|
SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$20,516.88
|
|
|
Service Code
|
MSDRG 948
|
| Min. Negotiated Rate |
$6,922.93 |
| Max. Negotiated Rate |
$20,516.88 |
| Rate for Payer: Aetna Medicare |
$7,578.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,109.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,109.11
|
| Rate for Payer: BCBS MAPPO |
$7,287.29
|
| Rate for Payer: BCBS Trust/PPO |
$20,516.88
|
| Rate for Payer: BCN Commercial |
$20,516.88
|
| Rate for Payer: BCN Medicare Advantage |
$7,287.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,287.29
|
| Rate for Payer: Mclaren Medicare |
$7,287.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,651.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,380.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,016.02
|
| Rate for Payer: Nomi Health Commercial |
$10,326.45
|
| Rate for Payer: PACE Medicare |
$6,922.93
|
| Rate for Payer: PACE SWMI |
$7,287.29
|
| Rate for Payer: PHP Medicare Advantage |
$7,287.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,905.77
|
| Rate for Payer: Priority Health Medicare |
$7,287.29
|
| Rate for Payer: Priority Health Tiered Network |
$10,324.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7,287.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,048.15
|
| Rate for Payer: UHC Core |
$10,916.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,287.29
|
| Rate for Payer: UHC Exchange |
$8,915.17
|
| Rate for Payer: VA VA |
$7,287.29
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$7,174.92
|
|
|
Service Code
|
APR-DRG 8613
|
| Min. Negotiated Rate |
$6,833.25 |
| Max. Negotiated Rate |
$7,174.92 |
| Rate for Payer: BCBS Complete |
$7,174.92
|
| Rate for Payer: Mclaren Medicaid |
$6,833.25
|
| Rate for Payer: Meridian Medicaid |
$7,174.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,833.25
|
| Rate for Payer: UHC Medicaid |
$6,833.25
|
| Rate for Payer: UHCCP Medicaid |
$6,833.25
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$4,437.03
|
|
|
Service Code
|
APR-DRG 8612
|
| Min. Negotiated Rate |
$4,225.74 |
| Max. Negotiated Rate |
$4,437.03 |
| Rate for Payer: BCBS Complete |
$4,437.03
|
| Rate for Payer: Mclaren Medicaid |
$4,225.74
|
| Rate for Payer: Meridian Medicaid |
$4,437.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,225.74
|
| Rate for Payer: UHC Medicaid |
$4,225.74
|
| Rate for Payer: UHCCP Medicaid |
$4,225.74
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$2,918.27
|
|
|
Service Code
|
APR-DRG 8611
|
| Min. Negotiated Rate |
$2,779.31 |
| Max. Negotiated Rate |
$2,918.27 |
| Rate for Payer: BCBS Complete |
$2,918.27
|
| Rate for Payer: Mclaren Medicaid |
$2,779.31
|
| Rate for Payer: Meridian Medicaid |
$2,918.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,779.31
|
| Rate for Payer: UHC Medicaid |
$2,779.31
|
| Rate for Payer: UHCCP Medicaid |
$2,779.31
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$9,806.26
|
|
|
Service Code
|
APR-DRG 8614
|
| Min. Negotiated Rate |
$9,339.30 |
| Max. Negotiated Rate |
$9,806.26 |
| Rate for Payer: BCBS Complete |
$9,806.26
|
| Rate for Payer: Mclaren Medicaid |
$9,339.30
|
| Rate for Payer: Meridian Medicaid |
$9,806.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,339.30
|
| Rate for Payer: UHC Medicaid |
$9,339.30
|
| Rate for Payer: UHCCP Medicaid |
$9,339.30
|
|
|
SILDENAFIL 100 MG TABLET
|
Facility
|
IP
|
$9,025.19
|
|
|
Service Code
|
NDC 00069422030
|
| Hospital Charge Code |
22838
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,971.08 |
| Max. Negotiated Rate |
$8,122.67 |
| Rate for Payer: Aetna American Axle |
$5,866.37
|
| Rate for Payer: Aetna Commercial |
$7,671.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,866.37
|
| Rate for Payer: Cash Price |
$7,220.15
|
| Rate for Payer: Cofinity Advantage |
$6,317.63
|
| Rate for Payer: Cofinity Commercial |
$7,761.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,220.15
|
| Rate for Payer: Healthscope Commercial |
$8,122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,317.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,768.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,671.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,768.89
|
| Rate for Payer: PHP Commercial |
$7,671.41
|
| Rate for Payer: Priority Health SBD |
$5,685.87
|
| Rate for Payer: UMR Bronson Commercial |
$3,971.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,768.89
|
|
|
SILDENAFIL 100 MG TABLET
|
Facility
|
OP
|
$9,025.19
|
|
|
Service Code
|
NDC 00069422030
|
| Hospital Charge Code |
22838
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,339.32 |
| Max. Negotiated Rate |
$8,122.67 |
| Rate for Payer: Aetna American Axle |
$5,866.37
|
| Rate for Payer: Aetna Commercial |
$7,671.41
|
| Rate for Payer: Aetna Medicare |
$4,512.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,866.37
|
| Rate for Payer: BCBS Complete |
$3,610.08
|
| Rate for Payer: Cash Price |
$7,220.15
|
| Rate for Payer: Cofinity Advantage |
$6,317.63
|
| Rate for Payer: Cofinity Commercial |
$7,761.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,220.15
|
| Rate for Payer: Healthscope Commercial |
$8,122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,317.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,768.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,220.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,671.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,768.89
|
| Rate for Payer: PHP Commercial |
$7,671.41
|
| Rate for Payer: Priority Health SBD |
$5,685.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,866.37
|
| Rate for Payer: UHC Core |
$4,702.12
|
| Rate for Payer: UHC Exchange |
$3,546.90
|
| Rate for Payer: UMR Bronson Commercial |
$3,339.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,768.89
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/ML ORAL POWDR FOR SUSPENSION
|
Facility
|
OP
|
$535.45
|
|
|
Service Code
|
NDC 31722013631
|
| Hospital Charge Code |
172285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.12 |
| Max. Negotiated Rate |
$481.90 |
| Rate for Payer: Aetna American Axle |
$348.04
|
| Rate for Payer: Aetna Commercial |
$455.13
|
| Rate for Payer: Aetna Medicare |
$267.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.04
|
| Rate for Payer: BCBS Complete |
$214.18
|
| Rate for Payer: Cash Price |
$428.36
|
| Rate for Payer: Cofinity Advantage |
$374.81
|
| Rate for Payer: Cofinity Commercial |
$460.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.36
|
| Rate for Payer: Healthscope Commercial |
$481.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$428.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$401.59
|
| Rate for Payer: PHP Commercial |
$455.13
|
| Rate for Payer: Priority Health SBD |
$337.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.04
|
| Rate for Payer: UHC Core |
$278.97
|
| Rate for Payer: UHC Exchange |
$210.43
|
| Rate for Payer: UMR Bronson Commercial |
$198.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.59
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/ML ORAL POWDR FOR SUSPENSION
|
Facility
|
OP
|
$535.45
|
|
|
Service Code
|
NDC 69238157401
|
| Hospital Charge Code |
172285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.12 |
| Max. Negotiated Rate |
$481.90 |
| Rate for Payer: Aetna American Axle |
$348.04
|
| Rate for Payer: Aetna Commercial |
$455.13
|
| Rate for Payer: Aetna Medicare |
$267.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.04
|
| Rate for Payer: BCBS Complete |
$214.18
|
| Rate for Payer: Cash Price |
$428.36
|
| Rate for Payer: Cofinity Advantage |
$374.81
|
| Rate for Payer: Cofinity Commercial |
$460.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.36
|
| Rate for Payer: Healthscope Commercial |
$481.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$428.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$401.59
|
| Rate for Payer: PHP Commercial |
$455.13
|
| Rate for Payer: Priority Health SBD |
$337.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.04
|
| Rate for Payer: UHC Core |
$278.97
|
| Rate for Payer: UHC Exchange |
$210.43
|
| Rate for Payer: UMR Bronson Commercial |
$198.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.59
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/ML ORAL POWDR FOR SUSPENSION
|
Facility
|
IP
|
$535.45
|
|
|
Service Code
|
NDC 69238157401
|
| Hospital Charge Code |
172285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.60 |
| Max. Negotiated Rate |
$481.90 |
| Rate for Payer: Aetna American Axle |
$348.04
|
| Rate for Payer: Aetna Commercial |
$455.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.04
|
| Rate for Payer: Cash Price |
$428.36
|
| Rate for Payer: Cofinity Advantage |
$374.81
|
| Rate for Payer: Cofinity Commercial |
$460.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.36
|
| Rate for Payer: Healthscope Commercial |
$481.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$401.59
|
| Rate for Payer: PHP Commercial |
$455.13
|
| Rate for Payer: Priority Health SBD |
$337.33
|
| Rate for Payer: UMR Bronson Commercial |
$235.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.59
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/ML ORAL POWDR FOR SUSPENSION
|
Facility
|
IP
|
$535.45
|
|
|
Service Code
|
NDC 31722013631
|
| Hospital Charge Code |
172285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.60 |
| Max. Negotiated Rate |
$481.90 |
| Rate for Payer: Aetna American Axle |
$348.04
|
| Rate for Payer: Aetna Commercial |
$455.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.04
|
| Rate for Payer: Cash Price |
$428.36
|
| Rate for Payer: Cofinity Advantage |
$374.81
|
| Rate for Payer: Cofinity Commercial |
$460.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.36
|
| Rate for Payer: Healthscope Commercial |
$481.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$401.59
|
| Rate for Payer: PHP Commercial |
$455.13
|
| Rate for Payer: Priority Health SBD |
$337.33
|
| Rate for Payer: UMR Bronson Commercial |
$235.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.59
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/ML ORAL POWDR FOR SUSPENSION
|
Facility
|
OP
|
$454.81
|
|
|
Service Code
|
NDC 60219265101
|
| Hospital Charge Code |
172285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.28 |
| Max. Negotiated Rate |
$409.33 |
| Rate for Payer: Aetna American Axle |
$295.63
|
| Rate for Payer: Aetna Commercial |
$386.59
|
| Rate for Payer: Aetna Medicare |
$227.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.63
|
| Rate for Payer: BCBS Complete |
$181.92
|
| Rate for Payer: Cash Price |
$363.85
|
| Rate for Payer: Cofinity Advantage |
$318.37
|
| Rate for Payer: Cofinity Commercial |
$391.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.85
|
| Rate for Payer: Healthscope Commercial |
$409.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$386.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$341.11
|
| Rate for Payer: PHP Commercial |
$386.59
|
| Rate for Payer: Priority Health SBD |
$286.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.63
|
| Rate for Payer: UHC Core |
$236.96
|
| Rate for Payer: UHC Exchange |
$178.74
|
| Rate for Payer: UMR Bronson Commercial |
$168.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.11
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/ML ORAL POWDR FOR SUSPENSION
|
Facility
|
OP
|
$340.48
|
|
|
Service Code
|
NDC 69543041972
|
| Hospital Charge Code |
172285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$306.43 |
| Rate for Payer: Aetna American Axle |
$221.31
|
| Rate for Payer: Aetna Commercial |
$289.41
|
| Rate for Payer: Aetna Medicare |
$170.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.31
|
| Rate for Payer: BCBS Complete |
$136.19
|
| Rate for Payer: Cash Price |
$272.38
|
| Rate for Payer: Cofinity Advantage |
$238.34
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.38
|
| Rate for Payer: Healthscope Commercial |
$306.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.36
|
| Rate for Payer: PHP Commercial |
$289.41
|
| Rate for Payer: Priority Health SBD |
$214.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.31
|
| Rate for Payer: UHC Core |
$177.39
|
| Rate for Payer: UHC Exchange |
$133.81
|
| Rate for Payer: UMR Bronson Commercial |
$125.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.36
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/ML ORAL POWDR FOR SUSPENSION
|
Facility
|
IP
|
$340.48
|
|
|
Service Code
|
NDC 69543041972
|
| Hospital Charge Code |
172285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.81 |
| Max. Negotiated Rate |
$306.43 |
| Rate for Payer: Aetna American Axle |
$221.31
|
| Rate for Payer: Aetna Commercial |
$289.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.31
|
| Rate for Payer: Cash Price |
$272.38
|
| Rate for Payer: Cofinity Advantage |
$238.34
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.38
|
| Rate for Payer: Healthscope Commercial |
$306.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.36
|
| Rate for Payer: PHP Commercial |
$289.41
|
| Rate for Payer: Priority Health SBD |
$214.50
|
| Rate for Payer: UMR Bronson Commercial |
$149.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.36
|
|
|
SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/ML ORAL POWDR FOR SUSPENSION
|
Facility
|
IP
|
$454.81
|
|
|
Service Code
|
NDC 60219265101
|
| Hospital Charge Code |
172285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.12 |
| Max. Negotiated Rate |
$409.33 |
| Rate for Payer: Aetna American Axle |
$295.63
|
| Rate for Payer: Aetna Commercial |
$386.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.63
|
| Rate for Payer: Cash Price |
$363.85
|
| Rate for Payer: Cofinity Advantage |
$318.37
|
| Rate for Payer: Cofinity Commercial |
$391.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.85
|
| Rate for Payer: Healthscope Commercial |
$409.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$386.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$341.11
|
| Rate for Payer: PHP Commercial |
$386.59
|
| Rate for Payer: Priority Health SBD |
$286.53
|
| Rate for Payer: UMR Bronson Commercial |
$200.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.11
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
OP
|
$20,113.54
|
|
|
Service Code
|
NDC 00069419068
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,442.01 |
| Max. Negotiated Rate |
$18,102.19 |
| Rate for Payer: Aetna American Axle |
$13,073.80
|
| Rate for Payer: Aetna Commercial |
$17,096.51
|
| Rate for Payer: Aetna Medicare |
$10,056.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,073.80
|
| Rate for Payer: BCBS Complete |
$8,045.42
|
| Rate for Payer: Cash Price |
$16,090.83
|
| Rate for Payer: Cofinity Advantage |
$14,079.48
|
| Rate for Payer: Cofinity Commercial |
$17,297.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,090.83
|
| Rate for Payer: Healthscope Commercial |
$18,102.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,079.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,085.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,090.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,096.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,085.16
|
| Rate for Payer: PHP Commercial |
$17,096.51
|
| Rate for Payer: Priority Health SBD |
$12,671.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,073.80
|
| Rate for Payer: UHC Core |
$10,479.15
|
| Rate for Payer: UHC Exchange |
$7,904.62
|
| Rate for Payer: UMR Bronson Commercial |
$7,442.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,085.16
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
NDC 00904667104
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.16 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna American Axle |
$57.85
|
| Rate for Payer: Aetna Commercial |
$75.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.85
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Advantage |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$76.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.20
|
| Rate for Payer: Healthscope Commercial |
$80.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.75
|
| Rate for Payer: PHP Commercial |
$75.65
|
| Rate for Payer: Priority Health SBD |
$56.07
|
| Rate for Payer: UMR Bronson Commercial |
$39.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.75
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
OP
|
$410.40
|
|
|
Service Code
|
NDC 59762003301
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.85 |
| Max. Negotiated Rate |
$369.36 |
| Rate for Payer: Aetna American Axle |
$266.76
|
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna Medicare |
$205.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: BCBS Complete |
$164.16
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cofinity Advantage |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.80
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: Priority Health SBD |
$258.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.76
|
| Rate for Payer: UHC Core |
$213.82
|
| Rate for Payer: UHC Exchange |
$161.29
|
| Rate for Payer: UMR Bronson Commercial |
$151.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.80
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
NDC 00904667104
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna American Axle |
$57.85
|
| Rate for Payer: Aetna Commercial |
$75.65
|
| Rate for Payer: Aetna Medicare |
$44.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.85
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Advantage |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$76.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.20
|
| Rate for Payer: Healthscope Commercial |
$80.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.75
|
| Rate for Payer: PHP Commercial |
$75.65
|
| Rate for Payer: Priority Health SBD |
$56.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.85
|
| Rate for Payer: UHC Core |
$46.37
|
| Rate for Payer: UHC Exchange |
$34.98
|
| Rate for Payer: UMR Bronson Commercial |
$32.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.75
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
IP
|
$410.40
|
|
|
Service Code
|
NDC 59762003301
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.58 |
| Max. Negotiated Rate |
$369.36 |
| Rate for Payer: Aetna American Axle |
$266.76
|
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cofinity Advantage |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.80
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: Priority Health SBD |
$258.55
|
| Rate for Payer: UMR Bronson Commercial |
$180.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.80
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
OP
|
$176.99
|
|
|
Service Code
|
NDC 00093551798
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.49 |
| Max. Negotiated Rate |
$159.29 |
| Rate for Payer: Aetna American Axle |
$115.04
|
| Rate for Payer: Aetna Commercial |
$150.44
|
| Rate for Payer: Aetna Medicare |
$88.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.04
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Advantage |
$123.89
|
| Rate for Payer: Cofinity Commercial |
$152.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.59
|
| Rate for Payer: Healthscope Commercial |
$159.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.74
|
| Rate for Payer: PHP Commercial |
$150.44
|
| Rate for Payer: Priority Health SBD |
$111.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.04
|
| Rate for Payer: UHC Core |
$92.21
|
| Rate for Payer: UHC Exchange |
$69.56
|
| Rate for Payer: UMR Bronson Commercial |
$65.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.74
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 65162035109
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$171.31 |
| Rate for Payer: Aetna American Axle |
$123.73
|
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: Aetna Medicare |
$95.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.73
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Advantage |
$133.25
|
| Rate for Payer: Cofinity Commercial |
$163.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$171.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: Priority Health SBD |
$119.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.73
|
| Rate for Payer: UHC Core |
$99.17
|
| Rate for Payer: UHC Exchange |
$74.81
|
| Rate for Payer: UMR Bronson Commercial |
$70.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.76
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
IP
|
$20,113.54
|
|
|
Service Code
|
NDC 00069419068
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,849.96 |
| Max. Negotiated Rate |
$18,102.19 |
| Rate for Payer: Aetna American Axle |
$13,073.80
|
| Rate for Payer: Aetna Commercial |
$17,096.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,073.80
|
| Rate for Payer: Cash Price |
$16,090.83
|
| Rate for Payer: Cofinity Advantage |
$14,079.48
|
| Rate for Payer: Cofinity Commercial |
$17,297.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,090.83
|
| Rate for Payer: Healthscope Commercial |
$18,102.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,079.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,085.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,096.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,085.16
|
| Rate for Payer: PHP Commercial |
$17,096.51
|
| Rate for Payer: Priority Health SBD |
$12,671.53
|
| Rate for Payer: UMR Bronson Commercial |
$8,849.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,085.16
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 65162035109
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$171.31 |
| Rate for Payer: Aetna American Axle |
$123.73
|
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.73
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Advantage |
$133.25
|
| Rate for Payer: Cofinity Commercial |
$163.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$171.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: Priority Health SBD |
$119.92
|
| Rate for Payer: UMR Bronson Commercial |
$83.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.76
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
IP
|
$176.99
|
|
|
Service Code
|
NDC 00093551798
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$159.29 |
| Rate for Payer: Aetna American Axle |
$115.04
|
| Rate for Payer: Aetna Commercial |
$150.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.04
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Advantage |
$123.89
|
| Rate for Payer: Cofinity Commercial |
$152.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.59
|
| Rate for Payer: Healthscope Commercial |
$159.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.74
|
| Rate for Payer: PHP Commercial |
$150.44
|
| Rate for Payer: Priority Health SBD |
$111.50
|
| Rate for Payer: UMR Bronson Commercial |
$77.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.74
|
|
