|
SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,240.00
|
|
|
Service Code
|
HCPCS J2850
|
| Hospital Charge Code |
91185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.04 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna American Axle |
$1,456.00
|
| Rate for Payer: Aetna Commercial |
$1,904.00
|
| Rate for Payer: Aetna Medicare |
$41.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,456.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.29
|
| Rate for Payer: BCBS Complete |
$22.09
|
| Rate for Payer: BCBS MAPPO |
$40.23
|
| Rate for Payer: BCBS Trust/PPO |
$135.67
|
| Rate for Payer: BCN Commercial |
$135.67
|
| Rate for Payer: BCN Medicare Advantage |
$40.23
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cofinity Advantage |
$1,568.00
|
| Rate for Payer: Cofinity Commercial |
$1,926.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,792.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.23
|
| Rate for Payer: Healthscope Commercial |
$2,016.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,568.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,680.00
|
| Rate for Payer: Mclaren Medicaid |
$40.23
|
| Rate for Payer: Mclaren Medicare |
$40.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.24
|
| Rate for Payer: Meridian Medicaid |
$42.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,904.00
|
| Rate for Payer: Nomi Health Commercial |
$120.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,680.00
|
| Rate for Payer: PACE Medicare |
$38.22
|
| Rate for Payer: PACE SWMI |
$40.23
|
| Rate for Payer: PHP Commercial |
$1,904.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$127.81
|
| Rate for Payer: Priority Health Medicare |
$40.23
|
| Rate for Payer: Priority Health SBD |
$1,411.20
|
| Rate for Payer: Priority Health Tiered Network |
$102.25
|
| Rate for Payer: Railroad Medicare Medicare |
$40.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.73
|
| Rate for Payer: UHC Core |
$66.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40.23
|
| Rate for Payer: UHC Exchange |
$66.73
|
| Rate for Payer: UHC Medicaid |
$21.04
|
| Rate for Payer: UHCCP Medicaid |
$21.04
|
| Rate for Payer: UMR Bronson Commercial |
$828.80
|
| Rate for Payer: VA VA |
$40.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,680.00
|
|
|
SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,240.00
|
|
|
Service Code
|
HCPCS J2850
|
| Hospital Charge Code |
91185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$985.60 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna American Axle |
$1,456.00
|
| Rate for Payer: Aetna Commercial |
$1,904.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,456.00
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cofinity Advantage |
$1,568.00
|
| Rate for Payer: Cofinity Commercial |
$1,926.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,792.00
|
| Rate for Payer: Healthscope Commercial |
$2,016.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,568.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,680.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,904.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,680.00
|
| Rate for Payer: PHP Commercial |
$1,904.00
|
| Rate for Payer: Priority Health SBD |
$1,411.20
|
| Rate for Payer: UMR Bronson Commercial |
$985.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,680.00
|
|
|
SECUKINUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,734.02
|
|
|
Service Code
|
HCPCS J3247
|
| Hospital Charge Code |
205647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,522.97 |
| Max. Negotiated Rate |
$5,160.62 |
| Rate for Payer: Aetna American Axle |
$3,727.11
|
| Rate for Payer: Aetna Commercial |
$4,873.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,727.11
|
| Rate for Payer: Cash Price |
$4,587.22
|
| Rate for Payer: Cofinity Advantage |
$4,013.81
|
| Rate for Payer: Cofinity Commercial |
$4,931.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,587.22
|
| Rate for Payer: Healthscope Commercial |
$5,160.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,013.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,300.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,873.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,300.52
|
| Rate for Payer: PHP Commercial |
$4,873.92
|
| Rate for Payer: Priority Health SBD |
$3,612.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,522.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,300.52
|
|
|
SECUKINUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,734.02
|
|
|
Service Code
|
HCPCS J3247
|
| Hospital Charge Code |
205647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$5,160.62 |
| Rate for Payer: Aetna American Axle |
$3,727.11
|
| Rate for Payer: Aetna Commercial |
$4,873.92
|
| Rate for Payer: Aetna Medicare |
$18.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,727.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.55
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS MAPPO |
$18.04
|
| Rate for Payer: BCBS Trust/PPO |
$58.59
|
| Rate for Payer: BCN Commercial |
$58.59
|
| Rate for Payer: BCN Medicare Advantage |
$18.04
|
| Rate for Payer: Cash Price |
$4,587.22
|
| Rate for Payer: Cash Price |
$4,587.22
|
| Rate for Payer: Cofinity Advantage |
$4,013.81
|
| Rate for Payer: Cofinity Commercial |
$4,931.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,587.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.04
|
| Rate for Payer: Healthscope Commercial |
$5,160.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,013.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,300.52
|
| Rate for Payer: Mclaren Medicaid |
$18.04
|
| Rate for Payer: Mclaren Medicare |
$18.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.94
|
| Rate for Payer: Meridian Medicaid |
$18.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,873.92
|
| Rate for Payer: Nomi Health Commercial |
$54.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,300.52
|
| Rate for Payer: PACE Medicare |
$17.14
|
| Rate for Payer: PACE SWMI |
$18.04
|
| Rate for Payer: PHP Commercial |
$4,873.92
|
| Rate for Payer: PHP Medicare Advantage |
$18.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$56.28
|
| Rate for Payer: Priority Health Medicare |
$18.04
|
| Rate for Payer: Priority Health SBD |
$3,612.43
|
| Rate for Payer: Priority Health Tiered Network |
$45.02
|
| Rate for Payer: Railroad Medicare Medicare |
$18.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.82
|
| Rate for Payer: UHC Core |
$29.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.04
|
| Rate for Payer: UHC Exchange |
$29.82
|
| Rate for Payer: UHC Medicaid |
$9.43
|
| Rate for Payer: UHCCP Medicaid |
$9.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,121.59
|
| Rate for Payer: VA VA |
$18.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,300.52
|
|
|
SEIZURE
|
Facility
|
IP
|
$3,811.13
|
|
|
Service Code
|
APR-DRG 0531
|
| Min. Negotiated Rate |
$3,629.64 |
| Max. Negotiated Rate |
$3,811.13 |
| Rate for Payer: BCBS Complete |
$3,811.13
|
| Rate for Payer: Mclaren Medicaid |
$3,629.64
|
| Rate for Payer: Meridian Medicaid |
$3,811.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,629.64
|
| Rate for Payer: UHC Medicaid |
$3,629.64
|
| Rate for Payer: UHCCP Medicaid |
$3,629.64
|
|
|
SEIZURE
|
Facility
|
IP
|
$4,872.87
|
|
|
Service Code
|
APR-DRG 0532
|
| Min. Negotiated Rate |
$4,640.82 |
| Max. Negotiated Rate |
$4,872.87 |
| Rate for Payer: BCBS Complete |
$4,872.87
|
| Rate for Payer: Mclaren Medicaid |
$4,640.82
|
| Rate for Payer: Meridian Medicaid |
$4,872.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,640.82
|
| Rate for Payer: UHC Medicaid |
$4,640.82
|
| Rate for Payer: UHCCP Medicaid |
$4,640.82
|
|
|
SEIZURE
|
Facility
|
IP
|
$14,895.23
|
|
|
Service Code
|
APR-DRG 0534
|
| Min. Negotiated Rate |
$14,185.94 |
| Max. Negotiated Rate |
$14,895.23 |
| Rate for Payer: BCBS Complete |
$14,895.23
|
| Rate for Payer: Mclaren Medicaid |
$14,185.94
|
| Rate for Payer: Meridian Medicaid |
$14,895.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,185.94
|
| Rate for Payer: UHC Medicaid |
$14,185.94
|
| Rate for Payer: UHCCP Medicaid |
$14,185.94
|
|
|
SEIZURE
|
Facility
|
IP
|
$7,248.16
|
|
|
Service Code
|
APR-DRG 0533
|
| Min. Negotiated Rate |
$6,903.01 |
| Max. Negotiated Rate |
$7,248.16 |
| Rate for Payer: BCBS Complete |
$7,248.16
|
| Rate for Payer: Mclaren Medicaid |
$6,903.01
|
| Rate for Payer: Meridian Medicaid |
$7,248.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,903.01
|
| Rate for Payer: UHC Medicaid |
$6,903.01
|
| Rate for Payer: UHCCP Medicaid |
$6,903.01
|
|
|
SEIZURES WITH MCC
|
Facility
|
IP
|
$34,250.61
|
|
|
Service Code
|
MSDRG 100
|
| Min. Negotiated Rate |
$15,950.35 |
| Max. Negotiated Rate |
$34,250.61 |
| Rate for Payer: Aetna Medicare |
$17,461.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,987.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,987.30
|
| Rate for Payer: BCBS MAPPO |
$16,789.84
|
| Rate for Payer: BCBS Trust/PPO |
$34,250.61
|
| Rate for Payer: BCN Commercial |
$34,250.61
|
| Rate for Payer: BCN Medicare Advantage |
$16,789.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,789.84
|
| Rate for Payer: Mclaren Medicare |
$16,789.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,629.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,308.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,468.82
|
| Rate for Payer: Nomi Health Commercial |
$24,984.72
|
| Rate for Payer: PACE Medicare |
$15,950.35
|
| Rate for Payer: PACE SWMI |
$16,789.84
|
| Rate for Payer: PHP Medicare Advantage |
$16,789.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,225.36
|
| Rate for Payer: Priority Health Medicare |
$16,789.84
|
| Rate for Payer: Priority Health Tiered Network |
$24,980.28
|
| Rate for Payer: Railroad Medicare Medicare |
$16,789.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,569.84
|
| Rate for Payer: UHC Core |
$26,412.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,789.84
|
| Rate for Payer: UHC Exchange |
$21,570.14
|
| Rate for Payer: VA VA |
$16,789.84
|
|
|
SEIZURES WITHOUT MCC
|
Facility
|
IP
|
$15,943.54
|
|
|
Service Code
|
MSDRG 101
|
| Min. Negotiated Rate |
$7,734.09 |
| Max. Negotiated Rate |
$15,943.54 |
| Rate for Payer: Aetna Medicare |
$8,466.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,176.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,176.44
|
| Rate for Payer: BCBS MAPPO |
$8,141.15
|
| Rate for Payer: BCBS Trust/PPO |
$15,943.54
|
| Rate for Payer: BCN Commercial |
$15,943.54
|
| Rate for Payer: BCN Medicare Advantage |
$8,141.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,141.15
|
| Rate for Payer: Mclaren Medicare |
$8,141.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,548.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,362.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,955.26
|
| Rate for Payer: Nomi Health Commercial |
$11,643.54
|
| Rate for Payer: PACE Medicare |
$7,734.09
|
| Rate for Payer: PACE SWMI |
$8,141.15
|
| Rate for Payer: PHP Medicare Advantage |
$8,141.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,551.84
|
| Rate for Payer: Priority Health Medicare |
$8,141.15
|
| Rate for Payer: Priority Health Tiered Network |
$11,641.47
|
| Rate for Payer: Railroad Medicare Medicare |
$8,141.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,712.38
|
| Rate for Payer: UHC Core |
$12,308.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,141.15
|
| Rate for Payer: UHC Exchange |
$10,052.26
|
| Rate for Payer: VA VA |
$8,141.15
|
|
|
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY
|
Facility
|
OP
|
$5,632.42
|
|
|
Service Code
|
CPT 36245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,632.42 |
| Max. Negotiated Rate |
$5,632.42 |
| Rate for Payer: BCBS Trust/PPO |
$5,632.42
|
| Rate for Payer: BCN Commercial |
$5,632.42
|
|
|
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY
|
Facility
|
OP
|
$4,860.07
|
|
|
Service Code
|
CPT 36215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,860.07 |
| Max. Negotiated Rate |
$4,860.07 |
| Rate for Payer: BCBS Trust/PPO |
$4,860.07
|
| Rate for Payer: BCN Commercial |
$4,860.07
|
|
|
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY
|
Facility
|
OP
|
$4,192.98
|
|
|
Service Code
|
CPT 36246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,192.98 |
| Max. Negotiated Rate |
$4,192.98 |
| Rate for Payer: BCBS Trust/PPO |
$4,192.98
|
| Rate for Payer: BCN Commercial |
$4,192.98
|
|
|
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELECTIVE ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY
|
Facility
|
OP
|
$5,560.16
|
|
|
Service Code
|
CPT 36247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,560.16 |
| Max. Negotiated Rate |
$5,560.16 |
| Rate for Payer: BCBS Trust/PPO |
$5,560.16
|
| Rate for Payer: BCN Commercial |
$5,560.16
|
|
|
SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; FIRST ORDER BRANCH (EG, RENAL VEIN, JUGULAR VEIN)
|
Facility
|
OP
|
$4,366.18
|
|
|
Service Code
|
CPT 36011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,366.18 |
| Max. Negotiated Rate |
$4,366.18 |
| Rate for Payer: BCBS Trust/PPO |
$4,366.18
|
| Rate for Payer: BCN Commercial |
$4,366.18
|
|
|
SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; SECOND ORDER, OR MORE SELECTIVE, BRANCH (EG, LEFT ADRENAL VEIN, PETROSAL SINUS)
|
Facility
|
OP
|
$4,452.00
|
|
|
Service Code
|
CPT 36012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,452.00 |
| Max. Negotiated Rate |
$4,452.00 |
| Rate for Payer: BCBS Trust/PPO |
$4,452.00
|
| Rate for Payer: BCN Commercial |
$4,452.00
|
|
|
SELEGILINE 5 MG CAPSULE
|
Facility
|
OP
|
$177.41
|
|
|
Service Code
|
NDC 60505005501
|
| Hospital Charge Code |
17280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.64 |
| Max. Negotiated Rate |
$159.67 |
| Rate for Payer: Aetna American Axle |
$115.32
|
| Rate for Payer: Aetna Commercial |
$150.80
|
| Rate for Payer: Aetna Medicare |
$88.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.32
|
| Rate for Payer: BCBS Complete |
$70.96
|
| Rate for Payer: Cash Price |
$141.93
|
| Rate for Payer: Cofinity Advantage |
$124.19
|
| Rate for Payer: Cofinity Commercial |
$152.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.93
|
| Rate for Payer: Healthscope Commercial |
$159.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.06
|
| Rate for Payer: PHP Commercial |
$150.80
|
| Rate for Payer: Priority Health SBD |
$111.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.32
|
| Rate for Payer: UHC Core |
$92.43
|
| Rate for Payer: UHC Exchange |
$69.72
|
| Rate for Payer: UMR Bronson Commercial |
$65.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.06
|
|
|
SELEGILINE 5 MG CAPSULE
|
Facility
|
IP
|
$177.41
|
|
|
Service Code
|
NDC 60505005501
|
| Hospital Charge Code |
17280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.06 |
| Max. Negotiated Rate |
$159.67 |
| Rate for Payer: Aetna American Axle |
$115.32
|
| Rate for Payer: Aetna Commercial |
$150.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.32
|
| Rate for Payer: Cash Price |
$141.93
|
| Rate for Payer: Cofinity Advantage |
$124.19
|
| Rate for Payer: Cofinity Commercial |
$152.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.93
|
| Rate for Payer: Healthscope Commercial |
$159.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.06
|
| Rate for Payer: PHP Commercial |
$150.80
|
| Rate for Payer: Priority Health SBD |
$111.77
|
| Rate for Payer: UMR Bronson Commercial |
$78.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.06
|
|
|
SELEGILINE 9 MG/24 HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$8,137.41
|
|
|
Service Code
|
NDC 49502090130
|
| Hospital Charge Code |
70782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,580.46 |
| Max. Negotiated Rate |
$7,323.67 |
| Rate for Payer: Aetna American Axle |
$5,289.32
|
| Rate for Payer: Aetna Commercial |
$6,916.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,289.32
|
| Rate for Payer: Cash Price |
$6,509.93
|
| Rate for Payer: Cofinity Advantage |
$5,696.19
|
| Rate for Payer: Cofinity Commercial |
$6,998.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,509.93
|
| Rate for Payer: Healthscope Commercial |
$7,323.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,696.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,103.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,916.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,103.06
|
| Rate for Payer: PHP Commercial |
$6,916.80
|
| Rate for Payer: Priority Health SBD |
$5,126.57
|
| Rate for Payer: UMR Bronson Commercial |
$3,580.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,103.06
|
|
|
SELEGILINE 9 MG/24 HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$8,137.41
|
|
|
Service Code
|
NDC 49502090130
|
| Hospital Charge Code |
70782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,010.84 |
| Max. Negotiated Rate |
$7,323.67 |
| Rate for Payer: Aetna American Axle |
$5,289.32
|
| Rate for Payer: Aetna Commercial |
$6,916.80
|
| Rate for Payer: Aetna Medicare |
$4,068.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,289.32
|
| Rate for Payer: BCBS Complete |
$3,254.96
|
| Rate for Payer: Cash Price |
$6,509.93
|
| Rate for Payer: Cofinity Advantage |
$5,696.19
|
| Rate for Payer: Cofinity Commercial |
$6,998.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,509.93
|
| Rate for Payer: Healthscope Commercial |
$7,323.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,696.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,103.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,509.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,916.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,103.06
|
| Rate for Payer: PHP Commercial |
$6,916.80
|
| Rate for Payer: Priority Health SBD |
$5,126.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,289.32
|
| Rate for Payer: UHC Core |
$4,239.59
|
| Rate for Payer: UHC Exchange |
$3,198.00
|
| Rate for Payer: UMR Bronson Commercial |
$3,010.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,103.06
|
|
|
SELENIUM 50 MCG TABLET
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 07610002120
|
| Hospital Charge Code |
7140
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.05
|
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Advantage |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
SELENIUM 50 MCG TABLET
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
NDC 07610002120
|
| Hospital Charge Code |
7140
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.05
|
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna Medicare |
$44.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Advantage |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.05
|
| Rate for Payer: UHC Core |
$46.53
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$33.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$705.82
|
|
|
Service Code
|
NDC 00517656025
|
| Hospital Charge Code |
190643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$310.56 |
| Max. Negotiated Rate |
$635.24 |
| Rate for Payer: Aetna American Axle |
$458.78
|
| Rate for Payer: Aetna Commercial |
$599.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.78
|
| Rate for Payer: Cash Price |
$564.66
|
| Rate for Payer: Cofinity Advantage |
$494.07
|
| Rate for Payer: Cofinity Commercial |
$607.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.66
|
| Rate for Payer: Healthscope Commercial |
$635.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$494.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.37
|
| Rate for Payer: PHP Commercial |
$599.95
|
| Rate for Payer: Priority Health SBD |
$444.67
|
| Rate for Payer: UMR Bronson Commercial |
$310.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.37
|
|
|
SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$800.06
|
|
|
Service Code
|
NDC 00517656001
|
| Hospital Charge Code |
190643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$296.02 |
| Max. Negotiated Rate |
$720.05 |
| Rate for Payer: Aetna American Axle |
$520.04
|
| Rate for Payer: Aetna Commercial |
$680.05
|
| Rate for Payer: Aetna Medicare |
$400.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.04
|
| Rate for Payer: BCBS Complete |
$320.02
|
| Rate for Payer: Cash Price |
$640.05
|
| Rate for Payer: Cofinity Advantage |
$560.04
|
| Rate for Payer: Cofinity Commercial |
$688.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.05
|
| Rate for Payer: Healthscope Commercial |
$720.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$560.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$600.04
|
| Rate for Payer: PHP Commercial |
$680.05
|
| Rate for Payer: Priority Health SBD |
$504.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$520.04
|
| Rate for Payer: UHC Core |
$416.83
|
| Rate for Payer: UHC Exchange |
$314.42
|
| Rate for Payer: UMR Bronson Commercial |
$296.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.04
|
|
|
SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$705.82
|
|
|
Service Code
|
NDC 00517656025
|
| Hospital Charge Code |
190643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$261.15 |
| Max. Negotiated Rate |
$635.24 |
| Rate for Payer: Aetna American Axle |
$458.78
|
| Rate for Payer: Aetna Commercial |
$599.95
|
| Rate for Payer: Aetna Medicare |
$352.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.78
|
| Rate for Payer: BCBS Complete |
$282.33
|
| Rate for Payer: Cash Price |
$564.66
|
| Rate for Payer: Cofinity Advantage |
$494.07
|
| Rate for Payer: Cofinity Commercial |
$607.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.66
|
| Rate for Payer: Healthscope Commercial |
$635.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$494.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$529.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$529.37
|
| Rate for Payer: PHP Commercial |
$599.95
|
| Rate for Payer: Priority Health SBD |
$444.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.78
|
| Rate for Payer: UHC Core |
$367.73
|
| Rate for Payer: UHC Exchange |
$277.39
|
| Rate for Payer: UMR Bronson Commercial |
$261.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.37
|
|
