|
SPIRONOLACTONE 25 MG TABLET
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
NDC 63739054410
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.08 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna American Axle |
$183.30
|
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.30
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health SBD |
$177.66
|
| Rate for Payer: UMR Bronson Commercial |
$124.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
SPLIT-THICKNESS AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
|
Facility
|
OP
|
$10,050.52
|
|
|
Service Code
|
CPT 15120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,913.77 |
| Max. Negotiated Rate |
$10,050.52 |
| Rate for Payer: Aetna Medicare |
$3,713.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,050.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$6,823.53
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
SPLIT-THICKNESS AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR 1% OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050)
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 15100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; 10-20 STAB INCISIONS
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 37765
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 37766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OF OSSICULAR CONTINUITY, WITH OR WITHOUT USE OF FOREIGN MATERIAL;
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 69660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
STAVUDINE 30 MG CAPSULE
|
Facility
|
OP
|
$458.50
|
|
|
Service Code
|
NDC 65862004660
|
| Hospital Charge Code |
13310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.65 |
| Max. Negotiated Rate |
$412.65 |
| Rate for Payer: Aetna American Axle |
$298.02
|
| Rate for Payer: Aetna Commercial |
$389.73
|
| Rate for Payer: Aetna Medicare |
$229.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.02
|
| Rate for Payer: BCBS Complete |
$183.40
|
| Rate for Payer: Cash Price |
$366.80
|
| Rate for Payer: Cofinity Commercial |
$320.95
|
| Rate for Payer: Cofinity Commercial |
$394.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.80
|
| Rate for Payer: Healthscope Commercial |
$412.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.73
|
| Rate for Payer: PHP Commercial |
$389.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.02
|
| Rate for Payer: Priority Health SBD |
$288.86
|
| Rate for Payer: UMR Bronson Commercial |
$169.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.88
|
|
|
STAVUDINE 30 MG CAPSULE
|
Facility
|
IP
|
$458.50
|
|
|
Service Code
|
NDC 65862004660
|
| Hospital Charge Code |
13310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.74 |
| Max. Negotiated Rate |
$412.65 |
| Rate for Payer: Aetna American Axle |
$298.02
|
| Rate for Payer: Aetna Commercial |
$389.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.02
|
| Rate for Payer: Cash Price |
$366.80
|
| Rate for Payer: Cofinity Commercial |
$320.95
|
| Rate for Payer: Cofinity Commercial |
$394.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.80
|
| Rate for Payer: Healthscope Commercial |
$412.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.73
|
| Rate for Payer: PHP Commercial |
$389.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.02
|
| Rate for Payer: Priority Health SBD |
$288.86
|
| Rate for Payer: UMR Bronson Commercial |
$201.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.88
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
OP
|
$443.75
|
|
|
Service Code
|
NDC 62327033343
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.19 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna American Axle |
$288.44
|
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna Medicare |
$221.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: BCBS Complete |
$177.50
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Commercial |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.44
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UMR Bronson Commercial |
$164.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.81
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
OP
|
$443.75
|
|
|
Service Code
|
NDC 62327033303
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.19 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna American Axle |
$288.44
|
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna Medicare |
$221.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: BCBS Complete |
$177.50
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Commercial |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.44
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UMR Bronson Commercial |
$164.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.81
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
IP
|
$443.75
|
|
|
Service Code
|
NDC 62327033303
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna American Axle |
$288.44
|
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Commercial |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.44
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UMR Bronson Commercial |
$195.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.81
|
|
|
STERILE TALC 3 GRAM INTRAPLEURAL AEROSOL POWDER
|
Facility
|
IP
|
$443.75
|
|
|
Service Code
|
NDC 62327033343
|
| Hospital Charge Code |
186167
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$195.25 |
| Max. Negotiated Rate |
$399.38 |
| Rate for Payer: Aetna American Axle |
$288.44
|
| Rate for Payer: Aetna Commercial |
$377.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.44
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cofinity Commercial |
$310.62
|
| Rate for Payer: Cofinity Commercial |
$381.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.00
|
| Rate for Payer: Healthscope Commercial |
$399.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.19
|
| Rate for Payer: PHP Commercial |
$377.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.44
|
| Rate for Payer: Priority Health SBD |
$279.56
|
| Rate for Payer: UMR Bronson Commercial |
$195.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.81
|
|
|
STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$182.42
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
7508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$164.18 |
| Rate for Payer: Aetna American Axle |
$118.57
|
| Rate for Payer: Aetna Commercial |
$155.06
|
| Rate for Payer: Aetna Medicare |
$91.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.57
|
| Rate for Payer: BCBS Complete |
$72.97
|
| Rate for Payer: Cash Price |
$145.94
|
| Rate for Payer: Cofinity Commercial |
$127.69
|
| Rate for Payer: Cofinity Commercial |
$156.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.94
|
| Rate for Payer: Healthscope Commercial |
$164.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.06
|
| Rate for Payer: PHP Commercial |
$155.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.57
|
| Rate for Payer: Priority Health SBD |
$114.92
|
| Rate for Payer: UMR Bronson Commercial |
$67.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.81
|
|
|
STREPTOMYCIN 1 GRAM INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$182.42
|
|
|
Service Code
|
HCPCS J3000
|
| Hospital Charge Code |
7508
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.26 |
| Max. Negotiated Rate |
$164.18 |
| Rate for Payer: Aetna American Axle |
$118.57
|
| Rate for Payer: Aetna Commercial |
$155.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.57
|
| Rate for Payer: Cash Price |
$145.94
|
| Rate for Payer: Cofinity Commercial |
$127.69
|
| Rate for Payer: Cofinity Commercial |
$156.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.94
|
| Rate for Payer: Healthscope Commercial |
$164.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.06
|
| Rate for Payer: PHP Commercial |
$155.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.57
|
| Rate for Payer: Priority Health SBD |
$114.92
|
| Rate for Payer: UMR Bronson Commercial |
$80.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.81
|
|
|
STREPTOZOCIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,536.49
|
|
|
Service Code
|
HCPCS J9320
|
| Hospital Charge Code |
11436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$676.06 |
| Max. Negotiated Rate |
$1,382.84 |
| Rate for Payer: Aetna American Axle |
$998.72
|
| Rate for Payer: Aetna Commercial |
$1,306.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.72
|
| Rate for Payer: Cash Price |
$1,229.19
|
| Rate for Payer: Cofinity Commercial |
$1,075.54
|
| Rate for Payer: Cofinity Commercial |
$1,321.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,075.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.19
|
| Rate for Payer: Healthscope Commercial |
$1,382.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,075.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,152.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.02
|
| Rate for Payer: PHP Commercial |
$1,306.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$998.72
|
| Rate for Payer: Priority Health SBD |
$967.99
|
| Rate for Payer: UMR Bronson Commercial |
$676.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,152.37
|
|
|
STREPTOZOCIN 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,536.49
|
|
|
Service Code
|
HCPCS J9320
|
| Hospital Charge Code |
11436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$568.50 |
| Max. Negotiated Rate |
$1,382.84 |
| Rate for Payer: Aetna American Axle |
$998.72
|
| Rate for Payer: Aetna Commercial |
$1,306.02
|
| Rate for Payer: Aetna Medicare |
$768.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.72
|
| Rate for Payer: BCBS Complete |
$614.60
|
| Rate for Payer: Cash Price |
$1,229.19
|
| Rate for Payer: Cofinity Commercial |
$1,075.54
|
| Rate for Payer: Cofinity Commercial |
$1,321.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,075.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.19
|
| Rate for Payer: Healthscope Commercial |
$1,382.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,075.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,152.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.02
|
| Rate for Payer: PHP Commercial |
$1,306.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$998.72
|
| Rate for Payer: Priority Health SBD |
$967.99
|
| Rate for Payer: UMR Bronson Commercial |
$568.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,152.37
|
|
|
SUBCONJUNCTIVAL INJECTION
|
Facility
|
OP
|
$1,095.50
|
|
|
Service Code
|
CPT 68200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$1,095.50 |
| Rate for Payer: Aetna Medicare |
$404.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$486.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$486.48
|
| Rate for Payer: BCBS Complete |
$219.03
|
| Rate for Payer: BCBS MAPPO |
$389.18
|
| Rate for Payer: BCN Medicare Advantage |
$389.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.18
|
| Rate for Payer: Mclaren Medicaid |
$208.60
|
| Rate for Payer: Mclaren Medicare |
$389.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.64
|
| Rate for Payer: Meridian Medicaid |
$219.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.56
|
| Rate for Payer: PACE Medicare |
$369.72
|
| Rate for Payer: PACE SWMI |
$389.18
|
| Rate for Payer: PHP Medicare Advantage |
$389.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.60
|
| Rate for Payer: Priority Health Medicare |
$389.18
|
| Rate for Payer: Railroad Medicare Medicare |
$389.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,095.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.18
|
| Rate for Payer: UHC Exchange |
$743.76
|
| Rate for Payer: UHC Medicare Advantage |
$389.18
|
| Rate for Payer: UHCCP Medicaid |
$208.60
|
| Rate for Payer: VA VA |
$389.18
|
|
|
SUBMUCOSAL INJECTABLE COMPOSITION (ELEVIEW)
|
Facility
|
IP
|
$287.55
|
|
|
Service Code
|
NDC 05391530190
|
| Hospital Charge Code |
200133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$126.52 |
| Max. Negotiated Rate |
$258.80 |
| Rate for Payer: Aetna American Axle |
$186.91
|
| Rate for Payer: Aetna Commercial |
$244.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.91
|
| Rate for Payer: Cash Price |
$230.04
|
| Rate for Payer: Cofinity Commercial |
$201.28
|
| Rate for Payer: Cofinity Commercial |
$247.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.04
|
| Rate for Payer: Healthscope Commercial |
$258.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.42
|
| Rate for Payer: PHP Commercial |
$244.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.91
|
| Rate for Payer: Priority Health SBD |
$181.16
|
| Rate for Payer: UMR Bronson Commercial |
$126.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.66
|
|
|
SUBMUCOSAL INJECTABLE COMPOSITION (ELEVIEW)
|
Facility
|
OP
|
$287.55
|
|
|
Service Code
|
NDC 05391530190
|
| Hospital Charge Code |
200133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$106.39 |
| Max. Negotiated Rate |
$258.80 |
| Rate for Payer: Aetna American Axle |
$186.91
|
| Rate for Payer: Aetna Commercial |
$244.42
|
| Rate for Payer: Aetna Medicare |
$143.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.91
|
| Rate for Payer: BCBS Complete |
$115.02
|
| Rate for Payer: Cash Price |
$230.04
|
| Rate for Payer: Cofinity Commercial |
$201.28
|
| Rate for Payer: Cofinity Commercial |
$247.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.04
|
| Rate for Payer: Healthscope Commercial |
$258.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.42
|
| Rate for Payer: PHP Commercial |
$244.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.91
|
| Rate for Payer: Priority Health SBD |
$181.16
|
| Rate for Payer: UMR Bronson Commercial |
$106.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.66
|
|
|
SUBMUCOUS RESECTION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 30140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
SUCCIMER 100 MG CAPSULE
|
Facility
|
OP
|
$8,152.95
|
|
|
Service Code
|
NDC 55292020111
|
| Hospital Charge Code |
11438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,016.59 |
| Max. Negotiated Rate |
$7,337.65 |
| Rate for Payer: Aetna American Axle |
$5,299.42
|
| Rate for Payer: Aetna Commercial |
$6,930.01
|
| Rate for Payer: Aetna Medicare |
$4,076.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,299.42
|
| Rate for Payer: BCBS Complete |
$3,261.18
|
| Rate for Payer: Cash Price |
$6,522.36
|
| Rate for Payer: Cofinity Commercial |
$5,707.06
|
| Rate for Payer: Cofinity Commercial |
$7,011.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,707.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,522.36
|
| Rate for Payer: Healthscope Commercial |
$7,337.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,707.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,114.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,930.01
|
| Rate for Payer: PHP Commercial |
$6,930.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,299.42
|
| Rate for Payer: Priority Health SBD |
$5,136.36
|
| Rate for Payer: UMR Bronson Commercial |
$3,016.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,114.71
|
|
|
SUCCIMER 100 MG CAPSULE
|
Facility
|
IP
|
$8,152.95
|
|
|
Service Code
|
NDC 55292020111
|
| Hospital Charge Code |
11438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,587.30 |
| Max. Negotiated Rate |
$7,337.65 |
| Rate for Payer: Aetna American Axle |
$5,299.42
|
| Rate for Payer: Aetna Commercial |
$6,930.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,299.42
|
| Rate for Payer: Cash Price |
$6,522.36
|
| Rate for Payer: Cofinity Commercial |
$5,707.06
|
| Rate for Payer: Cofinity Commercial |
$7,011.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,707.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,522.36
|
| Rate for Payer: Healthscope Commercial |
$7,337.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,707.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,114.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,930.01
|
| Rate for Payer: PHP Commercial |
$6,930.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,299.42
|
| Rate for Payer: Priority Health SBD |
$5,136.36
|
| Rate for Payer: UMR Bronson Commercial |
$3,587.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,114.71
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$79.35
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.36 |
| Max. Negotiated Rate |
$71.42 |
| Rate for Payer: Aetna American Axle |
$51.58
|
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Medicare |
$39.67
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS Complete |
$11.39
|
| Rate for Payer: BCBS Complete |
$31.74
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$55.55
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.45
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: Priority Health SBD |
$49.99
|
| Rate for Payer: UMR Bronson Commercial |
$29.36
|
| Rate for Payer: UMR Bronson Commercial |
$8.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna American Axle |
$51.58
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$55.55
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$49.99
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UMR Bronson Commercial |
$9.51
|
| Rate for Payer: UMR Bronson Commercial |
$34.91
|
| Rate for Payer: UMR Bronson Commercial |
$12.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.14
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$19.03 |
| Rate for Payer: Aetna American Axle |
$13.74
|
| Rate for Payer: Aetna American Axle |
$20.80
|
| Rate for Payer: Aetna American Axle |
$18.51
|
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna American Axle |
$17.53
|
| Rate for Payer: Aetna American Axle |
$51.58
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Commercial |
$67.45
|
| Rate for Payer: Aetna Commercial |
$27.20
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$22.78
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cofinity Commercial |
$27.52
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$24.49
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$68.24
|
| Rate for Payer: Cofinity Commercial |
$55.55
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.48
|
| Rate for Payer: Healthscope Commercial |
$25.63
|
| Rate for Payer: Healthscope Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$28.80
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$24.21
|
| Rate for Payer: PHP Commercial |
$27.20
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$67.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.58
|
| Rate for Payer: Priority Health SBD |
$20.16
|
| Rate for Payer: Priority Health SBD |
$17.94
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: Priority Health SBD |
$49.99
|
| Rate for Payer: UMR Bronson Commercial |
$34.91
|
| Rate for Payer: UMR Bronson Commercial |
$9.51
|
| Rate for Payer: UMR Bronson Commercial |
$11.87
|
| Rate for Payer: UMR Bronson Commercial |
$14.08
|
| Rate for Payer: UMR Bronson Commercial |
$12.53
|
| Rate for Payer: UMR Bronson Commercial |
$9.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
