|
THIOTHIXENE 5 MG CAPSULE
|
Facility
|
IP
|
$703.68
|
|
|
Service Code
|
NDC 70954001610
|
| Hospital Charge Code |
7906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$309.62 |
| Max. Negotiated Rate |
$633.31 |
| Rate for Payer: Aetna American Axle |
$457.39
|
| Rate for Payer: Aetna Commercial |
$598.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.39
|
| Rate for Payer: Cash Price |
$562.94
|
| Rate for Payer: Cofinity Advantage |
$492.58
|
| Rate for Payer: Cofinity Commercial |
$605.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$562.94
|
| Rate for Payer: Healthscope Commercial |
$633.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$492.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$527.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$527.76
|
| Rate for Payer: PHP Commercial |
$598.13
|
| Rate for Payer: Priority Health SBD |
$443.32
|
| Rate for Payer: UMR Bronson Commercial |
$309.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$527.76
|
|
|
THIOTHIXENE 5 MG CAPSULE
|
Facility
|
OP
|
$703.68
|
|
|
Service Code
|
NDC 70954001610
|
| Hospital Charge Code |
7906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.36 |
| Max. Negotiated Rate |
$633.31 |
| Rate for Payer: Aetna American Axle |
$457.39
|
| Rate for Payer: Aetna Commercial |
$598.13
|
| Rate for Payer: Aetna Medicare |
$351.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.39
|
| Rate for Payer: BCBS Complete |
$281.47
|
| Rate for Payer: Cash Price |
$562.94
|
| Rate for Payer: Cofinity Advantage |
$492.58
|
| Rate for Payer: Cofinity Commercial |
$605.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$562.94
|
| Rate for Payer: Healthscope Commercial |
$633.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$492.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$527.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$562.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$527.76
|
| Rate for Payer: PHP Commercial |
$598.13
|
| Rate for Payer: Priority Health SBD |
$443.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.39
|
| Rate for Payer: UHC Core |
$366.62
|
| Rate for Payer: UHC Exchange |
$276.55
|
| Rate for Payer: UMR Bronson Commercial |
$260.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$527.76
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$2,021.35
|
|
|
Service Code
|
CPT 32555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$2,021.35 |
| Rate for Payer: Aetna Medicare |
$650.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$881.29
|
| Rate for Payer: BCN Commercial |
$881.29
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Mclaren Medicaid |
$625.05
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$656.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Nomi Health Commercial |
$1,875.15
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,021.35
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,617.08
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: VA VA |
$625.05
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$2,021.35
|
|
|
Service Code
|
CPT 32554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$2,021.35 |
| Rate for Payer: Aetna Medicare |
$650.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$550.04
|
| Rate for Payer: BCN Commercial |
$550.04
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Mclaren Medicaid |
$625.05
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$656.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Nomi Health Commercial |
$1,875.15
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,021.35
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,617.08
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: VA VA |
$625.05
|
|
|
THORACOSCOPY; WITH BIOPSY(IES) OF PLEURA
|
Facility
|
OP
|
$19,480.40
|
|
|
Service Code
|
CPT 32609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.44 |
| Max. Negotiated Rate |
$19,480.40 |
| Rate for Payer: Aetna Medicare |
$6,264.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,738.06
|
| Rate for Payer: BCN Commercial |
$4,738.06
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Mclaren Medicaid |
$6,023.79
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$6,324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Nomi Health Commercial |
$18,071.37
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,480.40
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health Tiered Network |
$15,584.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
|
THROMBECTOMY, OPEN, ARTERIOVENOUS FISTULA WITHOUT REVISION, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$17,930.33
|
|
|
Service Code
|
CPT 36831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,544.91
|
| Rate for Payer: BCN Commercial |
$3,544.91
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
THROMBIN 5000UNITS/EPINEPHRINE TOPICAL 30ML/NS 1L
|
Facility
|
IP
|
$218.05
|
|
|
Service Code
|
NDC 09900000200
|
| Hospital Charge Code |
500527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.94 |
| Max. Negotiated Rate |
$196.25 |
| Rate for Payer: Aetna American Axle |
$141.73
|
| Rate for Payer: Aetna Commercial |
$185.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.73
|
| Rate for Payer: Cash Price |
$174.44
|
| Rate for Payer: Cofinity Advantage |
$152.63
|
| Rate for Payer: Cofinity Commercial |
$187.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.44
|
| Rate for Payer: Healthscope Commercial |
$196.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.54
|
| Rate for Payer: PHP Commercial |
$185.34
|
| Rate for Payer: Priority Health SBD |
$137.37
|
| Rate for Payer: UMR Bronson Commercial |
$95.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.54
|
|
|
THROMBIN 5000UNITS/EPINEPHRINE TOPICAL 30ML/NS 1L
|
Facility
|
OP
|
$218.05
|
|
|
Service Code
|
NDC 09900000200
|
| Hospital Charge Code |
500527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.68 |
| Max. Negotiated Rate |
$196.25 |
| Rate for Payer: Aetna American Axle |
$141.73
|
| Rate for Payer: Aetna Commercial |
$185.34
|
| Rate for Payer: Aetna Medicare |
$109.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.73
|
| Rate for Payer: BCBS Complete |
$87.22
|
| Rate for Payer: Cash Price |
$174.44
|
| Rate for Payer: Cofinity Advantage |
$152.63
|
| Rate for Payer: Cofinity Commercial |
$187.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.44
|
| Rate for Payer: Healthscope Commercial |
$196.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.54
|
| Rate for Payer: PHP Commercial |
$185.34
|
| Rate for Payer: Priority Health SBD |
$137.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.73
|
| Rate for Payer: UHC Core |
$113.60
|
| Rate for Payer: UHC Exchange |
$85.69
|
| Rate for Payer: UMR Bronson Commercial |
$80.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.54
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SOLUTION
|
Facility
|
OP
|
$765.50
|
|
|
Service Code
|
NDC 60793021720
|
| Hospital Charge Code |
108932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$283.24 |
| Max. Negotiated Rate |
$688.95 |
| Rate for Payer: Aetna American Axle |
$497.57
|
| Rate for Payer: Aetna Commercial |
$650.67
|
| Rate for Payer: Aetna Medicare |
$382.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.57
|
| Rate for Payer: BCBS Complete |
$306.20
|
| Rate for Payer: Cash Price |
$612.40
|
| Rate for Payer: Cofinity Advantage |
$535.85
|
| Rate for Payer: Cofinity Commercial |
$658.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.40
|
| Rate for Payer: Healthscope Commercial |
$688.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$535.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$612.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.12
|
| Rate for Payer: PHP Commercial |
$650.67
|
| Rate for Payer: Priority Health SBD |
$482.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.57
|
| Rate for Payer: UHC Core |
$398.83
|
| Rate for Payer: UHC Exchange |
$300.84
|
| Rate for Payer: UMR Bronson Commercial |
$283.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.12
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SOLUTION
|
Facility
|
IP
|
$765.50
|
|
|
Service Code
|
NDC 60793021720
|
| Hospital Charge Code |
108932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$336.82 |
| Max. Negotiated Rate |
$688.95 |
| Rate for Payer: Aetna American Axle |
$497.57
|
| Rate for Payer: Aetna Commercial |
$650.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.57
|
| Rate for Payer: Cash Price |
$612.40
|
| Rate for Payer: Cofinity Advantage |
$535.85
|
| Rate for Payer: Cofinity Commercial |
$658.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.40
|
| Rate for Payer: Healthscope Commercial |
$688.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$535.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.12
|
| Rate for Payer: PHP Commercial |
$650.67
|
| Rate for Payer: Priority Health SBD |
$482.26
|
| Rate for Payer: UMR Bronson Commercial |
$336.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.12
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
IP
|
$876.13
|
|
|
Service Code
|
NDC 60793021721
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$385.50 |
| Max. Negotiated Rate |
$788.52 |
| Rate for Payer: Aetna American Axle |
$569.48
|
| Rate for Payer: Aetna Commercial |
$744.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.48
|
| Rate for Payer: Cash Price |
$700.90
|
| Rate for Payer: Cofinity Advantage |
$613.29
|
| Rate for Payer: Cofinity Commercial |
$753.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.90
|
| Rate for Payer: Healthscope Commercial |
$788.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$613.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.10
|
| Rate for Payer: PHP Commercial |
$744.71
|
| Rate for Payer: Priority Health SBD |
$551.96
|
| Rate for Payer: UMR Bronson Commercial |
$385.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.10
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
IP
|
$876.13
|
|
|
Service Code
|
NDC 60793021722
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$385.50 |
| Max. Negotiated Rate |
$788.52 |
| Rate for Payer: Aetna American Axle |
$569.48
|
| Rate for Payer: Aetna Commercial |
$744.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.48
|
| Rate for Payer: Cash Price |
$700.90
|
| Rate for Payer: Cofinity Advantage |
$613.29
|
| Rate for Payer: Cofinity Commercial |
$753.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.90
|
| Rate for Payer: Healthscope Commercial |
$788.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$613.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.10
|
| Rate for Payer: PHP Commercial |
$744.71
|
| Rate for Payer: Priority Health SBD |
$551.96
|
| Rate for Payer: UMR Bronson Commercial |
$385.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.10
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
OP
|
$876.13
|
|
|
Service Code
|
NDC 60793021722
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$324.17 |
| Max. Negotiated Rate |
$788.52 |
| Rate for Payer: Aetna American Axle |
$569.48
|
| Rate for Payer: Aetna Commercial |
$744.71
|
| Rate for Payer: Aetna Medicare |
$438.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.48
|
| Rate for Payer: BCBS Complete |
$350.45
|
| Rate for Payer: Cash Price |
$700.90
|
| Rate for Payer: Cofinity Advantage |
$613.29
|
| Rate for Payer: Cofinity Commercial |
$753.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.90
|
| Rate for Payer: Healthscope Commercial |
$788.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$613.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$700.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.10
|
| Rate for Payer: PHP Commercial |
$744.71
|
| Rate for Payer: Priority Health SBD |
$551.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.48
|
| Rate for Payer: UHC Core |
$456.46
|
| Rate for Payer: UHC Exchange |
$344.32
|
| Rate for Payer: UMR Bronson Commercial |
$324.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.10
|
|
|
THROMBIN (BOVINE) 20,000 UNIT TOPICAL SPRAY
|
Facility
|
OP
|
$876.13
|
|
|
Service Code
|
NDC 60793021721
|
| Hospital Charge Code |
108841
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$324.17 |
| Max. Negotiated Rate |
$788.52 |
| Rate for Payer: Aetna American Axle |
$569.48
|
| Rate for Payer: Aetna Commercial |
$744.71
|
| Rate for Payer: Aetna Medicare |
$438.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.48
|
| Rate for Payer: BCBS Complete |
$350.45
|
| Rate for Payer: Cash Price |
$700.90
|
| Rate for Payer: Cofinity Advantage |
$613.29
|
| Rate for Payer: Cofinity Commercial |
$753.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.90
|
| Rate for Payer: Healthscope Commercial |
$788.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$613.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$700.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.10
|
| Rate for Payer: PHP Commercial |
$744.71
|
| Rate for Payer: Priority Health SBD |
$551.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.48
|
| Rate for Payer: UHC Core |
$456.46
|
| Rate for Payer: UHC Exchange |
$344.32
|
| Rate for Payer: UMR Bronson Commercial |
$324.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.10
|
|
|
THROMBIN (BOVINE) 5,000 UNIT NASAL SPRAY SYRINGE
|
Facility
|
OP
|
$217.41
|
|
|
Service Code
|
NDC 60793020505
|
| Hospital Charge Code |
161618
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.44 |
| Max. Negotiated Rate |
$195.67 |
| Rate for Payer: Aetna American Axle |
$141.32
|
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Aetna Medicare |
$108.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.32
|
| Rate for Payer: BCBS Complete |
$86.96
|
| Rate for Payer: Cash Price |
$173.93
|
| Rate for Payer: Cofinity Advantage |
$152.19
|
| Rate for Payer: Cofinity Commercial |
$186.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.93
|
| Rate for Payer: Healthscope Commercial |
$195.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.06
|
| Rate for Payer: PHP Commercial |
$184.80
|
| Rate for Payer: Priority Health SBD |
$136.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.32
|
| Rate for Payer: UHC Core |
$113.27
|
| Rate for Payer: UHC Exchange |
$85.44
|
| Rate for Payer: UMR Bronson Commercial |
$80.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.06
|
|
|
THROMBIN (BOVINE) 5,000 UNIT NASAL SPRAY SYRINGE
|
Facility
|
IP
|
$217.41
|
|
|
Service Code
|
NDC 60793020505
|
| Hospital Charge Code |
161618
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.66 |
| Max. Negotiated Rate |
$195.67 |
| Rate for Payer: Aetna American Axle |
$141.32
|
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.32
|
| Rate for Payer: Cash Price |
$173.93
|
| Rate for Payer: Cofinity Advantage |
$152.19
|
| Rate for Payer: Cofinity Commercial |
$186.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.93
|
| Rate for Payer: Healthscope Commercial |
$195.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.06
|
| Rate for Payer: PHP Commercial |
$184.80
|
| Rate for Payer: Priority Health SBD |
$136.97
|
| Rate for Payer: UMR Bronson Commercial |
$95.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.06
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
IP
|
$194.11
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$174.70 |
| Rate for Payer: Aetna American Axle |
$126.17
|
| Rate for Payer: Aetna Commercial |
$164.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.17
|
| Rate for Payer: Cash Price |
$155.29
|
| Rate for Payer: Cofinity Advantage |
$135.88
|
| Rate for Payer: Cofinity Commercial |
$166.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.29
|
| Rate for Payer: Healthscope Commercial |
$174.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.58
|
| Rate for Payer: PHP Commercial |
$164.99
|
| Rate for Payer: Priority Health SBD |
$122.29
|
| Rate for Payer: UMR Bronson Commercial |
$85.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.58
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
OP
|
$194.11
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$174.70 |
| Rate for Payer: Aetna American Axle |
$126.17
|
| Rate for Payer: Aetna Commercial |
$164.99
|
| Rate for Payer: Aetna Medicare |
$97.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.17
|
| Rate for Payer: BCBS Complete |
$77.64
|
| Rate for Payer: Cash Price |
$155.29
|
| Rate for Payer: Cofinity Advantage |
$135.88
|
| Rate for Payer: Cofinity Commercial |
$166.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.29
|
| Rate for Payer: Healthscope Commercial |
$174.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.58
|
| Rate for Payer: PHP Commercial |
$164.99
|
| Rate for Payer: Priority Health SBD |
$122.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.17
|
| Rate for Payer: UHC Core |
$101.13
|
| Rate for Payer: UHC Exchange |
$76.29
|
| Rate for Payer: UMR Bronson Commercial |
$71.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.58
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE
|
Facility
|
OP
|
$207.08
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
87798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.62 |
| Max. Negotiated Rate |
$186.37 |
| Rate for Payer: Aetna American Axle |
$134.60
|
| Rate for Payer: Aetna Commercial |
$176.02
|
| Rate for Payer: Aetna Medicare |
$103.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.60
|
| Rate for Payer: BCBS Complete |
$82.83
|
| Rate for Payer: Cash Price |
$165.66
|
| Rate for Payer: Cofinity Advantage |
$144.96
|
| Rate for Payer: Cofinity Commercial |
$178.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.66
|
| Rate for Payer: Healthscope Commercial |
$186.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.31
|
| Rate for Payer: PHP Commercial |
$176.02
|
| Rate for Payer: Priority Health SBD |
$130.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.60
|
| Rate for Payer: UHC Core |
$107.89
|
| Rate for Payer: UHC Exchange |
$81.38
|
| Rate for Payer: UMR Bronson Commercial |
$76.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.31
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SPRAY SYRINGE
|
Facility
|
IP
|
$207.08
|
|
|
Service Code
|
NDC 60793070505
|
| Hospital Charge Code |
87798
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.12 |
| Max. Negotiated Rate |
$186.37 |
| Rate for Payer: Aetna American Axle |
$134.60
|
| Rate for Payer: Aetna Commercial |
$176.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.60
|
| Rate for Payer: Cash Price |
$165.66
|
| Rate for Payer: Cofinity Advantage |
$144.96
|
| Rate for Payer: Cofinity Commercial |
$178.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.66
|
| Rate for Payer: Healthscope Commercial |
$186.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.31
|
| Rate for Payer: PHP Commercial |
$176.02
|
| Rate for Payer: Priority Health SBD |
$130.46
|
| Rate for Payer: UMR Bronson Commercial |
$91.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.31
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
OP
|
$261.89
|
|
|
Service Code
|
NDC 00338032201
|
| Hospital Charge Code |
89570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$235.70 |
| Rate for Payer: Aetna American Axle |
$170.23
|
| Rate for Payer: Aetna Commercial |
$222.61
|
| Rate for Payer: Aetna Medicare |
$130.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.23
|
| Rate for Payer: BCBS Complete |
$104.76
|
| Rate for Payer: Cash Price |
$209.51
|
| Rate for Payer: Cofinity Advantage |
$183.32
|
| Rate for Payer: Cofinity Commercial |
$225.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.51
|
| Rate for Payer: Healthscope Commercial |
$235.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.42
|
| Rate for Payer: PHP Commercial |
$222.61
|
| Rate for Payer: Priority Health SBD |
$164.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.23
|
| Rate for Payer: UHC Core |
$136.44
|
| Rate for Payer: UHC Exchange |
$102.92
|
| Rate for Payer: UMR Bronson Commercial |
$96.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.42
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
OP
|
$261.89
|
|
|
Service Code
|
NDC 00338032401
|
| Hospital Charge Code |
89570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$235.70 |
| Rate for Payer: Aetna American Axle |
$170.23
|
| Rate for Payer: Aetna Commercial |
$222.61
|
| Rate for Payer: Aetna Medicare |
$130.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.23
|
| Rate for Payer: BCBS Complete |
$104.76
|
| Rate for Payer: Cash Price |
$209.51
|
| Rate for Payer: Cofinity Advantage |
$183.32
|
| Rate for Payer: Cofinity Commercial |
$225.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.51
|
| Rate for Payer: Healthscope Commercial |
$235.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.42
|
| Rate for Payer: PHP Commercial |
$222.61
|
| Rate for Payer: Priority Health SBD |
$164.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.23
|
| Rate for Payer: UHC Core |
$136.44
|
| Rate for Payer: UHC Exchange |
$102.92
|
| Rate for Payer: UMR Bronson Commercial |
$96.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.42
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
IP
|
$261.89
|
|
|
Service Code
|
NDC 00338032201
|
| Hospital Charge Code |
89570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.23 |
| Max. Negotiated Rate |
$235.70 |
| Rate for Payer: Aetna American Axle |
$170.23
|
| Rate for Payer: Aetna Commercial |
$222.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.23
|
| Rate for Payer: Cash Price |
$209.51
|
| Rate for Payer: Cofinity Advantage |
$183.32
|
| Rate for Payer: Cofinity Commercial |
$225.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.51
|
| Rate for Payer: Healthscope Commercial |
$235.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.42
|
| Rate for Payer: PHP Commercial |
$222.61
|
| Rate for Payer: Priority Health SBD |
$164.99
|
| Rate for Payer: UMR Bronson Commercial |
$115.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.42
|
|
|
THROMBIN (RECOMBINANT) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
IP
|
$261.89
|
|
|
Service Code
|
NDC 00338032401
|
| Hospital Charge Code |
89570
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.23 |
| Max. Negotiated Rate |
$235.70 |
| Rate for Payer: Aetna American Axle |
$170.23
|
| Rate for Payer: Aetna Commercial |
$222.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.23
|
| Rate for Payer: Cash Price |
$209.51
|
| Rate for Payer: Cofinity Advantage |
$183.32
|
| Rate for Payer: Cofinity Commercial |
$225.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.51
|
| Rate for Payer: Healthscope Commercial |
$235.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.42
|
| Rate for Payer: PHP Commercial |
$222.61
|
| Rate for Payer: Priority Health SBD |
$164.99
|
| Rate for Payer: UMR Bronson Commercial |
$115.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.42
|
|
|
THYROID DISORDERS
|
Facility
|
IP
|
$3,520.57
|
|
|
Service Code
|
APR-DRG 4271
|
| Min. Negotiated Rate |
$3,352.92 |
| Max. Negotiated Rate |
$3,520.57 |
| Rate for Payer: BCBS Complete |
$3,520.57
|
| Rate for Payer: Mclaren Medicaid |
$3,352.92
|
| Rate for Payer: Meridian Medicaid |
$3,520.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,352.92
|
| Rate for Payer: UHC Medicaid |
$3,352.92
|
| Rate for Payer: UHCCP Medicaid |
$3,352.92
|
|
