|
QUINIDINE SULFATE 200 MG TABLET
|
Facility
|
IP
|
$1,245.98
|
|
|
Service Code
|
NDC 42806051330
|
| Hospital Charge Code |
6777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$548.23 |
| Max. Negotiated Rate |
$1,121.38 |
| Rate for Payer: Aetna American Axle |
$809.89
|
| Rate for Payer: Aetna Commercial |
$1,059.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.89
|
| Rate for Payer: Cash Price |
$996.78
|
| Rate for Payer: Cofinity Commercial |
$1,071.54
|
| Rate for Payer: Cofinity Commercial |
$872.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$872.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$996.78
|
| Rate for Payer: Healthscope Commercial |
$1,121.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$872.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$934.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,059.08
|
| Rate for Payer: PHP Commercial |
$1,059.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.89
|
| Rate for Payer: Priority Health SBD |
$784.97
|
| Rate for Payer: UMR Bronson Commercial |
$548.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$934.49
|
|
|
QUINIDINE SULFATE 300 MG TABLET
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
NDC 00185104701
|
| Hospital Charge Code |
6778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna American Axle |
$222.30
|
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.30
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health SBD |
$215.46
|
| Rate for Payer: UMR Bronson Commercial |
$150.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
QUINIDINE SULFATE 300 MG TABLET
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
NDC 00185104701
|
| Hospital Charge Code |
6778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.54 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna American Axle |
$222.30
|
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Medicare |
$171.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.30
|
| Rate for Payer: BCBS Complete |
$136.80
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health SBD |
$215.46
|
| Rate for Payer: UMR Bronson Commercial |
$126.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
RABEPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,964.37
|
|
|
Service Code
|
NDC 62856024330
|
| Hospital Charge Code |
25896
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$726.82 |
| Max. Negotiated Rate |
$1,767.93 |
| Rate for Payer: Aetna American Axle |
$1,276.84
|
| Rate for Payer: Aetna Commercial |
$1,669.71
|
| Rate for Payer: Aetna Medicare |
$982.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.84
|
| Rate for Payer: BCBS Complete |
$785.75
|
| Rate for Payer: Cash Price |
$1,571.50
|
| Rate for Payer: Cofinity Commercial |
$1,375.06
|
| Rate for Payer: Cofinity Commercial |
$1,689.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,375.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.50
|
| Rate for Payer: Healthscope Commercial |
$1,767.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,375.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.71
|
| Rate for Payer: PHP Commercial |
$1,669.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.84
|
| Rate for Payer: Priority Health SBD |
$1,237.55
|
| Rate for Payer: UMR Bronson Commercial |
$726.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.28
|
|
|
RABEPRAZOLE 20 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,964.37
|
|
|
Service Code
|
NDC 62856024330
|
| Hospital Charge Code |
25896
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$864.32 |
| Max. Negotiated Rate |
$1,767.93 |
| Rate for Payer: Aetna American Axle |
$1,276.84
|
| Rate for Payer: Aetna Commercial |
$1,669.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.84
|
| Rate for Payer: Cash Price |
$1,571.50
|
| Rate for Payer: Cofinity Commercial |
$1,375.06
|
| Rate for Payer: Cofinity Commercial |
$1,689.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,375.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.50
|
| Rate for Payer: Healthscope Commercial |
$1,767.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,375.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.71
|
| Rate for Payer: PHP Commercial |
$1,669.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.84
|
| Rate for Payer: Priority Health SBD |
$1,237.55
|
| Rate for Payer: UMR Bronson Commercial |
$864.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.28
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$2,016.48
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$887.25 |
| Max. Negotiated Rate |
$1,814.83 |
| Rate for Payer: Aetna American Axle |
$1,310.71
|
| Rate for Payer: Aetna Commercial |
$1,714.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.71
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cofinity Commercial |
$1,411.54
|
| Rate for Payer: Cofinity Commercial |
$1,734.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,411.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.18
|
| Rate for Payer: Healthscope Commercial |
$1,814.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,411.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,512.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.01
|
| Rate for Payer: PHP Commercial |
$1,714.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,310.71
|
| Rate for Payer: Priority Health SBD |
$1,270.38
|
| Rate for Payer: UMR Bronson Commercial |
$887.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,512.36
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$2,016.48
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$1,814.83 |
| Rate for Payer: Aetna American Axle |
$1,310.71
|
| Rate for Payer: Aetna American Axle |
$3,932.16
|
| Rate for Payer: Aetna American Axle |
$5,324.79
|
| Rate for Payer: Aetna Commercial |
$6,963.18
|
| Rate for Payer: Aetna Commercial |
$1,714.01
|
| Rate for Payer: Aetna Commercial |
$5,142.05
|
| Rate for Payer: Aetna Medicare |
$291.04
|
| Rate for Payer: Aetna Medicare |
$291.04
|
| Rate for Payer: Aetna Medicare |
$291.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,932.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,324.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.81
|
| Rate for Payer: BCBS Complete |
$157.50
|
| Rate for Payer: BCBS Complete |
$157.50
|
| Rate for Payer: BCBS Complete |
$157.50
|
| Rate for Payer: BCBS MAPPO |
$279.85
|
| Rate for Payer: BCBS MAPPO |
$279.85
|
| Rate for Payer: BCBS MAPPO |
$279.85
|
| Rate for Payer: BCN Medicare Advantage |
$279.85
|
| Rate for Payer: BCN Medicare Advantage |
$279.85
|
| Rate for Payer: BCN Medicare Advantage |
$279.85
|
| Rate for Payer: Cash Price |
$4,839.58
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cash Price |
$6,553.58
|
| Rate for Payer: Cash Price |
$6,553.58
|
| Rate for Payer: Cash Price |
$4,839.58
|
| Rate for Payer: Cofinity Commercial |
$4,234.63
|
| Rate for Payer: Cofinity Commercial |
$7,045.10
|
| Rate for Payer: Cofinity Commercial |
$5,734.39
|
| Rate for Payer: Cofinity Commercial |
$5,202.54
|
| Rate for Payer: Cofinity Commercial |
$1,411.54
|
| Rate for Payer: Cofinity Commercial |
$1,734.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,411.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,734.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,234.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,553.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,839.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.85
|
| Rate for Payer: Healthscope Commercial |
$7,372.78
|
| Rate for Payer: Healthscope Commercial |
$1,814.83
|
| Rate for Payer: Healthscope Commercial |
$5,444.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,234.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,411.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,734.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,512.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,537.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,143.98
|
| Rate for Payer: Mclaren Medicaid |
$150.00
|
| Rate for Payer: Mclaren Medicaid |
$150.00
|
| Rate for Payer: Mclaren Medicaid |
$150.00
|
| Rate for Payer: Mclaren Medicare |
$279.85
|
| Rate for Payer: Mclaren Medicare |
$279.85
|
| Rate for Payer: Mclaren Medicare |
$279.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.84
|
| Rate for Payer: Meridian Medicaid |
$157.50
|
| Rate for Payer: Meridian Medicaid |
$157.50
|
| Rate for Payer: Meridian Medicaid |
$157.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,142.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,963.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.01
|
| Rate for Payer: PACE Medicare |
$265.86
|
| Rate for Payer: PACE Medicare |
$265.86
|
| Rate for Payer: PACE Medicare |
$265.86
|
| Rate for Payer: PACE SWMI |
$279.85
|
| Rate for Payer: PACE SWMI |
$279.85
|
| Rate for Payer: PACE SWMI |
$279.85
|
| Rate for Payer: PHP Commercial |
$5,142.05
|
| Rate for Payer: PHP Commercial |
$1,714.01
|
| Rate for Payer: PHP Commercial |
$6,963.18
|
| Rate for Payer: PHP Medicare Advantage |
$279.85
|
| Rate for Payer: PHP Medicare Advantage |
$279.85
|
| Rate for Payer: PHP Medicare Advantage |
$279.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,310.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,932.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,324.79
|
| Rate for Payer: Priority Health Medicare |
$279.85
|
| Rate for Payer: Priority Health Medicare |
$279.85
|
| Rate for Payer: Priority Health Medicare |
$279.85
|
| Rate for Payer: Priority Health SBD |
$3,811.17
|
| Rate for Payer: Priority Health SBD |
$5,160.95
|
| Rate for Payer: Priority Health SBD |
$1,270.38
|
| Rate for Payer: Railroad Medicare Medicare |
$279.85
|
| Rate for Payer: Railroad Medicare Medicare |
$279.85
|
| Rate for Payer: Railroad Medicare Medicare |
$279.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.85
|
| Rate for Payer: UHC Exchange |
$534.82
|
| Rate for Payer: UHC Exchange |
$534.82
|
| Rate for Payer: UHC Exchange |
$534.82
|
| Rate for Payer: UHC Medicare Advantage |
$279.85
|
| Rate for Payer: UHC Medicare Advantage |
$279.85
|
| Rate for Payer: UHC Medicare Advantage |
$279.85
|
| Rate for Payer: UHCCP Medicaid |
$150.00
|
| Rate for Payer: UHCCP Medicaid |
$150.00
|
| Rate for Payer: UHCCP Medicaid |
$150.00
|
| Rate for Payer: UMR Bronson Commercial |
$746.10
|
| Rate for Payer: UMR Bronson Commercial |
$3,031.03
|
| Rate for Payer: UMR Bronson Commercial |
$2,238.30
|
| Rate for Payer: VA VA |
$279.85
|
| Rate for Payer: VA VA |
$279.85
|
| Rate for Payer: VA VA |
$279.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,537.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,512.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,143.98
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
OP
|
$1,212.93
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.13 |
| Max. Negotiated Rate |
$1,091.64 |
| Rate for Payer: Aetna American Axle |
$788.40
|
| Rate for Payer: Aetna American Axle |
$661.90
|
| Rate for Payer: Aetna Commercial |
$865.56
|
| Rate for Payer: Aetna Commercial |
$1,030.99
|
| Rate for Payer: Aetna Medicare |
$326.23
|
| Rate for Payer: Aetna Medicare |
$326.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$392.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$392.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$392.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$392.10
|
| Rate for Payer: BCBS Complete |
$176.54
|
| Rate for Payer: BCBS Complete |
$176.54
|
| Rate for Payer: BCBS MAPPO |
$313.68
|
| Rate for Payer: BCBS MAPPO |
$313.68
|
| Rate for Payer: BCN Medicare Advantage |
$313.68
|
| Rate for Payer: BCN Medicare Advantage |
$313.68
|
| Rate for Payer: Cash Price |
$814.65
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$814.65
|
| Rate for Payer: Cofinity Commercial |
$712.82
|
| Rate for Payer: Cofinity Commercial |
$875.75
|
| Rate for Payer: Cofinity Commercial |
$1,043.12
|
| Rate for Payer: Cofinity Commercial |
$849.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$712.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.68
|
| Rate for Payer: Healthscope Commercial |
$1,091.64
|
| Rate for Payer: Healthscope Commercial |
$916.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$712.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$763.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$909.70
|
| Rate for Payer: Mclaren Medicaid |
$168.13
|
| Rate for Payer: Mclaren Medicaid |
$168.13
|
| Rate for Payer: Mclaren Medicare |
$313.68
|
| Rate for Payer: Mclaren Medicare |
$313.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.36
|
| Rate for Payer: Meridian Medicaid |
$176.54
|
| Rate for Payer: Meridian Medicaid |
$176.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.56
|
| Rate for Payer: PACE Medicare |
$298.00
|
| Rate for Payer: PACE Medicare |
$298.00
|
| Rate for Payer: PACE SWMI |
$313.68
|
| Rate for Payer: PACE SWMI |
$313.68
|
| Rate for Payer: PHP Commercial |
$865.56
|
| Rate for Payer: PHP Commercial |
$1,030.99
|
| Rate for Payer: PHP Medicare Advantage |
$313.68
|
| Rate for Payer: PHP Medicare Advantage |
$313.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.40
|
| Rate for Payer: Priority Health Medicare |
$313.68
|
| Rate for Payer: Priority Health Medicare |
$313.68
|
| Rate for Payer: Priority Health SBD |
$641.54
|
| Rate for Payer: Priority Health SBD |
$764.15
|
| Rate for Payer: Railroad Medicare Medicare |
$313.68
|
| Rate for Payer: Railroad Medicare Medicare |
$313.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$882.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$882.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.68
|
| Rate for Payer: UHC Exchange |
$599.47
|
| Rate for Payer: UHC Exchange |
$599.47
|
| Rate for Payer: UHC Medicare Advantage |
$313.68
|
| Rate for Payer: UHC Medicare Advantage |
$313.68
|
| Rate for Payer: UHCCP Medicaid |
$168.13
|
| Rate for Payer: UHCCP Medicaid |
$168.13
|
| Rate for Payer: UMR Bronson Commercial |
$376.77
|
| Rate for Payer: UMR Bronson Commercial |
$448.78
|
| Rate for Payer: VA VA |
$313.68
|
| Rate for Payer: VA VA |
$313.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$909.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$763.73
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
IP
|
$1,018.31
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$448.06 |
| Max. Negotiated Rate |
$916.48 |
| Rate for Payer: Aetna American Axle |
$661.90
|
| Rate for Payer: Aetna American Axle |
$788.40
|
| Rate for Payer: Aetna Commercial |
$865.56
|
| Rate for Payer: Aetna Commercial |
$1,030.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.40
|
| Rate for Payer: Cash Price |
$814.65
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cofinity Commercial |
$849.05
|
| Rate for Payer: Cofinity Commercial |
$1,043.12
|
| Rate for Payer: Cofinity Commercial |
$712.82
|
| Rate for Payer: Cofinity Commercial |
$875.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$712.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Healthscope Commercial |
$916.48
|
| Rate for Payer: Healthscope Commercial |
$1,091.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$712.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$763.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$909.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.56
|
| Rate for Payer: PHP Commercial |
$1,030.99
|
| Rate for Payer: PHP Commercial |
$865.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.40
|
| Rate for Payer: Priority Health SBD |
$641.54
|
| Rate for Payer: Priority Health SBD |
$764.15
|
| Rate for Payer: UMR Bronson Commercial |
$448.06
|
| Rate for Payer: UMR Bronson Commercial |
$533.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$763.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$909.70
|
|
|
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 Commercial |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.68
|
| 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: PHP Commercial |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.35
|
| 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
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$6.69
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna American Axle |
$4.35
|
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: Aetna Medicare |
$3.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.35
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$4.68
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.68
|
| 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: PHP Commercial |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.35
|
| Rate for Payer: Priority Health SBD |
$4.21
|
| Rate for Payer: UMR Bronson Commercial |
$2.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.02
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
RADIAL STYLOIDECTOMY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 25230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
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
|
$8,907.47
|
|
|
Service Code
|
CPT 25116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); FLEXORS
|
Facility
|
OP
|
$4,393.64
|
|
|
Service Code
|
CPT 25115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$836.62 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,982.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF BACK OR FLANK; 5 CM OR GREATER
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 21936
|
|
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
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF NECK OR ANTERIOR THORAX; 5 CM OR GREATER
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 21558
|
|
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
|
|
|
RADICAL RESECTION OF TUMOR, METACARPAL
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
RADIOLOGIC EXAMINATION, HIP, UNILATERAL, WITH PELVIS WHEN PERFORMED; 1 VIEW
|
Facility
|
OP
|
$241.72
|
|
|
Service Code
|
CPT 73501
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$241.72 |
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$164.11
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$46.03
|
| Rate for Payer: VA VA |
$85.87
|
|
|
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 Commercial |
$3,311.89
|
| Rate for Payer: Cofinity Commercial |
$4,068.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,311.89
|
| 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: PHP Commercial |
$4,021.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.33
|
| Rate for Payer: Priority Health SBD |
$2,980.70
|
| 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
|
$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 Commercial |
$3,311.89
|
| Rate for Payer: Cofinity Commercial |
$4,068.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,311.89
|
| 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: PHP Commercial |
$4,021.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.33
|
| 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
|
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 Commercial |
$331.19
|
| Rate for Payer: Cofinity Commercial |
$406.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.19
|
| 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: PHP Commercial |
$402.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.53
|
| 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
|
|
|
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 Commercial |
$331.19
|
| Rate for Payer: Cofinity Commercial |
$406.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.19
|
| 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: PHP Commercial |
$402.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.53
|
| Rate for Payer: Priority Health SBD |
$298.07
|
| Rate for Payer: UMR Bronson Commercial |
$175.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.85
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$111.72
|
|
|
Service Code
|
NDC 69097082502
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$100.55 |
| Rate for Payer: Aetna American Axle |
$72.62
|
| Rate for Payer: Aetna Commercial |
$94.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.62
|
| Rate for Payer: Cash Price |
$89.38
|
| Rate for Payer: Cofinity Commercial |
$78.20
|
| Rate for Payer: Cofinity Commercial |
$96.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.38
|
| Rate for Payer: Healthscope Commercial |
$100.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.96
|
| Rate for Payer: PHP Commercial |
$94.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.62
|
| Rate for Payer: Priority Health SBD |
$70.38
|
| Rate for Payer: UMR Bronson Commercial |
$49.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.79
|
|
