|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$37.05
|
|
|
Service Code
|
NDC 45802010752
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$33.34 |
| Rate for Payer: Aetna American Axle |
$24.08
|
| Rate for Payer: Aetna Commercial |
$31.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.08
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cofinity Advantage |
$25.93
|
| Rate for Payer: Cofinity Commercial |
$31.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$33.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.79
|
| Rate for Payer: PHP Commercial |
$31.49
|
| Rate for Payer: Priority Health SBD |
$23.34
|
| Rate for Payer: UMR Bronson Commercial |
$16.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.79
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$28.79
|
|
|
Service Code
|
NDC 00810067013
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Advantage |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.71
|
| Rate for Payer: UHC Core |
$15.00
|
| Rate for Payer: UHC Exchange |
$11.31
|
| Rate for Payer: UMR Bronson Commercial |
$10.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$28.79
|
|
|
Service Code
|
NDC 00810067013
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Advantage |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.59
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UMR Bronson Commercial |
$12.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$37.05
|
|
|
Service Code
|
NDC 45802010752
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$33.34 |
| Rate for Payer: Aetna American Axle |
$24.08
|
| Rate for Payer: Aetna Commercial |
$31.49
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.08
|
| Rate for Payer: BCBS Complete |
$14.82
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cofinity Advantage |
$25.93
|
| Rate for Payer: Cofinity Commercial |
$31.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$33.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.79
|
| Rate for Payer: PHP Commercial |
$31.49
|
| Rate for Payer: Priority Health SBD |
$23.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.08
|
| Rate for Payer: UHC Core |
$19.30
|
| Rate for Payer: UHC Exchange |
$14.56
|
| Rate for Payer: UMR Bronson Commercial |
$13.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.79
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 09900000882
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna American Axle |
$1.88
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Advantage |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
PSYCHOSES
|
Facility
|
IP
|
$22,767.84
|
|
|
Service Code
|
MSDRG 885
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$22,767.84 |
| Rate for Payer: Aetna Medicare |
$12,764.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,342.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,342.46
|
| Rate for Payer: BCBS MAPPO |
$12,273.97
|
| Rate for Payer: BCBS Trust/PPO |
$18,776.48
|
| Rate for Payer: BCN Commercial |
$18,776.48
|
| Rate for Payer: BCN Medicare Advantage |
$12,273.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,273.97
|
| Rate for Payer: Mclaren Medicare |
$12,273.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,887.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,115.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,501.37
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$11,660.27
|
| Rate for Payer: PACE SWMI |
$12,273.97
|
| Rate for Payer: PHP Medicare Advantage |
$12,273.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,519.41
|
| Rate for Payer: Priority Health Medicare |
$12,273.97
|
| Rate for Payer: Priority Health Tiered Network |
$18,015.52
|
| Rate for Payer: Railroad Medicare Medicare |
$12,273.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,767.84
|
| Rate for Payer: UHC Core |
$19,048.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,273.97
|
| Rate for Payer: UHC Exchange |
$15,556.16
|
| Rate for Payer: VA VA |
$12,273.97
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
OP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna American Axle |
$5.75
|
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.75
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Advantage |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.64
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.75
|
| Rate for Payer: UHC Core |
$4.61
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UMR Bronson Commercial |
$3.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna American Axle |
$5.75
|
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.75
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Advantage |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.64
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UMR Bronson Commercial |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
|
IP
|
$22,798.06
|
|
|
Service Code
|
MSDRG 189
|
| Min. Negotiated Rate |
$10,378.02 |
| Max. Negotiated Rate |
$22,798.06 |
| Rate for Payer: Aetna Medicare |
$11,361.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,655.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,655.29
|
| Rate for Payer: BCBS MAPPO |
$10,924.23
|
| Rate for Payer: BCBS Trust/PPO |
$22,798.06
|
| Rate for Payer: BCN Commercial |
$22,798.06
|
| Rate for Payer: BCN Medicare Advantage |
$10,924.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,924.23
|
| Rate for Payer: Mclaren Medicare |
$10,924.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,470.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,562.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,016.65
|
| Rate for Payer: Nomi Health Commercial |
$15,936.66
|
| Rate for Payer: PACE Medicare |
$10,378.02
|
| Rate for Payer: PACE SWMI |
$10,924.23
|
| Rate for Payer: PHP Medicare Advantage |
$10,924.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,917.29
|
| Rate for Payer: Priority Health Medicare |
$10,924.23
|
| Rate for Payer: Priority Health Tiered Network |
$15,933.83
|
| Rate for Payer: Railroad Medicare Medicare |
$10,924.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,137.02
|
| Rate for Payer: UHC Core |
$16,847.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,924.23
|
| Rate for Payer: UHC Exchange |
$13,758.65
|
| Rate for Payer: VA VA |
$10,924.23
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$4,556.28
|
|
|
Service Code
|
APR-DRG 1342
|
| Min. Negotiated Rate |
$4,339.32 |
| Max. Negotiated Rate |
$4,556.28 |
| Rate for Payer: BCBS Complete |
$4,556.28
|
| Rate for Payer: Mclaren Medicaid |
$4,339.32
|
| Rate for Payer: Meridian Medicaid |
$4,556.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,339.32
|
| Rate for Payer: UHC Medicaid |
$4,339.32
|
| Rate for Payer: UHCCP Medicaid |
$4,339.32
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$11,941.85
|
|
|
Service Code
|
APR-DRG 1344
|
| Min. Negotiated Rate |
$11,373.19 |
| Max. Negotiated Rate |
$11,941.85 |
| Rate for Payer: BCBS Complete |
$11,941.85
|
| Rate for Payer: Mclaren Medicaid |
$11,373.19
|
| Rate for Payer: Meridian Medicaid |
$11,941.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,373.19
|
| Rate for Payer: UHC Medicaid |
$11,373.19
|
| Rate for Payer: UHCCP Medicaid |
$11,373.19
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$3,603.50
|
|
|
Service Code
|
APR-DRG 1341
|
| Min. Negotiated Rate |
$3,431.90 |
| Max. Negotiated Rate |
$3,603.50 |
| Rate for Payer: BCBS Complete |
$3,603.50
|
| Rate for Payer: Mclaren Medicaid |
$3,431.90
|
| Rate for Payer: Meridian Medicaid |
$3,603.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,431.90
|
| Rate for Payer: UHC Medicaid |
$3,431.90
|
| Rate for Payer: UHCCP Medicaid |
$3,431.90
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$7,199.74
|
|
|
Service Code
|
APR-DRG 1343
|
| Min. Negotiated Rate |
$6,856.89 |
| Max. Negotiated Rate |
$7,199.74 |
| Rate for Payer: BCBS Complete |
$7,199.74
|
| Rate for Payer: Mclaren Medicaid |
$6,856.89
|
| Rate for Payer: Meridian Medicaid |
$7,199.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,856.89
|
| Rate for Payer: UHC Medicaid |
$6,856.89
|
| Rate for Payer: UHCCP Medicaid |
$6,856.89
|
|
|
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
|
IP
|
$28,697.28
|
|
|
Service Code
|
MSDRG 175
|
| Min. Negotiated Rate |
$11,475.97 |
| Max. Negotiated Rate |
$28,697.28 |
| Rate for Payer: Aetna Medicare |
$12,563.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,099.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,099.96
|
| Rate for Payer: BCBS MAPPO |
$12,079.97
|
| Rate for Payer: BCBS Trust/PPO |
$28,697.28
|
| Rate for Payer: BCN Commercial |
$28,697.28
|
| Rate for Payer: BCN Medicare Advantage |
$12,079.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,079.97
|
| Rate for Payer: Mclaren Medicare |
$12,079.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,683.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,891.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,287.97
|
| Rate for Payer: Nomi Health Commercial |
$17,719.44
|
| Rate for Payer: PACE Medicare |
$11,475.97
|
| Rate for Payer: PACE SWMI |
$12,079.97
|
| Rate for Payer: PHP Medicare Advantage |
$12,079.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,145.37
|
| Rate for Payer: Priority Health Medicare |
$12,079.97
|
| Rate for Payer: Priority Health Tiered Network |
$17,716.29
|
| Rate for Payer: Railroad Medicare Medicare |
$12,079.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,389.68
|
| Rate for Payer: UHC Core |
$18,731.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,079.97
|
| Rate for Payer: UHC Exchange |
$15,297.78
|
| Rate for Payer: VA VA |
$12,079.97
|
|
|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$16,443.15
|
|
|
Service Code
|
MSDRG 176
|
| Min. Negotiated Rate |
$6,958.68 |
| Max. Negotiated Rate |
$16,443.15 |
| Rate for Payer: Aetna Medicare |
$7,617.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,156.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,156.16
|
| Rate for Payer: BCBS MAPPO |
$7,324.93
|
| Rate for Payer: BCBS Trust/PPO |
$16,443.15
|
| Rate for Payer: BCN Commercial |
$16,443.15
|
| Rate for Payer: BCN Medicare Advantage |
$7,324.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,324.93
|
| Rate for Payer: Mclaren Medicare |
$7,324.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,691.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,423.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,057.42
|
| Rate for Payer: Nomi Health Commercial |
$10,384.50
|
| Rate for Payer: PACE Medicare |
$6,958.68
|
| Rate for Payer: PACE SWMI |
$7,324.93
|
| Rate for Payer: PHP Medicare Advantage |
$7,324.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,978.32
|
| Rate for Payer: Priority Health Medicare |
$7,324.93
|
| Rate for Payer: Priority Health Tiered Network |
$10,382.66
|
| Rate for Payer: Railroad Medicare Medicare |
$7,324.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,121.50
|
| Rate for Payer: UHC Core |
$10,977.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,324.93
|
| Rate for Payer: UHC Exchange |
$8,965.28
|
| Rate for Payer: VA VA |
$7,324.93
|
|
|
PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION
|
Facility
|
OP
|
$1,309.90
|
|
|
Service Code
|
CPT 11104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$198.26 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$198.26
|
| Rate for Payer: BCN Commercial |
$198.26
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS, WITH OR WITHOUT INJECTION OF MEDICATION
|
Facility
|
OP
|
$2,281.79
|
|
|
Service Code
|
CPT 55000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.42 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$100.42
|
| Rate for Payer: BCN Commercial |
$100.42
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$690.42
|
|
|
Service Code
|
NDC 70954048410
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.46 |
| Max. Negotiated Rate |
$621.38 |
| Rate for Payer: Aetna American Axle |
$448.77
|
| Rate for Payer: Aetna Commercial |
$586.86
|
| Rate for Payer: Aetna Medicare |
$345.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.77
|
| Rate for Payer: BCBS Complete |
$276.17
|
| Rate for Payer: Cash Price |
$552.34
|
| Rate for Payer: Cofinity Advantage |
$483.29
|
| Rate for Payer: Cofinity Commercial |
$593.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.34
|
| Rate for Payer: Healthscope Commercial |
$621.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.82
|
| Rate for Payer: PHP Commercial |
$586.86
|
| Rate for Payer: Priority Health SBD |
$434.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.77
|
| Rate for Payer: UHC Core |
$359.71
|
| Rate for Payer: UHC Exchange |
$271.34
|
| Rate for Payer: UMR Bronson Commercial |
$255.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.82
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$948.17
|
|
|
Service Code
|
NDC 61748001206
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$417.19 |
| Max. Negotiated Rate |
$853.35 |
| Rate for Payer: Aetna American Axle |
$616.31
|
| Rate for Payer: Aetna Commercial |
$805.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.31
|
| Rate for Payer: Cash Price |
$758.54
|
| Rate for Payer: Cofinity Advantage |
$663.72
|
| Rate for Payer: Cofinity Commercial |
$815.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.54
|
| Rate for Payer: Healthscope Commercial |
$853.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$663.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$805.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$711.13
|
| Rate for Payer: PHP Commercial |
$805.94
|
| Rate for Payer: Priority Health SBD |
$597.35
|
| Rate for Payer: UMR Bronson Commercial |
$417.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.13
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$948.17
|
|
|
Service Code
|
NDC 61748001206
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$350.82 |
| Max. Negotiated Rate |
$853.35 |
| Rate for Payer: Aetna American Axle |
$616.31
|
| Rate for Payer: Aetna Commercial |
$805.94
|
| Rate for Payer: Aetna Medicare |
$474.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.31
|
| Rate for Payer: BCBS Complete |
$379.27
|
| Rate for Payer: Cash Price |
$758.54
|
| Rate for Payer: Cofinity Advantage |
$663.72
|
| Rate for Payer: Cofinity Commercial |
$815.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.54
|
| Rate for Payer: Healthscope Commercial |
$853.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$663.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$758.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$805.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$711.13
|
| Rate for Payer: PHP Commercial |
$805.94
|
| Rate for Payer: Priority Health SBD |
$597.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.31
|
| Rate for Payer: UHC Core |
$494.00
|
| Rate for Payer: UHC Exchange |
$372.63
|
| Rate for Payer: UMR Bronson Commercial |
$350.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.13
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$690.42
|
|
|
Service Code
|
NDC 70954048410
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.78 |
| Max. Negotiated Rate |
$621.38 |
| Rate for Payer: Aetna American Axle |
$448.77
|
| Rate for Payer: Aetna Commercial |
$586.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.77
|
| Rate for Payer: Cash Price |
$552.34
|
| Rate for Payer: Cofinity Advantage |
$483.29
|
| Rate for Payer: Cofinity Commercial |
$593.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.34
|
| Rate for Payer: Healthscope Commercial |
$621.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.82
|
| Rate for Payer: PHP Commercial |
$586.86
|
| Rate for Payer: Priority Health SBD |
$434.96
|
| Rate for Payer: UMR Bronson Commercial |
$303.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.82
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$969.03
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$426.37 |
| Max. Negotiated Rate |
$872.13 |
| Rate for Payer: Aetna American Axle |
$629.87
|
| Rate for Payer: Aetna Commercial |
$823.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.87
|
| Rate for Payer: Cash Price |
$775.22
|
| Rate for Payer: Cofinity Advantage |
$678.32
|
| Rate for Payer: Cofinity Commercial |
$833.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.22
|
| Rate for Payer: Healthscope Commercial |
$872.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$678.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$726.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$726.77
|
| Rate for Payer: PHP Commercial |
$823.68
|
| Rate for Payer: Priority Health SBD |
$610.49
|
| Rate for Payer: UMR Bronson Commercial |
$426.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$726.77
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$1,420.25
|
|
|
Service Code
|
NDC 61748001209
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$525.49 |
| Max. Negotiated Rate |
$1,278.22 |
| Rate for Payer: Aetna American Axle |
$923.16
|
| Rate for Payer: Aetna Commercial |
$1,207.21
|
| Rate for Payer: Aetna Medicare |
$710.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.16
|
| Rate for Payer: BCBS Complete |
$568.10
|
| Rate for Payer: Cash Price |
$1,136.20
|
| Rate for Payer: Cofinity Advantage |
$994.17
|
| Rate for Payer: Cofinity Commercial |
$1,221.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.20
|
| Rate for Payer: Healthscope Commercial |
$1,278.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,136.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,065.19
|
| Rate for Payer: PHP Commercial |
$1,207.21
|
| Rate for Payer: Priority Health SBD |
$894.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$923.16
|
| Rate for Payer: UHC Core |
$739.95
|
| Rate for Payer: UHC Exchange |
$558.16
|
| Rate for Payer: UMR Bronson Commercial |
$525.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.19
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$1,420.25
|
|
|
Service Code
|
NDC 61748001209
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$624.91 |
| Max. Negotiated Rate |
$1,278.22 |
| Rate for Payer: Aetna American Axle |
$923.16
|
| Rate for Payer: Aetna Commercial |
$1,207.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.16
|
| Rate for Payer: Cash Price |
$1,136.20
|
| Rate for Payer: Cofinity Advantage |
$994.17
|
| Rate for Payer: Cofinity Commercial |
$1,221.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.20
|
| Rate for Payer: Healthscope Commercial |
$1,278.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,065.19
|
| Rate for Payer: PHP Commercial |
$1,207.21
|
| Rate for Payer: Priority Health SBD |
$894.76
|
| Rate for Payer: UMR Bronson Commercial |
$624.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.19
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$969.03
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$358.54 |
| Max. Negotiated Rate |
$872.13 |
| Rate for Payer: Aetna American Axle |
$629.87
|
| Rate for Payer: Aetna Commercial |
$823.68
|
| Rate for Payer: Aetna Medicare |
$484.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.87
|
| Rate for Payer: BCBS Complete |
$387.61
|
| Rate for Payer: Cash Price |
$775.22
|
| Rate for Payer: Cofinity Advantage |
$678.32
|
| Rate for Payer: Cofinity Commercial |
$833.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.22
|
| Rate for Payer: Healthscope Commercial |
$872.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$678.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$726.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$775.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$726.77
|
| Rate for Payer: PHP Commercial |
$823.68
|
| Rate for Payer: Priority Health SBD |
$610.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.87
|
| Rate for Payer: UHC Core |
$504.86
|
| Rate for Payer: UHC Exchange |
$380.83
|
| Rate for Payer: UMR Bronson Commercial |
$358.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$726.77
|
|
