Aetna American Axle |
$29.61
|
| Rate for Payer: Aetna Commercial |
$38.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.61
|
| Rate for Payer: Cash Price |
$36.44
|
| Rate for Payer: Cofinity Commercial |
$31.89
|
| Rate for Payer: Cofinity Commercial |
$39.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.44
|
| Rate for Payer: Healthscope Commercial |
$40.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.72
|
| Rate for Payer: PHP Commercial |
$38.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.61
|
| Rate for Payer: Priority Health SBD |
$28.70
|
| Rate for Payer: UMR Bronson Commercial |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.16
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$58.83
|
|
|
Service Code
|
NDC 70000045102
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$52.95 |
| Rate for Payer: Aetna American Axle |
$38.24
|
| Rate for Payer: Aetna Commercial |
$50.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.24
|
| Rate for Payer: Cash Price |
$47.06
|
| Rate for Payer: Cofinity Commercial |
$41.18
|
| Rate for Payer: Cofinity Commercial |
$50.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.06
|
| Rate for Payer: Healthscope Commercial |
$52.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.01
|
| Rate for Payer: PHP Commercial |
$50.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.24
|
| Rate for Payer: Priority Health SBD |
$37.06
|
| Rate for Payer: UMR Bronson Commercial |
$25.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.12
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$58.83
|
|
|
Service Code
|
NDC 70000045102
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$52.95 |
| Rate for Payer: Aetna American Axle |
$38.24
|
| Rate for Payer: Aetna Commercial |
$50.01
|
| Rate for Payer: Aetna Medicare |
$29.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.24
|
| Rate for Payer: BCBS Complete |
$23.53
|
| Rate for Payer: Cash Price |
$47.06
|
| Rate for Payer: Cofinity Commercial |
$41.18
|
| Rate for Payer: Cofinity Commercial |
$50.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.06
|
| Rate for Payer: Healthscope Commercial |
$52.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.01
|
| Rate for Payer: PHP Commercial |
$50.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.24
|
| Rate for Payer: Priority Health SBD |
$37.06
|
| Rate for Payer: UMR Bronson Commercial |
$21.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.12
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$191.53
|
|
|
Service Code
|
NDC 00574705050
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.27 |
| Max. Negotiated Rate |
$172.38 |
| Rate for Payer: Aetna American Axle |
$124.49
|
| Rate for Payer: Aetna Commercial |
$162.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.49
|
| Rate for Payer: Cash Price |
$153.22
|
| Rate for Payer: Cofinity Commercial |
$134.07
|
| Rate for Payer: Cofinity Commercial |
$164.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$134.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.22
|
| Rate for Payer: Healthscope Commercial |
$172.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.80
|
| Rate for Payer: PHP Commercial |
$162.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.49
|
| Rate for Payer: Priority Health SBD |
$120.66
|
| Rate for Payer: UMR Bronson Commercial |
$84.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.65
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$26.94
|
|
|
Service Code
|
NDC 81421002101
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Aetna American Axle |
$17.51
|
| Rate for Payer: Aetna Commercial |
$22.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.51
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Cofinity Commercial |
$18.86
|
| Rate for Payer: Cofinity Commercial |
$23.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.55
|
| Rate for Payer: Healthscope Commercial |
$24.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.90
|
| Rate for Payer: PHP Commercial |
$22.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.51
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: UMR Bronson Commercial |
$11.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$36.38
|
|
|
Service Code
|
NDC 68784010212
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$32.74 |
| Rate for Payer: Aetna American Axle |
$23.65
|
| Rate for Payer: Aetna Commercial |
$30.92
|
| Rate for Payer: Aetna Medicare |
$18.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.65
|
| Rate for Payer: BCBS Complete |
$14.55
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cofinity Commercial |
$25.47
|
| Rate for Payer: Cofinity Commercial |
$31.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.10
|
| Rate for Payer: Healthscope Commercial |
$32.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.92
|
| Rate for Payer: PHP Commercial |
$30.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.65
|
| Rate for Payer: Priority Health SBD |
$22.92
|
| Rate for Payer: UMR Bronson Commercial |
$13.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.29
|
|
|
BISACODYL 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$38.42
|
|
|
Service Code
|
NDC 00904714212
|
| Hospital Charge Code |
1080
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$34.58 |
| Rate for Payer: Aetna American Axle |
$24.97
|
| Rate for Payer: Aetna Commercial |
$32.66
|
| Rate for Payer: Aetna Medicare |
$19.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.97
|
| Rate for Payer: BCBS Complete |
$15.37
|
| Rate for Payer: Cash Price |
$30.74
|
| Rate for Payer: Cofinity Commercial |
$26.89
|
| Rate for Payer: Cofinity Commercial |
$33.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.74
|
| Rate for Payer: Healthscope Commercial |
$34.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.66
|
| Rate for Payer: PHP Commercial |
$32.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.97
|
| Rate for Payer: Priority Health SBD |
$24.20
|
| Rate for Payer: UMR Bronson Commercial |
$14.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.82
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 09900001926
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna American Axle |
$0.38
|
| Rate for Payer: Aetna Commercial |
$0.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.38
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cofinity Commercial |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$0.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.50
|
| Rate for Payer: PHP Commercial |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.38
|
| Rate for Payer: Priority Health SBD |
$0.37
|
| Rate for Payer: UMR Bronson Commercial |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.44
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$19.98
|
|
|
Service Code
|
NDC 00904674817
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.39 |
| Max. Negotiated Rate |
$17.98 |
| Rate for Payer: Aetna American Axle |
$12.99
|
| Rate for Payer: Aetna Commercial |
$16.98
|
| Rate for Payer: Aetna Medicare |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.99
|
| Rate for Payer: BCBS Complete |
$7.99
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Cofinity Commercial |
$13.99
|
| Rate for Payer: Cofinity Commercial |
$17.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.98
|
| Rate for Payer: Healthscope Commercial |
$17.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.98
|
| Rate for Payer: PHP Commercial |
$16.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health SBD |
$12.59
|
| Rate for Payer: UMR Bronson Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.98
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$12.93
|
|
|
Service Code
|
NDC 50844060756
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$11.64 |
| Rate for Payer: Aetna American Axle |
$8.40
|
| Rate for Payer: Aetna Commercial |
$10.99
|
| Rate for Payer: Aetna Medicare |
$6.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.40
|
| Rate for Payer: BCBS Complete |
$5.17
|
| Rate for Payer: Cash Price |
$10.34
|
| Rate for Payer: Cofinity Commercial |
$11.12
|
| Rate for Payer: Cofinity Commercial |
$9.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.34
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.99
|
| Rate for Payer: PHP Commercial |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health SBD |
$8.15
|
| Rate for Payer: UMR Bronson Commercial |
$4.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.70
|
|
|
BISACODYL 5 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 09900001926
|
| Hospital Charge Code |
1079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna American Axle |
$0.38
|
| Rate for Payer: Aetna Commercial |
$0.50
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.38
|
| Rate for Payer: BCBS Complete |
$0.24
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cofinity Commercial |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$0.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.50
|
| Rate for Payer: PHP Commercial |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.38
|
| Rate for Payer: Priority Health SBD |
$0.37
|
| Rate for Payer: UMR Bronson Commercial |
$0.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.44
|
|
