|
TENECTEPLASE 25 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30,830.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
212669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,565.36 |
| Max. Negotiated Rate |
$27,747.33 |
| Rate for Payer: Aetna American Axle |
$20,039.74
|
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,039.74
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Advantage |
$21,581.26
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,581.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,122.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: Priority Health SBD |
$19,423.13
|
| Rate for Payer: UMR Bronson Commercial |
$13,565.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,122.78
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30,830.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.26 |
| Max. Negotiated Rate |
$27,747.33 |
| Rate for Payer: Aetna American Axle |
$20,039.74
|
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: Aetna Medicare |
$205.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,039.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.80
|
| Rate for Payer: BCBS Complete |
$108.43
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCBS Trust/PPO |
$606.25
|
| Rate for Payer: BCN Commercial |
$606.25
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Advantage |
$21,581.26
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,581.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,122.78
|
| Rate for Payer: Mclaren Medicaid |
$197.44
|
| Rate for Payer: Mclaren Medicare |
$197.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Meridian Medicaid |
$207.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$217.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Nomi Health Commercial |
$592.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: PACE Medicare |
$187.57
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$543.17
|
| Rate for Payer: Priority Health Medicare |
$197.44
|
| Rate for Payer: Priority Health SBD |
$19,423.13
|
| Rate for Payer: Priority Health Tiered Network |
$434.54
|
| Rate for Payer: Railroad Medicare Medicare |
$197.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.50
|
| Rate for Payer: UHC Core |
$308.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$197.44
|
| Rate for Payer: UHC Exchange |
$308.50
|
| Rate for Payer: UHC Medicaid |
$103.26
|
| Rate for Payer: UHCCP Medicaid |
$103.26
|
| Rate for Payer: UMR Bronson Commercial |
$11,407.24
|
| Rate for Payer: VA VA |
$197.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,122.78
|
|
|
TENECTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30,830.37
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
186094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,565.36 |
| Max. Negotiated Rate |
$27,747.33 |
| Rate for Payer: Aetna American Axle |
$20,039.74
|
| Rate for Payer: Aetna Commercial |
$26,205.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,039.74
|
| Rate for Payer: Cash Price |
$24,664.30
|
| Rate for Payer: Cofinity Advantage |
$21,581.26
|
| Rate for Payer: Cofinity Commercial |
$26,514.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,664.30
|
| Rate for Payer: Healthscope Commercial |
$27,747.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,581.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,122.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,205.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,122.78
|
| Rate for Payer: PHP Commercial |
$26,205.81
|
| Rate for Payer: Priority Health SBD |
$19,423.13
|
| Rate for Payer: UMR Bronson Commercial |
$13,565.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,122.78
|
|
|
TENODESIS OF LONG TENDON OF BICEPS
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 23430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$6,305.97
|
| Rate for Payer: BCN Commercial |
$6,305.97
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
OP
|
$4,522.03
|
|
|
Service Code
|
NDC 61958040101
|
| Hospital Charge Code |
31684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,673.15 |
| Max. Negotiated Rate |
$4,069.83 |
| Rate for Payer: Aetna American Axle |
$2,939.32
|
| Rate for Payer: Aetna Commercial |
$3,843.73
|
| Rate for Payer: Aetna Medicare |
$2,261.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,939.32
|
| Rate for Payer: BCBS Complete |
$1,808.81
|
| Rate for Payer: Cash Price |
$3,617.62
|
| Rate for Payer: Cofinity Advantage |
$3,165.42
|
| Rate for Payer: Cofinity Commercial |
$3,888.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,617.62
|
| Rate for Payer: Healthscope Commercial |
$4,069.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,165.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,391.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,617.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,843.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,391.52
|
| Rate for Payer: PHP Commercial |
$3,843.73
|
| Rate for Payer: Priority Health SBD |
$2,848.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,939.32
|
| Rate for Payer: UHC Core |
$2,355.98
|
| Rate for Payer: UHC Exchange |
$1,777.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,673.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,391.52
|
|
|
TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET
|
Facility
|
IP
|
$4,522.03
|
|
|
Service Code
|
NDC 61958040101
|
| Hospital Charge Code |
31684
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,989.69 |
| Max. Negotiated Rate |
$4,069.83 |
| Rate for Payer: Aetna American Axle |
$2,939.32
|
| Rate for Payer: Aetna Commercial |
$3,843.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,939.32
|
| Rate for Payer: Cash Price |
$3,617.62
|
| Rate for Payer: Cofinity Advantage |
$3,165.42
|
| Rate for Payer: Cofinity Commercial |
$3,888.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,617.62
|
| Rate for Payer: Healthscope Commercial |
$4,069.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,165.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,391.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,843.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,391.52
|
| Rate for Payer: PHP Commercial |
$3,843.73
|
| Rate for Payer: Priority Health SBD |
$2,848.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,989.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,391.52
|
|
|
TENOLYSIS, FLEXOR, FOOT; SINGLE TENDON
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 28220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$458.92 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$458.92
|
| Rate for Payer: BCN Commercial |
$458.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; MULTIPLE TENDONS (THROUGH SEPARATE INCISION[S])
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 27681
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE; SINGLE, EACH TENDON
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 27680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
TENOLYSIS, FLEXOR TENDON; PALM AND FINGER, EACH TENDON
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 26442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
TENOLYSIS, FLEXOR TENDON; PALM OR FINGER, EACH TENDON
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 26440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,532.26
|
| Rate for Payer: BCN Commercial |
$2,532.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
TENOTOMY, ADDUCTOR OF HIP, PERCUTANEOUS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 27000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,293.43
|
| Rate for Payer: BCN Commercial |
$2,293.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 28234
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,744.87
|
| Rate for Payer: BCN Commercial |
$1,744.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 25290
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 27606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,293.43
|
| Rate for Payer: BCN Commercial |
$2,293.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
TENOTOMY, PERCUTANEOUS, TOE; MULTIPLE TENDONS
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 28011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,744.87
|
| Rate for Payer: BCN Commercial |
$1,744.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$48,676.40
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.42 |
| Max. Negotiated Rate |
$43,808.76 |
| Rate for Payer: Aetna American Axle |
$31,639.66
|
| Rate for Payer: Aetna Commercial |
$41,374.94
|
| Rate for Payer: Aetna Medicare |
$382.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31,639.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$459.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$459.89
|
| Rate for Payer: BCBS Complete |
$202.06
|
| Rate for Payer: BCBS MAPPO |
$367.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.55
|
| Rate for Payer: BCN Commercial |
$1,197.55
|
| Rate for Payer: BCN Medicare Advantage |
$367.91
|
| Rate for Payer: Cash Price |
$38,941.12
|
| Rate for Payer: Cash Price |
$38,941.12
|
| Rate for Payer: Cofinity Advantage |
$34,073.48
|
| Rate for Payer: Cofinity Commercial |
$41,861.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,941.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$367.91
|
| Rate for Payer: Healthscope Commercial |
$43,808.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34,073.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36,507.30
|
| Rate for Payer: Mclaren Medicaid |
$367.91
|
| Rate for Payer: Mclaren Medicare |
$367.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$386.31
|
| Rate for Payer: Meridian Medicaid |
$386.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$423.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$404.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,374.94
|
| Rate for Payer: Nomi Health Commercial |
$1,103.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,507.30
|
| Rate for Payer: PACE Medicare |
$349.51
|
| Rate for Payer: PACE SWMI |
$367.91
|
| Rate for Payer: PHP Commercial |
$41,374.94
|
| Rate for Payer: PHP Medicare Advantage |
$367.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,132.87
|
| Rate for Payer: Priority Health Medicare |
$367.91
|
| Rate for Payer: Priority Health SBD |
$30,666.13
|
| Rate for Payer: Priority Health Tiered Network |
$906.30
|
| Rate for Payer: Railroad Medicare Medicare |
$367.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.36
|
| Rate for Payer: UHC Core |
$609.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$367.91
|
| Rate for Payer: UHC Exchange |
$609.36
|
| Rate for Payer: UHC Medicaid |
$192.42
|
| Rate for Payer: UHCCP Medicaid |
$192.42
|
| Rate for Payer: UMR Bronson Commercial |
$18,010.27
|
| Rate for Payer: VA VA |
$367.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36,507.30
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$48,676.40
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,417.62 |
| Max. Negotiated Rate |
$43,808.76 |
| Rate for Payer: Aetna American Axle |
$31,639.66
|
| Rate for Payer: Aetna Commercial |
$41,374.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31,639.66
|
| Rate for Payer: Cash Price |
$38,941.12
|
| Rate for Payer: Cofinity Advantage |
$34,073.48
|
| Rate for Payer: Cofinity Commercial |
$41,861.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38,941.12
|
| Rate for Payer: Healthscope Commercial |
$43,808.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34,073.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36,507.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,374.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,507.30
|
| Rate for Payer: PHP Commercial |
$41,374.94
|
| Rate for Payer: Priority Health SBD |
$30,666.13
|
| Rate for Payer: UMR Bronson Commercial |
$21,417.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36,507.30
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$31.29
|
|
|
Service Code
|
NDC 51672208002
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna American Axle |
$20.34
|
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.34
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Advantage |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$26.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$28.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.47
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: Priority Health SBD |
$19.71
|
| Rate for Payer: UMR Bronson Commercial |
$13.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.47
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$25.99
|
|
|
Service Code
|
NDC 51672208001
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$23.39 |
| Rate for Payer: Aetna American Axle |
$16.89
|
| Rate for Payer: Aetna Commercial |
$22.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.89
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cofinity Advantage |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$22.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.79
|
| Rate for Payer: Healthscope Commercial |
$23.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.49
|
| Rate for Payer: PHP Commercial |
$22.09
|
| Rate for Payer: Priority Health SBD |
$16.37
|
| Rate for Payer: UMR Bronson Commercial |
$11.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.49
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
NDC 96295013323
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Advantage |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.17
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$25.99
|
|
|
Service Code
|
NDC 51672208001
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$23.39 |
| Rate for Payer: Aetna American Axle |
$16.89
|
| Rate for Payer: Aetna Commercial |
$22.09
|
| Rate for Payer: Aetna Medicare |
$12.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.89
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.79
|
| Rate for Payer: Cofinity Advantage |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$22.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.79
|
| Rate for Payer: Healthscope Commercial |
$23.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.49
|
| Rate for Payer: PHP Commercial |
$22.09
|
| Rate for Payer: Priority Health SBD |
$16.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.89
|
| Rate for Payer: UHC Core |
$13.54
|
| Rate for Payer: UHC Exchange |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.49
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
NDC 96295013323
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Advantage |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.17
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.88
|
| Rate for Payer: UHC Core |
$11.93
|
| Rate for Payer: UHC Exchange |
$9.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$31.29
|
|
|
Service Code
|
NDC 51672208002
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna American Axle |
$20.34
|
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Medicare |
$15.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.34
|
| Rate for Payer: BCBS Complete |
$12.52
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Advantage |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$26.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$28.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.47
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: Priority Health SBD |
$19.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.34
|
| Rate for Payer: UHC Core |
$16.30
|
| Rate for Payer: UHC Exchange |
$12.30
|
| Rate for Payer: UMR Bronson Commercial |
$11.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.47
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$68.39
|
|
|
Service Code
|
NDC 69097073102
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$61.55 |
| Rate for Payer: Aetna American Axle |
$44.45
|
| Rate for Payer: Aetna Commercial |
$58.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.45
|
| Rate for Payer: Cash Price |
$54.71
|
| Rate for Payer: Cofinity Advantage |
$47.87
|
| Rate for Payer: Cofinity Commercial |
$58.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.71
|
| Rate for Payer: Healthscope Commercial |
$61.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.29
|
| Rate for Payer: PHP Commercial |
$58.13
|
| Rate for Payer: Priority Health SBD |
$43.09
|
| Rate for Payer: UMR Bronson Commercial |
$30.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.29
|
|
