|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$6.69
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna American Axle |
$4.35
|
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.35
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Advantage |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.35
|
| Rate for Payer: Healthscope Commercial |
$6.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.02
|
| Rate for Payer: PHP Commercial |
$5.69
|
| Rate for Payer: Priority Health SBD |
$4.21
|
| Rate for Payer: UMR Bronson Commercial |
$2.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.02
|
|
|
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); EXTENSORS, WITH OR WITHOUT TRANSPOSITION OF DORSAL RETINACULUM
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 25116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); FLEXORS
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 25115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,733.98
|
| Rate for Payer: BCN Commercial |
$2,733.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
RADICAL RESECTION OF CAPSULE, SOFT TISSUE, AND HETEROTOPIC BONE, ELBOW, WITH CONTRACTURE RELEASE (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 24149
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,985.59
|
| Rate for Payer: BCN Commercial |
$4,985.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FOOT OR TOE; 3 CM OR GREATER
|
Facility
|
OP
|
$9,359.82
|
|
|
Service Code
|
CPT 28047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,513.70 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.27
|
| Rate for Payer: BCN Commercial |
$2,264.27
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Mclaren Medicaid |
$2,894.27
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE
|
Facility
|
OP
|
$473.13
|
|
|
Service Code
|
NDC 10858008110
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.06 |
| Max. Negotiated Rate |
$425.82 |
| Rate for Payer: Aetna American Axle |
$307.53
|
| Rate for Payer: Aetna Commercial |
$402.16
|
| Rate for Payer: Aetna Medicare |
$236.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.53
|
| Rate for Payer: BCBS Complete |
$189.25
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cofinity Advantage |
$331.19
|
| Rate for Payer: Cofinity Commercial |
$406.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.50
|
| Rate for Payer: Healthscope Commercial |
$425.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.85
|
| Rate for Payer: PHP Commercial |
$402.16
|
| Rate for Payer: Priority Health SBD |
$298.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.53
|
| Rate for Payer: UHC Core |
$246.50
|
| Rate for Payer: UHC Exchange |
$185.94
|
| Rate for Payer: UMR Bronson Commercial |
$175.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.85
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE
|
Facility
|
IP
|
$4,731.27
|
|
|
Service Code
|
NDC 10858008107
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,081.76 |
| Max. Negotiated Rate |
$4,258.14 |
| Rate for Payer: Aetna American Axle |
$3,075.33
|
| Rate for Payer: Aetna Commercial |
$4,021.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,075.33
|
| Rate for Payer: Cash Price |
$3,785.02
|
| Rate for Payer: Cofinity Advantage |
$3,311.89
|
| Rate for Payer: Cofinity Commercial |
$4,068.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.02
|
| Rate for Payer: Healthscope Commercial |
$4,258.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,311.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,021.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,548.45
|
| Rate for Payer: PHP Commercial |
$4,021.58
|
| Rate for Payer: Priority Health SBD |
$2,980.70
|
| Rate for Payer: UMR Bronson Commercial |
$2,081.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,548.45
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE
|
Facility
|
OP
|
$4,731.27
|
|
|
Service Code
|
NDC 10858008107
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,750.57 |
| Max. Negotiated Rate |
$4,258.14 |
| Rate for Payer: Aetna American Axle |
$3,075.33
|
| Rate for Payer: Aetna Commercial |
$4,021.58
|
| Rate for Payer: Aetna Medicare |
$2,365.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,075.33
|
| Rate for Payer: BCBS Complete |
$1,892.51
|
| Rate for Payer: Cash Price |
$3,785.02
|
| Rate for Payer: Cofinity Advantage |
$3,311.89
|
| Rate for Payer: Cofinity Commercial |
$4,068.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.02
|
| Rate for Payer: Healthscope Commercial |
$4,258.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,311.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,548.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,785.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,021.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,548.45
|
| Rate for Payer: PHP Commercial |
$4,021.58
|
| Rate for Payer: Priority Health SBD |
$2,980.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,075.33
|
| Rate for Payer: UHC Core |
$2,464.99
|
| Rate for Payer: UHC Exchange |
$1,859.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,750.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,548.45
|
|
|
RADIOPAQUE PVC MARKERS-BARIUM SULFATE 24 MARKERS CAPSULE
|
Facility
|
IP
|
$473.13
|
|
|
Service Code
|
NDC 10858008110
|
| Hospital Charge Code |
21381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.18 |
| Max. Negotiated Rate |
$425.82 |
| Rate for Payer: Aetna American Axle |
$307.53
|
| Rate for Payer: Aetna Commercial |
$402.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.53
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cofinity Advantage |
$331.19
|
| Rate for Payer: Cofinity Commercial |
$406.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.50
|
| Rate for Payer: Healthscope Commercial |
$425.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.85
|
| Rate for Payer: PHP Commercial |
$402.16
|
| Rate for Payer: Priority Health SBD |
$298.07
|
| Rate for Payer: UMR Bronson Commercial |
$208.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.85
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$12,260.86
|
|
|
Service Code
|
APR-DRG 6922
|
| Min. Negotiated Rate |
$11,677.01 |
| Max. Negotiated Rate |
$12,260.86 |
| Rate for Payer: BCBS Complete |
$12,260.86
|
| Rate for Payer: Mclaren Medicaid |
$11,677.01
|
| Rate for Payer: Meridian Medicaid |
$12,260.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,677.01
|
| Rate for Payer: UHC Medicaid |
$11,677.01
|
| Rate for Payer: UHCCP Medicaid |
$11,677.01
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$16,242.69
|
|
|
Service Code
|
APR-DRG 6923
|
| Min. Negotiated Rate |
$15,469.22 |
| Max. Negotiated Rate |
$16,242.69 |
| Rate for Payer: BCBS Complete |
$16,242.69
|
| Rate for Payer: Mclaren Medicaid |
$15,469.22
|
| Rate for Payer: Meridian Medicaid |
$16,242.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,469.22
|
| Rate for Payer: UHC Medicaid |
$15,469.22
|
| Rate for Payer: UHCCP Medicaid |
$15,469.22
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$69,387.89
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$22,089.11 |
| Max. Negotiated Rate |
$69,387.89 |
| Rate for Payer: Aetna Medicare |
$24,181.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,064.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,064.61
|
| Rate for Payer: BCBS MAPPO |
$23,251.69
|
| Rate for Payer: BCBS Trust/PPO |
$69,387.89
|
| Rate for Payer: BCN Commercial |
$69,387.89
|
| Rate for Payer: BCN Medicare Advantage |
$23,251.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,251.69
|
| Rate for Payer: Mclaren Medicare |
$23,251.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,414.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,739.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,576.86
|
| Rate for Payer: Nomi Health Commercial |
$34,952.55
|
| Rate for Payer: PACE Medicare |
$22,089.11
|
| Rate for Payer: PACE SWMI |
$23,251.69
|
| Rate for Payer: PHP Medicare Advantage |
$23,251.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$43,682.94
|
| Rate for Payer: Priority Health Medicare |
$23,251.69
|
| Rate for Payer: Priority Health Tiered Network |
$34,946.35
|
| Rate for Payer: Railroad Medicare Medicare |
$23,251.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,164.85
|
| Rate for Payer: UHC Core |
$36,949.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,251.69
|
| Rate for Payer: UHC Exchange |
$30,175.70
|
| Rate for Payer: VA VA |
$23,251.69
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$21,432.14
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$20,411.56 |
| Max. Negotiated Rate |
$21,432.14 |
| Rate for Payer: BCBS Complete |
$21,432.14
|
| Rate for Payer: Mclaren Medicaid |
$20,411.56
|
| Rate for Payer: Meridian Medicaid |
$21,432.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,411.56
|
| Rate for Payer: UHC Medicaid |
$20,411.56
|
| Rate for Payer: UHCCP Medicaid |
$20,411.56
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$4,882.55
|
|
|
Service Code
|
APR-DRG 6921
|
| Min. Negotiated Rate |
$4,650.05 |
| Max. Negotiated Rate |
$4,882.55 |
| Rate for Payer: BCBS Complete |
$4,882.55
|
| Rate for Payer: Mclaren Medicaid |
$4,650.05
|
| Rate for Payer: Meridian Medicaid |
$4,882.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,650.05
|
| Rate for Payer: UHC Medicaid |
$4,650.05
|
| Rate for Payer: UHCCP Medicaid |
$4,650.05
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$108.87
|
|
|
Service Code
|
NDC 69097082502
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$97.98 |
| Rate for Payer: Aetna American Axle |
$70.77
|
| Rate for Payer: Aetna Commercial |
$92.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.77
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cofinity Advantage |
$76.21
|
| Rate for Payer: Cofinity Commercial |
$93.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.10
|
| Rate for Payer: Healthscope Commercial |
$97.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.65
|
| Rate for Payer: PHP Commercial |
$92.54
|
| Rate for Payer: Priority Health SBD |
$68.59
|
| Rate for Payer: UMR Bronson Commercial |
$47.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.65
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$310.65
|
|
|
Service Code
|
NDC 69097082507
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.69 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna American Axle |
$201.92
|
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.92
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Advantage |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.52
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.99
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health SBD |
$195.71
|
| Rate for Payer: UMR Bronson Commercial |
$136.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.99
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$108.87
|
|
|
Service Code
|
NDC 69097082502
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$97.98 |
| Rate for Payer: Aetna American Axle |
$70.77
|
| Rate for Payer: Aetna Commercial |
$92.54
|
| Rate for Payer: Aetna Medicare |
$54.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.77
|
| Rate for Payer: BCBS Complete |
$43.55
|
| Rate for Payer: Cash Price |
$87.10
|
| Rate for Payer: Cofinity Advantage |
$76.21
|
| Rate for Payer: Cofinity Commercial |
$93.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.10
|
| Rate for Payer: Healthscope Commercial |
$97.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.65
|
| Rate for Payer: PHP Commercial |
$92.54
|
| Rate for Payer: Priority Health SBD |
$68.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.77
|
| Rate for Payer: UHC Core |
$56.72
|
| Rate for Payer: UHC Exchange |
$42.79
|
| Rate for Payer: UMR Bronson Commercial |
$40.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.65
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$310.65
|
|
|
Service Code
|
NDC 69097082507
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna American Axle |
$201.92
|
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: Aetna Medicare |
$155.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.92
|
| Rate for Payer: BCBS Complete |
$124.26
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Advantage |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.52
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.99
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health SBD |
$195.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.92
|
| Rate for Payer: UHC Core |
$161.85
|
| Rate for Payer: UHC Exchange |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$114.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.99
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$87.12
|
|
|
Service Code
|
NDC 65162005703
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$78.41 |
| Rate for Payer: Aetna American Axle |
$56.63
|
| Rate for Payer: Aetna Commercial |
$74.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: Cash Price |
$69.70
|
| Rate for Payer: Cofinity Advantage |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$74.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.70
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.34
|
| Rate for Payer: PHP Commercial |
$74.05
|
| Rate for Payer: Priority Health SBD |
$54.89
|
| Rate for Payer: UMR Bronson Commercial |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.34
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$87.12
|
|
|
Service Code
|
NDC 65162005703
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$78.41 |
| Rate for Payer: Aetna American Axle |
$56.63
|
| Rate for Payer: Aetna Commercial |
$74.05
|
| Rate for Payer: Aetna Medicare |
$43.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: BCBS Complete |
$34.85
|
| Rate for Payer: Cash Price |
$69.70
|
| Rate for Payer: Cofinity Advantage |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$74.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.70
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.34
|
| Rate for Payer: PHP Commercial |
$74.05
|
| Rate for Payer: Priority Health SBD |
$54.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.63
|
| Rate for Payer: UHC Core |
$45.39
|
| Rate for Payer: UHC Exchange |
$34.24
|
| Rate for Payer: UMR Bronson Commercial |
$32.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.34
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,688.31
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,382.86 |
| Max. Negotiated Rate |
$6,919.48 |
| Rate for Payer: Aetna American Axle |
$4,997.40
|
| Rate for Payer: Aetna Commercial |
$6,535.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,997.40
|
| Rate for Payer: Cash Price |
$6,150.65
|
| Rate for Payer: Cofinity Advantage |
$5,381.82
|
| Rate for Payer: Cofinity Commercial |
$6,611.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,150.65
|
| Rate for Payer: Healthscope Commercial |
$6,919.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,381.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,766.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,535.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,766.23
|
| Rate for Payer: PHP Commercial |
$6,535.06
|
| Rate for Payer: Priority Health SBD |
$4,843.64
|
| Rate for Payer: UMR Bronson Commercial |
$3,382.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,766.23
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
OP
|
$7,688.31
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,844.67 |
| Max. Negotiated Rate |
$6,919.48 |
| Rate for Payer: Aetna American Axle |
$4,997.40
|
| Rate for Payer: Aetna Commercial |
$6,535.06
|
| Rate for Payer: Aetna Medicare |
$3,844.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,997.40
|
| Rate for Payer: BCBS Complete |
$3,075.32
|
| Rate for Payer: Cash Price |
$6,150.65
|
| Rate for Payer: Cofinity Advantage |
$5,381.82
|
| Rate for Payer: Cofinity Commercial |
$6,611.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,150.65
|
| Rate for Payer: Healthscope Commercial |
$6,919.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,381.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,766.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,150.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,535.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,766.23
|
| Rate for Payer: PHP Commercial |
$6,535.06
|
| Rate for Payer: Priority Health SBD |
$4,843.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,997.40
|
| Rate for Payer: UHC Core |
$4,005.61
|
| Rate for Payer: UHC Exchange |
$3,021.51
|
| Rate for Payer: UMR Bronson Commercial |
$2,844.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,766.23
|
|
|
RAMIPRIL 10 MG CAPSULE
|
Facility
|
OP
|
$133.95
|
|
|
Service Code
|
NDC 65862047701
|
| Hospital Charge Code |
11259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna American Axle |
$87.07
|
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: Aetna Medicare |
$66.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.07
|
| Rate for Payer: BCBS Complete |
$53.58
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Advantage |
$93.77
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.46
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: Priority Health SBD |
$84.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.07
|
| Rate for Payer: UHC Core |
$69.79
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UMR Bronson Commercial |
$49.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
RAMIPRIL 10 MG CAPSULE
|
Facility
|
IP
|
$133.95
|
|
|
Service Code
|
NDC 65862047701
|
| Hospital Charge Code |
11259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.94 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna American Axle |
$87.07
|
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.07
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Advantage |
$93.77
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.46
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: Priority Health SBD |
$84.39
|
| Rate for Payer: UMR Bronson Commercial |
$58.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$82.08
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna American Axle |
$53.35
|
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: Aetna Medicare |
$41.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.35
|
| Rate for Payer: BCBS Complete |
$32.83
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cofinity Advantage |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$70.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.66
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.56
|
| Rate for Payer: PHP Commercial |
$69.77
|
| Rate for Payer: Priority Health SBD |
$51.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.35
|
| Rate for Payer: UHC Core |
$42.76
|
| Rate for Payer: UHC Exchange |
$32.26
|
| Rate for Payer: UMR Bronson Commercial |
$30.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.56
|
|
