|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
OP
|
$93.77
|
|
|
Service Code
|
NDC 69097085902
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Aetna American Axle |
$60.95
|
| Rate for Payer: Aetna Commercial |
$79.70
|
| Rate for Payer: Aetna Medicare |
$46.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.95
|
| Rate for Payer: BCBS Complete |
$37.51
|
| Rate for Payer: Cash Price |
$75.02
|
| Rate for Payer: Cofinity Advantage |
$65.64
|
| Rate for Payer: Cofinity Commercial |
$80.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.02
|
| Rate for Payer: Healthscope Commercial |
$84.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.33
|
| Rate for Payer: PHP Commercial |
$79.70
|
| Rate for Payer: Priority Health SBD |
$59.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.95
|
| Rate for Payer: UHC Core |
$48.85
|
| Rate for Payer: UHC Exchange |
$36.85
|
| Rate for Payer: UMR Bronson Commercial |
$34.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.33
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
OP
|
$68.39
|
|
|
Service Code
|
NDC 69097073102
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$61.55 |
| Rate for Payer: Aetna American Axle |
$44.45
|
| Rate for Payer: Aetna Commercial |
$58.13
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.45
|
| Rate for Payer: BCBS Complete |
$27.36
|
| 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: MI Amish Medical Board Commercial |
$54.71
|
| 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: UHC All Payor (Choice/PPO) |
$44.45
|
| Rate for Payer: UHC Core |
$35.63
|
| Rate for Payer: UHC Exchange |
$26.88
|
| Rate for Payer: UMR Bronson Commercial |
$25.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.29
|
|
|
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
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$93.77
|
|
|
Service Code
|
NDC 69097085902
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.26 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Aetna American Axle |
$60.95
|
| Rate for Payer: Aetna Commercial |
$79.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.95
|
| Rate for Payer: Cash Price |
$75.02
|
| Rate for Payer: Cofinity Advantage |
$65.64
|
| Rate for Payer: Cofinity Commercial |
$80.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.02
|
| Rate for Payer: Healthscope Commercial |
$84.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.33
|
| Rate for Payer: PHP Commercial |
$79.70
|
| Rate for Payer: Priority Health SBD |
$59.08
|
| Rate for Payer: UMR Bronson Commercial |
$41.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.33
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$66.41
|
|
|
Service Code
|
NDC 65862007930
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.22 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Aetna American Axle |
$43.17
|
| Rate for Payer: Aetna Commercial |
$56.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.17
|
| Rate for Payer: Cash Price |
$53.13
|
| Rate for Payer: Cofinity Advantage |
$46.49
|
| Rate for Payer: Cofinity Commercial |
$57.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.13
|
| Rate for Payer: Healthscope Commercial |
$59.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.81
|
| Rate for Payer: PHP Commercial |
$56.45
|
| Rate for Payer: Priority Health SBD |
$41.84
|
| Rate for Payer: UMR Bronson Commercial |
$29.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.81
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$21.32
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$19.19 |
| Rate for Payer: Aetna American Axle |
$13.86
|
| Rate for Payer: Aetna American Axle |
$10.99
|
| Rate for Payer: Aetna American Axle |
$15.63
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna Commercial |
$14.37
|
| Rate for Payer: Aetna Medicare |
$10.66
|
| Rate for Payer: Aetna Medicare |
$8.46
|
| Rate for Payer: Aetna Medicare |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: BCBS Complete |
$6.76
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cofinity Advantage |
$16.84
|
| Rate for Payer: Cofinity Advantage |
$14.92
|
| Rate for Payer: Cofinity Advantage |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$15.22
|
| Rate for Payer: Healthscope Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.12
|
| Rate for Payer: PHP Commercial |
$14.37
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: Priority Health SBD |
$10.65
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: Priority Health SBD |
$13.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC Core |
$4.08
|
| Rate for Payer: UHC Core |
$4.08
|
| Rate for Payer: UHC Core |
$4.08
|
| Rate for Payer: UHC Exchange |
$4.08
|
| Rate for Payer: UHC Exchange |
$4.08
|
| Rate for Payer: UHC Exchange |
$4.08
|
| Rate for Payer: UMR Bronson Commercial |
$8.90
|
| Rate for Payer: UMR Bronson Commercial |
$6.26
|
| Rate for Payer: UMR Bronson Commercial |
$7.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.04
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$16.91
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna American Axle |
$10.99
|
| Rate for Payer: Aetna American Axle |
$15.63
|
| Rate for Payer: Aetna American Axle |
$13.86
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Commercial |
$14.37
|
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Advantage |
$16.84
|
| Rate for Payer: Cofinity Advantage |
$11.84
|
| Rate for Payer: Cofinity Advantage |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$15.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.12
|
| Rate for Payer: PHP Commercial |
$14.37
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: Priority Health SBD |
$10.65
|
| Rate for Payer: Priority Health SBD |
$13.43
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: UMR Bronson Commercial |
$7.44
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
| Rate for Payer: UMR Bronson Commercial |
$9.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.04
|
|
|
TESTES PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$39,013.36
|
|
|
Service Code
|
MSDRG 711
|
| Min. Negotiated Rate |
$17,118.19 |
| Max. Negotiated Rate |
$39,013.36 |
| Rate for Payer: Aetna Medicare |
$18,739.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,523.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,523.94
|
| Rate for Payer: BCBS MAPPO |
$18,019.15
|
| Rate for Payer: BCBS Trust/PPO |
$39,013.36
|
| Rate for Payer: BCN Commercial |
$39,013.36
|
| Rate for Payer: BCN Medicare Advantage |
$18,019.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,019.15
|
| Rate for Payer: Mclaren Medicare |
$18,019.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,920.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,722.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,821.06
|
| Rate for Payer: Nomi Health Commercial |
$26,881.02
|
| Rate for Payer: PACE Medicare |
$17,118.19
|
| Rate for Payer: PACE SWMI |
$18,019.15
|
| Rate for Payer: PHP Medicare Advantage |
$18,019.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,595.32
|
| Rate for Payer: Priority Health Medicare |
$18,019.15
|
| Rate for Payer: Priority Health Tiered Network |
$26,876.25
|
| Rate for Payer: Railroad Medicare Medicare |
$18,019.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,965.94
|
| Rate for Payer: UHC Core |
$28,416.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,019.15
|
| Rate for Payer: UHC Exchange |
$23,207.28
|
| Rate for Payer: VA VA |
$18,019.15
|
|
|
TESTES PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,505.11
|
|
|
Service Code
|
MSDRG 712
|
| Min. Negotiated Rate |
$9,299.95 |
| Max. Negotiated Rate |
$21,505.11 |
| Rate for Payer: Aetna Medicare |
$10,181.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,236.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,236.77
|
| Rate for Payer: BCBS MAPPO |
$9,789.42
|
| Rate for Payer: BCBS Trust/PPO |
$21,505.11
|
| Rate for Payer: BCN Commercial |
$21,505.11
|
| Rate for Payer: BCN Medicare Advantage |
$9,789.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,789.42
|
| Rate for Payer: Mclaren Medicare |
$9,789.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,278.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,768.36
|
| Rate for Payer: Nomi Health Commercial |
$14,186.13
|
| Rate for Payer: PACE Medicare |
$9,299.95
|
| Rate for Payer: PACE SWMI |
$9,789.42
|
| Rate for Payer: PHP Medicare Advantage |
$9,789.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,729.52
|
| Rate for Payer: Priority Health Medicare |
$9,789.42
|
| Rate for Payer: Priority Health Tiered Network |
$14,183.61
|
| Rate for Payer: Railroad Medicare Medicare |
$9,789.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,925.11
|
| Rate for Payer: UHC Core |
$14,996.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,789.42
|
| Rate for Payer: UHC Exchange |
$12,247.36
|
| Rate for Payer: VA VA |
$9,789.42
|
|
|
TESTOSTERONE 1 % (25 MG/2.5 GRAM) TRANSDERMAL GEL PACKET
|
Facility
|
OP
|
$64.11
|
|
|
Service Code
|
NDC 00051842530
|
| Hospital Charge Code |
109728
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$57.70 |
| Rate for Payer: Aetna American Axle |
$41.67
|
| Rate for Payer: Aetna Commercial |
$54.49
|
| Rate for Payer: Aetna Medicare |
$32.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.67
|
| Rate for Payer: BCBS Complete |
$25.64
|
| Rate for Payer: Cash Price |
$51.29
|
| Rate for Payer: Cofinity Advantage |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$55.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.29
|
| Rate for Payer: Healthscope Commercial |
$57.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.08
|
| Rate for Payer: PHP Commercial |
$54.49
|
| Rate for Payer: Priority Health SBD |
$40.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.67
|
| Rate for Payer: UHC Core |
$33.40
|
| Rate for Payer: UHC Exchange |
$25.20
|
| Rate for Payer: UMR Bronson Commercial |
$23.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.08
|
|
|
TESTOSTERONE 1 % (25 MG/2.5 GRAM) TRANSDERMAL GEL PACKET
|
Facility
|
IP
|
$64.11
|
|
|
Service Code
|
NDC 00051842530
|
| Hospital Charge Code |
109728
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$57.70 |
| Rate for Payer: Aetna American Axle |
$41.67
|
| Rate for Payer: Aetna Commercial |
$54.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.67
|
| Rate for Payer: Cash Price |
$51.29
|
| Rate for Payer: Cofinity Advantage |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$55.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.29
|
| Rate for Payer: Healthscope Commercial |
$57.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.08
|
| Rate for Payer: PHP Commercial |
$54.49
|
| Rate for Payer: Priority Health SBD |
$40.39
|
| Rate for Payer: UMR Bronson Commercial |
$28.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.08
|
|
|
TESTOSTERONE 1 % (50 MG/5 GRAM) TRANSDERMAL GEL PACKET
|
Facility
|
IP
|
$13.30
|
|
|
Service Code
|
NDC 00832112089
|
| Hospital Charge Code |
36093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$11.97 |
| Rate for Payer: Aetna American Axle |
$8.64
|
| Rate for Payer: Aetna Commercial |
$11.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.64
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cofinity Advantage |
$9.31
|
| Rate for Payer: Cofinity Commercial |
$11.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.64
|
| Rate for Payer: Healthscope Commercial |
$11.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.97
|
| Rate for Payer: PHP Commercial |
$11.30
|
| Rate for Payer: Priority Health SBD |
$8.38
|
| Rate for Payer: UMR Bronson Commercial |
$5.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.97
|
|
|
TESTOSTERONE 1 % (50 MG/5 GRAM) TRANSDERMAL GEL PACKET
|
Facility
|
OP
|
$13.30
|
|
|
Service Code
|
NDC 00832112089
|
| Hospital Charge Code |
36093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$11.97 |
| Rate for Payer: Aetna American Axle |
$8.64
|
| Rate for Payer: Aetna Commercial |
$11.30
|
| Rate for Payer: Aetna Medicare |
$6.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.64
|
| Rate for Payer: BCBS Complete |
$5.32
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cofinity Advantage |
$9.31
|
| Rate for Payer: Cofinity Commercial |
$11.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.64
|
| Rate for Payer: Healthscope Commercial |
$11.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.97
|
| Rate for Payer: PHP Commercial |
$11.30
|
| Rate for Payer: Priority Health SBD |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.64
|
| Rate for Payer: UHC Core |
$6.93
|
| Rate for Payer: UHC Exchange |
$5.23
|
| Rate for Payer: UMR Bronson Commercial |
$4.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.97
|
|
|
TESTOSTERONE 1 % (50 MG/5 GRAM) TRANSDERMAL GEL PACKET
|
Facility
|
OP
|
$13.30
|
|
|
Service Code
|
NDC 00832112035
|
| Hospital Charge Code |
36093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$11.97 |
| Rate for Payer: Aetna American Axle |
$8.64
|
| Rate for Payer: Aetna Commercial |
$11.30
|
| Rate for Payer: Aetna Medicare |
$6.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.64
|
| Rate for Payer: BCBS Complete |
$5.32
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cofinity Advantage |
$9.31
|
| Rate for Payer: Cofinity Commercial |
$11.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.64
|
| Rate for Payer: Healthscope Commercial |
$11.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.97
|
| Rate for Payer: PHP Commercial |
$11.30
|
| Rate for Payer: Priority Health SBD |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.64
|
| Rate for Payer: UHC Core |
$6.93
|
| Rate for Payer: UHC Exchange |
$5.23
|
| Rate for Payer: UMR Bronson Commercial |
$4.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.97
|
|
|
TESTOSTERONE 1 % (50 MG/5 GRAM) TRANSDERMAL GEL PACKET
|
Facility
|
IP
|
$13.30
|
|
|
Service Code
|
NDC 00832112035
|
| Hospital Charge Code |
36093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$11.97 |
| Rate for Payer: Aetna American Axle |
$8.64
|
| Rate for Payer: Aetna Commercial |
$11.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.64
|
| Rate for Payer: Cash Price |
$10.64
|
| Rate for Payer: Cofinity Advantage |
$9.31
|
| Rate for Payer: Cofinity Commercial |
$11.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.64
|
| Rate for Payer: Healthscope Commercial |
$11.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.97
|
| Rate for Payer: PHP Commercial |
$11.30
|
| Rate for Payer: Priority Health SBD |
$8.38
|
| Rate for Payer: UMR Bronson Commercial |
$5.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.97
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$325.50
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna American Axle |
$211.57
|
| Rate for Payer: Aetna American Axle |
$26.98
|
| Rate for Payer: Aetna American Axle |
$40.66
|
| Rate for Payer: Aetna American Axle |
$269.00
|
| Rate for Payer: Aetna American Axle |
$417.62
|
| Rate for Payer: Aetna American Axle |
$259.64
|
| Rate for Payer: Aetna American Axle |
$42.31
|
| Rate for Payer: Aetna American Axle |
$55.15
|
| Rate for Payer: Aetna American Axle |
$71.89
|
| Rate for Payer: Aetna American Axle |
$57.23
|
| Rate for Payer: Aetna American Axle |
$23.82
|
| Rate for Payer: Aetna Commercial |
$94.01
|
| Rate for Payer: Aetna Commercial |
$74.84
|
| Rate for Payer: Aetna Commercial |
$72.12
|
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna Commercial |
$55.34
|
| Rate for Payer: Aetna Commercial |
$339.53
|
| Rate for Payer: Aetna Commercial |
$31.15
|
| Rate for Payer: Aetna Commercial |
$546.12
|
| Rate for Payer: Aetna Commercial |
$351.77
|
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Aetna Commercial |
$53.17
|
| Rate for Payer: Aetna Medicare |
$44.02
|
| Rate for Payer: Aetna Medicare |
$18.32
|
| Rate for Payer: Aetna Medicare |
$55.30
|
| Rate for Payer: Aetna Medicare |
$199.72
|
| Rate for Payer: Aetna Medicare |
$162.75
|
| Rate for Payer: Aetna Medicare |
$32.55
|
| Rate for Payer: Aetna Medicare |
$42.42
|
| Rate for Payer: Aetna Medicare |
$321.25
|
| Rate for Payer: Aetna Medicare |
$20.75
|
| Rate for Payer: Aetna Medicare |
$31.27
|
| Rate for Payer: Aetna Medicare |
$206.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.23
|
| Rate for Payer: BCBS Complete |
$16.60
|
| Rate for Payer: BCBS Complete |
$159.78
|
| Rate for Payer: BCBS Complete |
$44.24
|
| Rate for Payer: BCBS Complete |
$257.00
|
| Rate for Payer: BCBS Complete |
$35.22
|
| Rate for Payer: BCBS Complete |
$25.02
|
| Rate for Payer: BCBS Complete |
$165.54
|
| Rate for Payer: BCBS Complete |
$33.94
|
| Rate for Payer: BCBS Complete |
$130.20
|
| Rate for Payer: BCBS Complete |
$26.04
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cash Price |
$29.32
|
| Rate for Payer: Cash Price |
$29.32
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cash Price |
$70.44
|
| Rate for Payer: Cash Price |
$67.88
|
| Rate for Payer: Cash Price |
$50.04
|
| Rate for Payer: Cash Price |
$67.88
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cash Price |
$319.56
|
| Rate for Payer: Cash Price |
$319.56
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cash Price |
$33.20
|
| Rate for Payer: Cash Price |
$514.00
|
| Rate for Payer: Cash Price |
$331.08
|
| Rate for Payer: Cash Price |
$331.08
|
| Rate for Payer: Cash Price |
$50.04
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cofinity Advantage |
$45.57
|
| Rate for Payer: Cofinity Advantage |
$227.85
|
| Rate for Payer: Cofinity Advantage |
$289.69
|
| Rate for Payer: Cofinity Advantage |
$279.62
|
| Rate for Payer: Cofinity Advantage |
$25.66
|
| Rate for Payer: Cofinity Advantage |
$29.05
|
| Rate for Payer: Cofinity Advantage |
$43.78
|
| Rate for Payer: Cofinity Advantage |
$77.42
|
| Rate for Payer: Cofinity Advantage |
$449.75
|
| Rate for Payer: Cofinity Advantage |
$61.63
|
| Rate for Payer: Cofinity Advantage |
$59.40
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Cofinity Commercial |
$552.55
|
| Rate for Payer: Cofinity Commercial |
$53.79
|
| Rate for Payer: Cofinity Commercial |
$55.99
|
| Rate for Payer: Cofinity Commercial |
$72.97
|
| Rate for Payer: Cofinity Commercial |
$355.91
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$75.72
|
| Rate for Payer: Cofinity Commercial |
$31.52
|
| Rate for Payer: Cofinity Commercial |
$343.53
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.00
|
| Rate for Payer: Healthscope Commercial |
$76.36
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Healthscope Commercial |
$99.54
|
| Rate for Payer: Healthscope Commercial |
$32.98
|
| Rate for Payer: Healthscope Commercial |
$359.50
|
| Rate for Payer: Healthscope Commercial |
$372.46
|
| Rate for Payer: Healthscope Commercial |
$37.35
|
| Rate for Payer: Healthscope Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$578.25
|
| Rate for Payer: Healthscope Commercial |
$58.59
|
| Rate for Payer: Healthscope Commercial |
$79.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$449.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$481.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.49
|
| Rate for Payer: PHP Commercial |
$35.27
|
| Rate for Payer: PHP Commercial |
$546.12
|
| Rate for Payer: PHP Commercial |
$53.17
|
| Rate for Payer: PHP Commercial |
$339.53
|
| Rate for Payer: PHP Commercial |
$72.12
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: PHP Commercial |
$55.34
|
| Rate for Payer: PHP Commercial |
$74.84
|
| Rate for Payer: PHP Commercial |
$351.77
|
| Rate for Payer: PHP Commercial |
$94.01
|
| Rate for Payer: PHP Commercial |
$31.15
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| Rate for Payer: Priority Health SBD |
$41.01
|
| Rate for Payer: Priority Health SBD |
$69.68
|
| Rate for Payer: Priority Health SBD |
$26.14
|
| Rate for Payer: Priority Health SBD |
$251.65
|
| Rate for Payer: Priority Health SBD |
$404.77
|
| Rate for Payer: Priority Health SBD |
$55.47
|
| Rate for Payer: Priority Health SBD |
$23.09
|
| Rate for Payer: Priority Health SBD |
$53.46
|
| Rate for Payer: Priority Health SBD |
$39.41
|
| Rate for Payer: Priority Health SBD |
$260.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$40.92
|
| Rate for Payer: UMR Bronson Commercial |
$24.09
|
| Rate for Payer: UMR Bronson Commercial |
$32.58
|
| Rate for Payer: UMR Bronson Commercial |
$23.14
|
| Rate for Payer: UMR Bronson Commercial |
$31.39
|
| Rate for Payer: UMR Bronson Commercial |
$13.56
|
| Rate for Payer: UMR Bronson Commercial |
$237.72
|
| Rate for Payer: UMR Bronson Commercial |
$153.12
|
| Rate for Payer: UMR Bronson Commercial |
$147.80
|
| Rate for Payer: UMR Bronson Commercial |
$15.36
|
| Rate for Payer: UMR Bronson Commercial |
$120.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.39
|
|
|
TESTOSTERONE CYPIONATE 200 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$62.55
|
|
|
Service Code
|
HCPCS J1071
|
| Hospital Charge Code |
7784
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$56.30 |
| Rate for Payer: Aetna American Axle |
$40.66
|
| Rate for Payer: Aetna American Axle |
$211.57
|
| Rate for Payer: Aetna American Axle |
$55.15
|
| Rate for Payer: Aetna American Axle |
$71.89
|
| Rate for Payer: Aetna Commercial |
$72.12
|
| Rate for Payer: Aetna Commercial |
$53.17
|
| Rate for Payer: Aetna Commercial |
$94.01
|
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.89
|
| Rate for Payer: Cash Price |
$88.48
|
| Rate for Payer: Cash Price |
$67.88
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$50.04
|
| Rate for Payer: Cofinity Advantage |
$227.85
|
| Rate for Payer: Cofinity Advantage |
$77.42
|
| Rate for Payer: Cofinity Advantage |
$43.78
|
| Rate for Payer: Cofinity Advantage |
$59.40
|
| Rate for Payer: Cofinity Commercial |
$53.79
|
| Rate for Payer: Cofinity Commercial |
$95.12
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Cofinity Commercial |
$72.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Healthscope Commercial |
$76.36
|
| Rate for Payer: Healthscope Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$99.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.95
|
| Rate for Payer: PHP Commercial |
$94.01
|
| Rate for Payer: PHP Commercial |
$53.17
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: PHP Commercial |
$72.12
|
| Rate for Payer: Priority Health SBD |
$53.46
|
| Rate for Payer: Priority Health SBD |
$69.68
|
| Rate for Payer: Priority Health SBD |
$39.41
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| Rate for Payer: UMR Bronson Commercial |
$143.22
|
| Rate for Payer: UMR Bronson Commercial |
$27.52
|
| Rate for Payer: UMR Bronson Commercial |
$48.66
|
| Rate for Payer: UMR Bronson Commercial |
$37.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.64
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$1,694.95
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$745.78 |
| Max. Negotiated Rate |
$1,525.45 |
| Rate for Payer: Aetna American Axle |
$1,101.72
|
| Rate for Payer: Aetna Commercial |
$1,440.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,101.72
|
| Rate for Payer: Cash Price |
$1,355.96
|
| Rate for Payer: Cofinity Advantage |
$1,186.46
|
| Rate for Payer: Cofinity Commercial |
$1,457.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,355.96
|
| Rate for Payer: Healthscope Commercial |
$1,525.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,186.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,271.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,440.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.21
|
| Rate for Payer: PHP Commercial |
$1,440.71
|
| Rate for Payer: Priority Health SBD |
$1,067.82
|
| Rate for Payer: UMR Bronson Commercial |
$745.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,271.21
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT/ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$1,694.95
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
118208
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$291.90 |
| Max. Negotiated Rate |
$1,908.41 |
| Rate for Payer: Aetna American Axle |
$1,101.72
|
| Rate for Payer: Aetna Commercial |
$1,440.71
|
| Rate for Payer: Aetna Medicare |
$580.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,101.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.65
|
| Rate for Payer: BCBS Complete |
$306.52
|
| Rate for Payer: BCBS MAPPO |
$558.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.41
|
| Rate for Payer: BCN Commercial |
$1,908.41
|
| Rate for Payer: BCN Medicare Advantage |
$558.12
|
| Rate for Payer: Cash Price |
$1,355.96
|
| Rate for Payer: Cash Price |
$1,355.96
|
| Rate for Payer: Cofinity Advantage |
$1,186.46
|
| Rate for Payer: Cofinity Commercial |
$1,457.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,355.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.12
|
| Rate for Payer: Healthscope Commercial |
$1,525.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,186.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,271.21
|
| Rate for Payer: Mclaren Medicaid |
$558.12
|
| Rate for Payer: Mclaren Medicare |
$558.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$586.03
|
| Rate for Payer: Meridian Medicaid |
$586.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$641.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$613.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,440.71
|
| Rate for Payer: Nomi Health Commercial |
$1,674.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,271.21
|
| Rate for Payer: PACE Medicare |
$530.21
|
| Rate for Payer: PACE SWMI |
$558.12
|
| Rate for Payer: PHP Commercial |
$1,440.71
|
| Rate for Payer: PHP Medicare Advantage |
$558.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$291.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,870.30
|
| Rate for Payer: Priority Health Medicare |
$558.12
|
| Rate for Payer: Priority Health SBD |
$1,067.82
|
| Rate for Payer: Priority Health Tiered Network |
$1,496.24
|
| Rate for Payer: Railroad Medicare Medicare |
$558.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.09
|
| Rate for Payer: UHC Core |
$971.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$558.12
|
| Rate for Payer: UHC Exchange |
$971.09
|
| Rate for Payer: UHC Medicaid |
$291.90
|
| Rate for Payer: UHCCP Medicaid |
$291.90
|
| Rate for Payer: UMR Bronson Commercial |
$627.13
|
| Rate for Payer: VA VA |
$558.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,271.21
|
|
|
TETRACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$87.85
|
|
|
Service Code
|
NDC 68682092005
|
| Hospital Charge Code |
7795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$79.06 |
| Rate for Payer: Aetna American Axle |
$57.10
|
| Rate for Payer: Aetna Commercial |
$74.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.10
|
| Rate for Payer: Cash Price |
$70.28
|
| Rate for Payer: Cofinity Advantage |
$61.49
|
| Rate for Payer: Cofinity Commercial |
$75.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.28
|
| Rate for Payer: Healthscope Commercial |
$79.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.89
|
| Rate for Payer: PHP Commercial |
$74.67
|
| Rate for Payer: Priority Health SBD |
$55.35
|
| Rate for Payer: UMR Bronson Commercial |
$38.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.89
|
|
|
TETRACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$87.85
|
|
|
Service Code
|
NDC 68682092005
|
| Hospital Charge Code |
7795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$79.06 |
| Rate for Payer: Aetna American Axle |
$57.10
|
| Rate for Payer: Aetna Commercial |
$74.67
|
| Rate for Payer: Aetna Medicare |
$43.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.10
|
| Rate for Payer: BCBS Complete |
$35.14
|
| Rate for Payer: Cash Price |
$70.28
|
| Rate for Payer: Cofinity Advantage |
$61.49
|
| Rate for Payer: Cofinity Commercial |
$75.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.28
|
| Rate for Payer: Healthscope Commercial |
$79.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.89
|
| Rate for Payer: PHP Commercial |
$74.67
|
| Rate for Payer: Priority Health SBD |
$55.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.10
|
| Rate for Payer: UHC Core |
$45.77
|
| Rate for Payer: UHC Exchange |
$34.53
|
| Rate for Payer: UMR Bronson Commercial |
$32.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.89
|
|
|
TETRACAINE HCL (BULK) POWDER
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
NDC 51552026909
|
| Hospital Charge Code |
13583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna American Axle |
$18.20
|
| Rate for Payer: Aetna Commercial |
$23.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Advantage |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$24.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.40
|
| Rate for Payer: Healthscope Commercial |
$25.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.00
|
| Rate for Payer: PHP Commercial |
$23.80
|
| Rate for Payer: Priority Health SBD |
$17.64
|
| Rate for Payer: UMR Bronson Commercial |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.00
|
|
|
TETRACAINE HCL (BULK) POWDER
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
NDC 62991206702
|
| Hospital Charge Code |
13583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Aetna American Axle |
$257.40
|
| Rate for Payer: Aetna Commercial |
$336.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cofinity Advantage |
$277.20
|
| Rate for Payer: Cofinity Commercial |
$340.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.80
|
| Rate for Payer: Healthscope Commercial |
$356.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.00
|
| Rate for Payer: PHP Commercial |
$336.60
|
| Rate for Payer: Priority Health SBD |
$249.48
|
| Rate for Payer: UMR Bronson Commercial |
$174.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.00
|
|
|
TETRACAINE HCL (BULK) POWDER
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
NDC 62991206702
|
| Hospital Charge Code |
13583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.52 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Aetna American Axle |
$257.40
|
| Rate for Payer: Aetna Commercial |
$336.60
|
| Rate for Payer: Aetna Medicare |
$198.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.40
|
| Rate for Payer: BCBS Complete |
$158.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cofinity Advantage |
$277.20
|
| Rate for Payer: Cofinity Commercial |
$340.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.80
|
| Rate for Payer: Healthscope Commercial |
$356.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.00
|
| Rate for Payer: PHP Commercial |
$336.60
|
| Rate for Payer: Priority Health SBD |
$249.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.40
|
| Rate for Payer: UHC Core |
$206.32
|
| Rate for Payer: UHC Exchange |
$155.63
|
| Rate for Payer: UMR Bronson Commercial |
$146.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.00
|
|
|
TETRACAINE HCL (BULK) POWDER
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
NDC 51552026909
|
| Hospital Charge Code |
13583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: Aetna American Axle |
$18.20
|
| Rate for Payer: Aetna Commercial |
$23.80
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.20
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Advantage |
$19.60
|
| Rate for Payer: Cofinity Commercial |
$24.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.40
|
| Rate for Payer: Healthscope Commercial |
$25.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.00
|
| Rate for Payer: PHP Commercial |
$23.80
|
| Rate for Payer: Priority Health SBD |
$17.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.20
|
| Rate for Payer: UHC Core |
$14.59
|
| Rate for Payer: UHC Exchange |
$11.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.00
|
|
