|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4,041.96
|
|
|
Service Code
|
NDC 00310028360
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,495.53 |
| Max. Negotiated Rate |
$3,637.76 |
| Rate for Payer: Aetna American Axle |
$2,627.27
|
| Rate for Payer: Aetna Commercial |
$3,435.67
|
| Rate for Payer: Aetna Medicare |
$2,020.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,627.27
|
| Rate for Payer: BCBS Complete |
$1,616.78
|
| Rate for Payer: Cash Price |
$3,233.57
|
| Rate for Payer: Cofinity Commercial |
$2,829.37
|
| Rate for Payer: Cofinity Commercial |
$3,476.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,829.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,233.57
|
| Rate for Payer: Healthscope Commercial |
$3,637.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,829.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,031.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,435.67
|
| Rate for Payer: PHP Commercial |
$3,435.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,627.27
|
| Rate for Payer: Priority Health SBD |
$2,546.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,495.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,031.47
|
|
|
QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$220.02
|
|
|
Service Code
|
NDC 68180061507
|
| Hospital Charge Code |
82090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.81 |
| Max. Negotiated Rate |
$198.02 |
| Rate for Payer: Aetna American Axle |
$143.01
|
| Rate for Payer: Aetna Commercial |
$187.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.01
|
| Rate for Payer: Cash Price |
$176.02
|
| Rate for Payer: Cofinity Commercial |
$154.01
|
| Rate for Payer: Cofinity Commercial |
$189.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.02
|
| Rate for Payer: Healthscope Commercial |
$198.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.02
|
| Rate for Payer: PHP Commercial |
$187.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.01
|
| Rate for Payer: Priority Health SBD |
$138.61
|
| Rate for Payer: UMR Bronson Commercial |
$96.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.02
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$143.82
|
|
|
Service Code
|
NDC 68180061207
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna American Axle |
$93.48
|
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna Medicare |
$71.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: BCBS Complete |
$57.53
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.48
|
| Rate for Payer: Priority Health SBD |
$90.61
|
| Rate for Payer: UMR Bronson Commercial |
$53.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$143.82
|
|
|
Service Code
|
NDC 68180061207
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna American Axle |
$93.48
|
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.48
|
| Rate for Payer: Priority Health SBD |
$90.61
|
| Rate for Payer: UMR Bronson Commercial |
$63.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$301.92
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.71 |
| Max. Negotiated Rate |
$271.73 |
| Rate for Payer: Aetna American Axle |
$196.25
|
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: Aetna Medicare |
$150.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.25
|
| Rate for Payer: BCBS Complete |
$120.77
|
| Rate for Payer: Cash Price |
$241.54
|
| Rate for Payer: Cofinity Commercial |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$259.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.54
|
| Rate for Payer: Healthscope Commercial |
$271.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.63
|
| Rate for Payer: PHP Commercial |
$256.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.25
|
| Rate for Payer: Priority Health SBD |
$190.21
|
| Rate for Payer: UMR Bronson Commercial |
$111.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.44
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,686.98
|
|
|
Service Code
|
NDC 00310028060
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$742.27 |
| Max. Negotiated Rate |
$1,518.28 |
| Rate for Payer: Aetna American Axle |
$1,096.54
|
| Rate for Payer: Aetna Commercial |
$1,433.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.54
|
| Rate for Payer: Cash Price |
$1,349.58
|
| Rate for Payer: Cofinity Commercial |
$1,180.89
|
| Rate for Payer: Cofinity Commercial |
$1,450.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,180.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.58
|
| Rate for Payer: Healthscope Commercial |
$1,518.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,180.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,265.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.93
|
| Rate for Payer: PHP Commercial |
$1,433.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.54
|
| Rate for Payer: Priority Health SBD |
$1,062.80
|
| Rate for Payer: UMR Bronson Commercial |
$742.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,265.24
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$301.92
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.84 |
| Max. Negotiated Rate |
$271.73 |
| Rate for Payer: Aetna American Axle |
$196.25
|
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.25
|
| Rate for Payer: Cash Price |
$241.54
|
| Rate for Payer: Cofinity Commercial |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$259.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.54
|
| Rate for Payer: Healthscope Commercial |
$271.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.63
|
| Rate for Payer: PHP Commercial |
$256.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.25
|
| Rate for Payer: Priority Health SBD |
$190.21
|
| Rate for Payer: UMR Bronson Commercial |
$132.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.44
|
|
|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,686.98
|
|
|
Service Code
|
NDC 00310028060
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$624.18 |
| Max. Negotiated Rate |
$1,518.28 |
| Rate for Payer: Aetna American Axle |
$1,096.54
|
| Rate for Payer: Aetna Commercial |
$1,433.93
|
| Rate for Payer: Aetna Medicare |
$843.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,096.54
|
| Rate for Payer: BCBS Complete |
$674.79
|
| Rate for Payer: Cash Price |
$1,349.58
|
| Rate for Payer: Cofinity Commercial |
$1,180.89
|
| Rate for Payer: Cofinity Commercial |
$1,450.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,180.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,349.58
|
| Rate for Payer: Healthscope Commercial |
$1,518.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,180.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,265.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,433.93
|
| Rate for Payer: PHP Commercial |
$1,433.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.54
|
| Rate for Payer: Priority Health SBD |
$1,062.80
|
| Rate for Payer: UMR Bronson Commercial |
$624.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,265.24
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$1,885.15
|
|
|
Service Code
|
NDC 53489014101
|
| Hospital Charge Code |
12197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$697.51 |
| Max. Negotiated Rate |
$1,696.64 |
| Rate for Payer: Aetna American Axle |
$1,225.35
|
| Rate for Payer: Aetna Commercial |
$1,602.38
|
| Rate for Payer: Aetna Medicare |
$942.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.35
|
| Rate for Payer: BCBS Complete |
$754.06
|
| Rate for Payer: Cash Price |
$1,508.12
|
| Rate for Payer: Cofinity Commercial |
$1,319.60
|
| Rate for Payer: Cofinity Commercial |
$1,621.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,319.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,508.12
|
| Rate for Payer: Healthscope Commercial |
$1,696.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,319.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,413.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,602.38
|
| Rate for Payer: PHP Commercial |
$1,602.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,225.35
|
| Rate for Payer: Priority Health SBD |
$1,187.64
|
| Rate for Payer: UMR Bronson Commercial |
$697.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,413.86
|
|
|
QUINIDINE GLUCONATE ER 324 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$1,885.15
|
|
|
Service Code
|
NDC 53489014101
|
| Hospital Charge Code |
12197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$829.47 |
| Max. Negotiated Rate |
$1,696.64 |
| Rate for Payer: Aetna American Axle |
$1,225.35
|
| Rate for Payer: Aetna Commercial |
$1,602.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,225.35
|
| Rate for Payer: Cash Price |
$1,508.12
|
| Rate for Payer: Cofinity Commercial |
$1,319.60
|
| Rate for Payer: Cofinity Commercial |
$1,621.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,319.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,508.12
|
| Rate for Payer: Healthscope Commercial |
$1,696.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,319.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,413.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,602.38
|
| Rate for Payer: PHP Commercial |
$1,602.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,225.35
|
| Rate for Payer: Priority Health SBD |
$1,187.64
|
| Rate for Payer: UMR Bronson Commercial |
$829.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,413.86
|
|
|
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 |
$934.48
|
| 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 |
$934.48
|
|
|
QUINIDINE SULFATE 200 MG TABLET
|
Facility
|
OP
|
$1,245.98
|
|
|
Service Code
|
NDC 42806051330
|
| Hospital Charge Code |
6777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$461.01 |
| 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 Medicare |
$622.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.89
|
| Rate for Payer: BCBS Complete |
$498.39
|
| 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 |
$934.48
|
| 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 |
$461.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$934.48
|
|
|
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
|
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
|
|
|
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
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$6,049.47
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$150.28 |
| Max. Negotiated Rate |
$5,444.52 |
| Rate for Payer: Aetna American Axle |
$3,932.16
|
| Rate for Payer: Aetna American Axle |
$5,324.79
|
| Rate for Payer: Aetna American Axle |
$1,310.71
|
| Rate for Payer: Aetna Commercial |
$1,714.01
|
| Rate for Payer: Aetna Commercial |
$5,142.05
|
| Rate for Payer: Aetna Commercial |
$6,963.18
|
| Rate for Payer: Aetna Medicare |
$291.58
|
| Rate for Payer: Aetna Medicare |
$291.58
|
| Rate for Payer: Aetna Medicare |
$291.58
|
| 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 |
$350.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$350.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$350.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$350.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$350.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$350.46
|
| Rate for Payer: BCBS Complete |
$157.79
|
| Rate for Payer: BCBS Complete |
$157.79
|
| Rate for Payer: BCBS Complete |
$157.79
|
| Rate for Payer: BCBS MAPPO |
$280.37
|
| Rate for Payer: BCBS MAPPO |
$280.37
|
| Rate for Payer: BCBS MAPPO |
$280.37
|
| Rate for Payer: BCBS Trust/PPO |
$886.01
|
| Rate for Payer: BCBS Trust/PPO |
$886.01
|
| Rate for Payer: BCBS Trust/PPO |
$886.01
|
| Rate for Payer: BCN Commercial |
$886.01
|
| Rate for Payer: BCN Commercial |
$886.01
|
| Rate for Payer: BCN Commercial |
$886.01
|
| Rate for Payer: BCN Medicare Advantage |
$280.37
|
| Rate for Payer: BCN Medicare Advantage |
$280.37
|
| Rate for Payer: BCN Medicare Advantage |
$280.37
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cash Price |
$6,553.58
|
| Rate for Payer: Cash Price |
$4,839.58
|
| Rate for Payer: Cash Price |
$4,839.58
|
| Rate for Payer: Cash Price |
$6,553.58
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cofinity Commercial |
$7,045.10
|
| Rate for Payer: Cofinity Commercial |
$1,734.17
|
| Rate for Payer: Cofinity Commercial |
$1,411.54
|
| Rate for Payer: Cofinity Commercial |
$5,202.54
|
| Rate for Payer: Cofinity Commercial |
$4,234.63
|
| Rate for Payer: Cofinity Commercial |
$5,734.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,734.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,234.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,411.54
|
| 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 |
$280.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.37
|
| 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 |
$1,411.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,734.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,234.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,537.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,512.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,143.98
|
| Rate for Payer: Mclaren Medicaid |
$150.28
|
| Rate for Payer: Mclaren Medicaid |
$150.28
|
| Rate for Payer: Mclaren Medicaid |
$150.28
|
| Rate for Payer: Mclaren Medicare |
$280.37
|
| Rate for Payer: Mclaren Medicare |
$280.37
|
| Rate for Payer: Mclaren Medicare |
$280.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.39
|
| Rate for Payer: Meridian Medicaid |
$157.79
|
| Rate for Payer: Meridian Medicaid |
$157.79
|
| Rate for Payer: Meridian Medicaid |
$157.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.43
|
| 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: Nomi Health Commercial |
$841.11
|
| Rate for Payer: Nomi Health Commercial |
$841.11
|
| Rate for Payer: Nomi Health Commercial |
$841.11
|
| Rate for Payer: PACE Medicare |
$266.35
|
| Rate for Payer: PACE Medicare |
$266.35
|
| Rate for Payer: PACE Medicare |
$266.35
|
| Rate for Payer: PACE SWMI |
$280.37
|
| Rate for Payer: PACE SWMI |
$280.37
|
| Rate for Payer: PACE SWMI |
$280.37
|
| Rate for Payer: PHP Commercial |
$6,963.18
|
| Rate for Payer: PHP Commercial |
$5,142.05
|
| Rate for Payer: PHP Commercial |
$1,714.01
|
| Rate for Payer: PHP Medicare Advantage |
$280.37
|
| Rate for Payer: PHP Medicare Advantage |
$280.37
|
| Rate for Payer: PHP Medicare Advantage |
$280.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.28
|
| 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 HMO/PPO/Tiered Network |
$828.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.02
|
| Rate for Payer: Priority Health Medicare |
$280.37
|
| Rate for Payer: Priority Health Medicare |
$280.37
|
| Rate for Payer: Priority Health Medicare |
$280.37
|
| Rate for Payer: Priority Health Narrow Network |
$662.42
|
| Rate for Payer: Priority Health Narrow Network |
$662.42
|
| Rate for Payer: Priority Health Narrow Network |
$662.42
|
| Rate for Payer: Priority Health SBD |
$3,811.17
|
| Rate for Payer: Priority Health SBD |
$1,270.38
|
| Rate for Payer: Priority Health SBD |
$5,160.95
|
| Rate for Payer: Railroad Medicare Medicare |
$280.37
|
| Rate for Payer: Railroad Medicare Medicare |
$280.37
|
| Rate for Payer: Railroad Medicare Medicare |
$280.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$789.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$789.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$789.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.37
|
| Rate for Payer: UHC Exchange |
$535.82
|
| Rate for Payer: UHC Exchange |
$535.82
|
| Rate for Payer: UHC Exchange |
$535.82
|
| Rate for Payer: UHC Medicare Advantage |
$280.37
|
| Rate for Payer: UHC Medicare Advantage |
$280.37
|
| Rate for Payer: UHC Medicare Advantage |
$280.37
|
| Rate for Payer: UHCCP Medicaid |
$150.28
|
| Rate for Payer: UHCCP Medicaid |
$150.28
|
| Rate for Payer: UHCCP Medicaid |
$150.28
|
| Rate for Payer: UMR Bronson Commercial |
$3,031.03
|
| Rate for Payer: UMR Bronson Commercial |
$746.10
|
| Rate for Payer: UMR Bronson Commercial |
$2,238.30
|
| Rate for Payer: VA VA |
$280.37
|
| Rate for Payer: VA VA |
$280.37
|
| Rate for Payer: VA VA |
$280.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,537.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,143.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,512.36
|
|
|
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 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
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
OP
|
$1,018.31
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.69 |
| Max. Negotiated Rate |
$1,174.82 |
| Rate for Payer: BCBS Trust/PPO |
$1,174.82
|
| Rate for Payer: BCN Commercial |
$1,174.82
|
| Rate for Payer: BCN Commercial |
$1,174.82
|
| Rate for Payer: BCN Medicare Advantage |
$327.78
|
| Rate for Payer: BCN Medicare Advantage |
$327.78
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$814.65
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$814.65
|
| 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 Commercial |
$849.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$712.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.05
|
| Rate for Payer: Aetna American Axle |
$661.90
|
| Rate for Payer: Aetna American Axle |
$788.40
|
| Rate for Payer: Aetna Commercial |
$1,030.99
|
| Rate for Payer: Aetna Commercial |
$865.56
|
| Rate for Payer: Aetna Medicare |
$340.89
|
| Rate for Payer: Aetna Medicare |
$340.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$409.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$409.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$409.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$409.72
|
| Rate for Payer: BCBS Complete |
$184.47
|
| Rate for Payer: BCBS Complete |
$184.47
|
| Rate for Payer: BCBS MAPPO |
$327.78
|
| Rate for Payer: BCBS MAPPO |
$327.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,174.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.78
|
| Rate for Payer: Healthscope Commercial |
$916.48
|
| Rate for Payer: Healthscope Commercial |
$1,091.64
|
| 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 |
$175.69
|
| Rate for Payer: Mclaren Medicaid |
$175.69
|
| Rate for Payer: Mclaren Medicare |
$327.78
|
| Rate for Payer: Mclaren Medicare |
$327.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.17
|
| Rate for Payer: Meridian Medicaid |
$184.47
|
| Rate for Payer: Meridian Medicaid |
$184.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.99
|
| Rate for Payer: Nomi Health Commercial |
$983.34
|
| Rate for Payer: Nomi Health Commercial |
$983.34
|
| Rate for Payer: PACE Medicare |
$311.39
|
| Rate for Payer: PACE Medicare |
$311.39
|
| Rate for Payer: PACE SWMI |
$327.78
|
| Rate for Payer: PACE SWMI |
$327.78
|
| Rate for Payer: PHP Commercial |
$865.56
|
| Rate for Payer: PHP Commercial |
$1,030.99
|
| Rate for Payer: PHP Medicare Advantage |
$327.78
|
| Rate for Payer: PHP Medicare Advantage |
$327.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.69
|
| 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 HMO/PPO/Tiered Network |
$1,007.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,007.71
|
| Rate for Payer: Priority Health Medicare |
$327.78
|
| Rate for Payer: Priority Health Medicare |
$327.78
|
| Rate for Payer: Priority Health Narrow Network |
$806.17
|
| Rate for Payer: Priority Health Narrow Network |
$806.17
|
| Rate for Payer: Priority Health SBD |
$641.54
|
| Rate for Payer: Priority Health SBD |
$764.15
|
| Rate for Payer: Railroad Medicare Medicare |
$327.78
|
| Rate for Payer: Railroad Medicare Medicare |
$327.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$922.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$922.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.78
|
| Rate for Payer: UHC Exchange |
$626.42
|
| Rate for Payer: UHC Exchange |
$626.42
|
| Rate for Payer: UHC Medicare Advantage |
$327.78
|
| Rate for Payer: UHC Medicare Advantage |
$327.78
|
| Rate for Payer: UHCCP Medicaid |
$175.69
|
| Rate for Payer: UHCCP Medicaid |
$175.69
|
| Rate for Payer: UMR Bronson Commercial |
$376.77
|
| Rate for Payer: UMR Bronson Commercial |
$448.78
|
| Rate for Payer: VA VA |
$327.78
|
| Rate for Payer: VA VA |
$327.78
|
| 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
|
$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
|
$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: UMR Bronson Commercial |
$2.48
|
| Rate for Payer: Aetna American Axle |
$4.35
|
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| 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: Van Buren County Sheriff Dept. Commercial |
$5.02
|
|
|
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
|
$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
|
$9,991.56
|
|
|
Service Code
|
CPT 25230
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.58
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$421.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
