|
SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,056.32
|
|
|
Service Code
|
HCPCS J2850
|
| Hospital Charge Code |
91185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$1,850.69 |
| Rate for Payer: Aetna American Axle |
$1,336.61
|
| Rate for Payer: Aetna Commercial |
$1,747.87
|
| Rate for Payer: Aetna Medicare |
$42.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,336.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.65
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS MAPPO |
$40.52
|
| Rate for Payer: BCN Medicare Advantage |
$40.52
|
| Rate for Payer: Cash Price |
$1,645.06
|
| Rate for Payer: Cash Price |
$1,645.06
|
| Rate for Payer: Cofinity Commercial |
$1,768.44
|
| Rate for Payer: Cofinity Commercial |
$1,439.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,439.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,645.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.52
|
| Rate for Payer: Healthscope Commercial |
$1,850.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,439.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,542.24
|
| Rate for Payer: Mclaren Medicaid |
$21.72
|
| Rate for Payer: Mclaren Medicare |
$40.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.55
|
| Rate for Payer: Meridian Medicaid |
$22.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,747.87
|
| Rate for Payer: PACE Medicare |
$38.49
|
| Rate for Payer: PACE SWMI |
$40.52
|
| Rate for Payer: PHP Commercial |
$1,747.87
|
| Rate for Payer: PHP Medicare Advantage |
$40.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.61
|
| Rate for Payer: Priority Health Medicare |
$40.52
|
| Rate for Payer: Priority Health SBD |
$1,295.48
|
| Rate for Payer: Railroad Medicare Medicare |
$40.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.52
|
| Rate for Payer: UHC Exchange |
$77.44
|
| Rate for Payer: UHC Medicare Advantage |
$40.52
|
| Rate for Payer: UHCCP Medicaid |
$21.72
|
| Rate for Payer: UMR Bronson Commercial |
$760.84
|
| Rate for Payer: VA VA |
$40.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,542.24
|
|
|
SECRETIN (HUMAN) 16 MCG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,056.32
|
|
|
Service Code
|
HCPCS J2850
|
| Hospital Charge Code |
91185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$904.78 |
| Max. Negotiated Rate |
$1,850.69 |
| Rate for Payer: Aetna American Axle |
$1,336.61
|
| Rate for Payer: Aetna Commercial |
$1,747.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,336.61
|
| Rate for Payer: Cash Price |
$1,645.06
|
| Rate for Payer: Cofinity Commercial |
$1,439.42
|
| Rate for Payer: Cofinity Commercial |
$1,768.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,439.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,645.06
|
| Rate for Payer: Healthscope Commercial |
$1,850.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,439.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,542.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,747.87
|
| Rate for Payer: PHP Commercial |
$1,747.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.61
|
| Rate for Payer: Priority Health SBD |
$1,295.48
|
| Rate for Payer: UMR Bronson Commercial |
$904.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,542.24
|
|
|
SECUKINUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,526.23
|
|
|
Service Code
|
HCPCS J3247
|
| Hospital Charge Code |
205647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$4,973.61 |
| Rate for Payer: Aetna American Axle |
$3,592.05
|
| Rate for Payer: Aetna Commercial |
$4,697.30
|
| Rate for Payer: Aetna Medicare |
$18.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,592.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.30
|
| Rate for Payer: BCBS Complete |
$10.04
|
| Rate for Payer: BCBS MAPPO |
$17.84
|
| Rate for Payer: BCN Medicare Advantage |
$17.84
|
| Rate for Payer: Cash Price |
$4,420.98
|
| Rate for Payer: Cash Price |
$4,420.98
|
| Rate for Payer: Cofinity Commercial |
$4,752.56
|
| Rate for Payer: Cofinity Commercial |
$3,868.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,868.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,420.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$4,973.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,868.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,144.67
|
| Rate for Payer: Mclaren Medicaid |
$9.56
|
| Rate for Payer: Mclaren Medicare |
$17.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.73
|
| Rate for Payer: Meridian Medicaid |
$10.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,697.30
|
| Rate for Payer: PACE Medicare |
$16.95
|
| Rate for Payer: PACE SWMI |
$17.84
|
| Rate for Payer: PHP Commercial |
$4,697.30
|
| Rate for Payer: PHP Medicare Advantage |
$17.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,592.05
|
| Rate for Payer: Priority Health Medicare |
$17.84
|
| Rate for Payer: Priority Health SBD |
$3,481.52
|
| Rate for Payer: Railroad Medicare Medicare |
$17.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.84
|
| Rate for Payer: UHC Exchange |
$34.09
|
| Rate for Payer: UHC Medicare Advantage |
$17.84
|
| Rate for Payer: UHCCP Medicaid |
$9.56
|
| Rate for Payer: UMR Bronson Commercial |
$2,044.71
|
| Rate for Payer: VA VA |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,144.67
|
|
|
SECUKINUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,526.23
|
|
|
Service Code
|
HCPCS J3247
|
| Hospital Charge Code |
205647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,431.54 |
| Max. Negotiated Rate |
$4,973.61 |
| Rate for Payer: Aetna American Axle |
$3,592.05
|
| Rate for Payer: Aetna Commercial |
$4,697.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,592.05
|
| Rate for Payer: Cash Price |
$4,420.98
|
| Rate for Payer: Cofinity Commercial |
$3,868.36
|
| Rate for Payer: Cofinity Commercial |
$4,752.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,868.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,420.98
|
| Rate for Payer: Healthscope Commercial |
$4,973.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,868.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,144.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,697.30
|
| Rate for Payer: PHP Commercial |
$4,697.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,592.05
|
| Rate for Payer: Priority Health SBD |
$3,481.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,431.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,144.67
|
|
|
SELECTIVE CATHETER PLACEMENT, COMMON CAROTID OR INNOMINATE ARTERY, UNILATERAL, ANY APPROACH, WITH ANGIOGRAPHY OF THE IPSILATERAL EXTRACRANIAL CAROTID CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAPHY OF THE CERVICOCEREBRAL ARCH, WHEN PERFORMED
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 36222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
SELECTIVE CATHETER PLACEMENT (FIRST-ORDER), MAIN RENAL ARTERY AND ANY ACCESSORY RENAL ARTERY(S) FOR RENAL ANGIOGRAPHY, INCLUDING ARTERIAL PUNCTURE AND CATHETER PLACEMENT(S), FLUOROSCOPY, CONTRAST INJECTION(S), IMAGE POSTPROCESSING, PERMANENT RECORDING OF IMAGES, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDING PRESSURE GRADIENT MEASUREMENTS WHEN PERFORMED, AND FLUSH AORTOGRAM WHEN PERFORMED; BILATERAL
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 36252
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
SELECTIVE CATHETER PLACEMENT, INTERNAL CAROTID ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL INTRACRANIAL CAROTID CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAPHY OF THE EXTRACRANIAL CAROTID AND CERVICOCEREBRAL ARCH, WHEN PERFORMED
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 36224
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
SELECTIVE CATHETER PLACEMENT, VERTEBRAL ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL VERTEBRAL CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAPHY OF THE CERVICOCEREBRAL ARCH, WHEN PERFORMED
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 36226
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
SELEGILINE 5 MG CAPSULE
|
Facility
|
OP
|
$152.64
|
|
|
Service Code
|
NDC 60505005501
|
| Hospital Charge Code |
17280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.48 |
| Max. Negotiated Rate |
$137.38 |
| Rate for Payer: Aetna American Axle |
$99.22
|
| Rate for Payer: Aetna Commercial |
$129.74
|
| Rate for Payer: Aetna Medicare |
$76.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.22
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: Cash Price |
$122.11
|
| Rate for Payer: Cofinity Commercial |
$106.85
|
| Rate for Payer: Cofinity Commercial |
$131.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.11
|
| Rate for Payer: Healthscope Commercial |
$137.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.74
|
| Rate for Payer: PHP Commercial |
$129.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.22
|
| Rate for Payer: Priority Health SBD |
$96.16
|
| Rate for Payer: UMR Bronson Commercial |
$56.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.48
|
|
|
SELEGILINE 5 MG CAPSULE
|
Facility
|
IP
|
$152.64
|
|
|
Service Code
|
NDC 60505005501
|
| Hospital Charge Code |
17280
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.16 |
| Max. Negotiated Rate |
$137.38 |
| Rate for Payer: Aetna American Axle |
$99.22
|
| Rate for Payer: Aetna Commercial |
$129.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.22
|
| Rate for Payer: Cash Price |
$122.11
|
| Rate for Payer: Cofinity Commercial |
$106.85
|
| Rate for Payer: Cofinity Commercial |
$131.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.11
|
| Rate for Payer: Healthscope Commercial |
$137.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.74
|
| Rate for Payer: PHP Commercial |
$129.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.22
|
| Rate for Payer: Priority Health SBD |
$96.16
|
| Rate for Payer: UMR Bronson Commercial |
$67.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.48
|
|
|
SELEGILINE 9 MG/24 HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$7,380.84
|
|
|
Service Code
|
NDC 49502090130
|
| Hospital Charge Code |
70782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,247.57 |
| Max. Negotiated Rate |
$6,642.76 |
| Rate for Payer: Aetna American Axle |
$4,797.55
|
| Rate for Payer: Aetna Commercial |
$6,273.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,797.55
|
| Rate for Payer: Cash Price |
$5,904.67
|
| Rate for Payer: Cofinity Commercial |
$5,166.59
|
| Rate for Payer: Cofinity Commercial |
$6,347.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,166.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,904.67
|
| Rate for Payer: Healthscope Commercial |
$6,642.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,166.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,535.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,273.71
|
| Rate for Payer: PHP Commercial |
$6,273.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,797.55
|
| Rate for Payer: Priority Health SBD |
$4,649.93
|
| Rate for Payer: UMR Bronson Commercial |
$3,247.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,535.63
|
|
|
SELEGILINE 9 MG/24 HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
OP
|
$7,380.84
|
|
|
Service Code
|
NDC 49502090130
|
| Hospital Charge Code |
70782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,730.91 |
| Max. Negotiated Rate |
$6,642.76 |
| Rate for Payer: Aetna American Axle |
$4,797.55
|
| Rate for Payer: Aetna Commercial |
$6,273.71
|
| Rate for Payer: Aetna Medicare |
$3,690.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,797.55
|
| Rate for Payer: BCBS Complete |
$2,952.34
|
| Rate for Payer: Cash Price |
$5,904.67
|
| Rate for Payer: Cofinity Commercial |
$5,166.59
|
| Rate for Payer: Cofinity Commercial |
$6,347.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,166.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,904.67
|
| Rate for Payer: Healthscope Commercial |
$6,642.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,166.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,535.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,273.71
|
| Rate for Payer: PHP Commercial |
$6,273.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,797.55
|
| Rate for Payer: Priority Health SBD |
$4,649.93
|
| Rate for Payer: UMR Bronson Commercial |
$2,730.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,535.63
|
|
|
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 Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.51
|
| 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: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.05
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$33.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
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 Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.51
|
| 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: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.05
|
| 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 60 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$734.01
|
|
|
Service Code
|
NDC 00517656001
|
| Hospital Charge Code |
190643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$271.58 |
| Max. Negotiated Rate |
$660.61 |
| Rate for Payer: Aetna American Axle |
$477.11
|
| Rate for Payer: Aetna Commercial |
$623.91
|
| Rate for Payer: Aetna Medicare |
$367.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.11
|
| Rate for Payer: BCBS Complete |
$293.60
|
| Rate for Payer: Cash Price |
$587.21
|
| Rate for Payer: Cofinity Commercial |
$513.81
|
| Rate for Payer: Cofinity Commercial |
$631.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$513.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.21
|
| Rate for Payer: Healthscope Commercial |
$660.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.91
|
| Rate for Payer: PHP Commercial |
$623.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.11
|
| Rate for Payer: Priority Health SBD |
$462.43
|
| Rate for Payer: UMR Bronson Commercial |
$271.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.51
|
|
|
SELENIUM 60 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$734.01
|
|
|
Service Code
|
NDC 00517656001
|
| Hospital Charge Code |
190643
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$322.96 |
| Max. Negotiated Rate |
$660.61 |
| Rate for Payer: Aetna American Axle |
$477.11
|
| Rate for Payer: Aetna Commercial |
$623.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.11
|
| Rate for Payer: Cash Price |
$587.21
|
| Rate for Payer: Cofinity Commercial |
$513.81
|
| Rate for Payer: Cofinity Commercial |
$631.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$513.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.21
|
| Rate for Payer: Healthscope Commercial |
$660.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.91
|
| Rate for Payer: PHP Commercial |
$623.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.11
|
| Rate for Payer: Priority Health SBD |
$462.43
|
| Rate for Payer: UMR Bronson Commercial |
$322.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.51
|
|
|
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 Commercial |
$494.07
|
| Rate for Payer: Cofinity Commercial |
$607.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$494.07
|
| 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: PHP Commercial |
$599.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.78
|
| 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
|
$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 Commercial |
$494.07
|
| Rate for Payer: Cofinity Commercial |
$607.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$494.07
|
| 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: PHP Commercial |
$599.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.78
|
| Rate for Payer: Priority Health SBD |
$444.67
|
| Rate for Payer: UMR Bronson Commercial |
$261.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$529.37
|
|
|
SELENIUM SD 10 MCG/ML IV
|
Facility
|
IP
|
$33.14
|
|
|
Service Code
|
NDC 09900000056
|
| Hospital Charge Code |
157114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna American Axle |
$21.54
|
| Rate for Payer: Aetna Commercial |
$28.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.54
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$28.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.51
|
| Rate for Payer: Healthscope Commercial |
$29.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.17
|
| Rate for Payer: PHP Commercial |
$28.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.54
|
| Rate for Payer: Priority Health SBD |
$20.88
|
| Rate for Payer: UMR Bronson Commercial |
$14.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.86
|
|
|
SELENIUM SD 10 MCG/ML IV
|
Facility
|
OP
|
$33.14
|
|
|
Service Code
|
NDC 09900000056
|
| Hospital Charge Code |
157114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna American Axle |
$21.54
|
| Rate for Payer: Aetna Commercial |
$28.17
|
| Rate for Payer: Aetna Medicare |
$16.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.54
|
| Rate for Payer: BCBS Complete |
$13.26
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$28.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.51
|
| Rate for Payer: Healthscope Commercial |
$29.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.17
|
| Rate for Payer: PHP Commercial |
$28.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.54
|
| Rate for Payer: Priority Health SBD |
$20.88
|
| Rate for Payer: UMR Bronson Commercial |
$12.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.86
|
|
|
SELENIUM SULFIDE 2.5 % LOTION
|
Facility
|
IP
|
$23.94
|
|
|
Service Code
|
NDC 45802004064
|
| Hospital Charge Code |
177121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna American Axle |
$15.56
|
| Rate for Payer: Aetna Commercial |
$20.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.56
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$20.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.56
|
| Rate for Payer: Priority Health SBD |
$15.08
|
| Rate for Payer: UMR Bronson Commercial |
$10.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
SELENIUM SULFIDE 2.5 % LOTION
|
Facility
|
OP
|
$23.94
|
|
|
Service Code
|
NDC 45802004064
|
| Hospital Charge Code |
177121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna American Axle |
$15.56
|
| Rate for Payer: Aetna Commercial |
$20.35
|
| Rate for Payer: Aetna Medicare |
$11.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.56
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$20.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.56
|
| Rate for Payer: Priority Health SBD |
$15.08
|
| Rate for Payer: UMR Bronson Commercial |
$8.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$44.52
|
|
|
Service Code
|
NDC 67618031030
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$40.07 |
| Rate for Payer: Aetna American Axle |
$28.94
|
| Rate for Payer: Aetna Commercial |
$37.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.94
|
| Rate for Payer: Cash Price |
$35.62
|
| Rate for Payer: Cofinity Commercial |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$38.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.62
|
| Rate for Payer: Healthscope Commercial |
$40.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.84
|
| Rate for Payer: PHP Commercial |
$37.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.94
|
| Rate for Payer: Priority Health SBD |
$28.05
|
| Rate for Payer: UMR Bronson Commercial |
$19.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.39
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
IP
|
$90.72
|
|
|
Service Code
|
NDC 57896045806
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.92 |
| Max. Negotiated Rate |
$81.65 |
| Rate for Payer: Aetna American Axle |
$58.97
|
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.97
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$63.50
|
| Rate for Payer: Cofinity Commercial |
$78.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Healthscope Commercial |
$81.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.11
|
| Rate for Payer: PHP Commercial |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.97
|
| Rate for Payer: Priority Health SBD |
$57.15
|
| Rate for Payer: UMR Bronson Commercial |
$39.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.04
|
|
|
SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET
|
Facility
|
OP
|
$146.16
|
|
|
Service Code
|
NDC 67618011060
|
| Hospital Charge Code |
24216
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$131.54 |
| Rate for Payer: Aetna American Axle |
$95.00
|
| Rate for Payer: Aetna Commercial |
$124.24
|
| Rate for Payer: Aetna Medicare |
$73.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.00
|
| Rate for Payer: BCBS Complete |
$58.46
|
| Rate for Payer: Cash Price |
$116.93
|
| Rate for Payer: Cofinity Commercial |
$102.31
|
| Rate for Payer: Cofinity Commercial |
$125.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.93
|
| Rate for Payer: Healthscope Commercial |
$131.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.24
|
| Rate for Payer: PHP Commercial |
$124.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.00
|
| Rate for Payer: Priority Health SBD |
$92.08
|
| Rate for Payer: UMR Bronson Commercial |
$54.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.62
|
|
