|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$136.50
|
|
|
Service Code
|
NDC 00228207610
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.06 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Aetna American Axle |
$88.72
|
| Rate for Payer: Aetna Commercial |
$116.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.72
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$117.39
|
| Rate for Payer: Cofinity Commercial |
$95.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.20
|
| Rate for Payer: Healthscope Commercial |
$122.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.02
|
| Rate for Payer: PHP Commercial |
$116.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.72
|
| Rate for Payer: Priority Health SBD |
$86.00
|
| Rate for Payer: UMR Bronson Commercial |
$60.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.38
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$148.75
|
|
|
Service Code
|
NDC 51079041820
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna American Axle |
$96.69
|
| Rate for Payer: Aetna Commercial |
$126.44
|
| Rate for Payer: Aetna Medicare |
$74.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.69
|
| Rate for Payer: BCBS Complete |
$59.50
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cofinity Commercial |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.00
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.44
|
| Rate for Payer: PHP Commercial |
$126.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.69
|
| Rate for Payer: Priority Health SBD |
$93.71
|
| Rate for Payer: UMR Bronson Commercial |
$55.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.56
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$136.50
|
|
|
Service Code
|
NDC 00228207610
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Aetna American Axle |
$88.72
|
| Rate for Payer: Aetna Commercial |
$116.02
|
| Rate for Payer: Aetna Medicare |
$68.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.72
|
| Rate for Payer: BCBS Complete |
$54.60
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$117.39
|
| Rate for Payer: Cofinity Commercial |
$95.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.20
|
| Rate for Payer: Healthscope Commercial |
$122.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.02
|
| Rate for Payer: PHP Commercial |
$116.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.72
|
| Rate for Payer: Priority Health SBD |
$86.00
|
| Rate for Payer: UMR Bronson Commercial |
$50.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.38
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$152.25
|
|
|
Service Code
|
NDC 00378401001
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.99 |
| Max. Negotiated Rate |
$137.02 |
| Rate for Payer: Aetna American Axle |
$98.96
|
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.96
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cofinity Commercial |
$106.58
|
| Rate for Payer: Cofinity Commercial |
$130.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.80
|
| Rate for Payer: Healthscope Commercial |
$137.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.41
|
| Rate for Payer: PHP Commercial |
$129.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.96
|
| Rate for Payer: Priority Health SBD |
$95.92
|
| Rate for Payer: UMR Bronson Commercial |
$66.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.19
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
NDC 51079041801
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna American Axle |
$0.97
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna Medicare |
$0.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.97
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.97
|
| Rate for Payer: Priority Health SBD |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
NDC 51079041801
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna American Axle |
$0.97
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.97
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.97
|
| Rate for Payer: Priority Health SBD |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$148.75
|
|
|
Service Code
|
NDC 51079041820
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna American Axle |
$96.69
|
| Rate for Payer: Aetna Commercial |
$126.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.69
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cofinity Commercial |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.00
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.44
|
| Rate for Payer: PHP Commercial |
$126.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.69
|
| Rate for Payer: Priority Health SBD |
$93.71
|
| Rate for Payer: UMR Bronson Commercial |
$65.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.56
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$152.25
|
|
|
Service Code
|
NDC 00378401001
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.33 |
| Max. Negotiated Rate |
$137.02 |
| Rate for Payer: Aetna American Axle |
$98.96
|
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Aetna Medicare |
$76.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.96
|
| Rate for Payer: BCBS Complete |
$60.90
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cofinity Commercial |
$106.58
|
| Rate for Payer: Cofinity Commercial |
$130.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.80
|
| Rate for Payer: Healthscope Commercial |
$137.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.41
|
| Rate for Payer: PHP Commercial |
$129.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.96
|
| Rate for Payer: Priority Health SBD |
$95.92
|
| Rate for Payer: UMR Bronson Commercial |
$56.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.19
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$964.86
|
|
|
Service Code
|
NDC 00406996001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$868.37 |
| Rate for Payer: Aetna American Axle |
$627.16
|
| Rate for Payer: Aetna Commercial |
$820.13
|
| Rate for Payer: Aetna Medicare |
$482.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.16
|
| Rate for Payer: BCBS Complete |
$385.94
|
| Rate for Payer: Cash Price |
$771.89
|
| Rate for Payer: Cofinity Commercial |
$675.40
|
| Rate for Payer: Cofinity Commercial |
$829.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$675.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.89
|
| Rate for Payer: Healthscope Commercial |
$868.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.13
|
| Rate for Payer: PHP Commercial |
$820.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.16
|
| Rate for Payer: Priority Health SBD |
$607.86
|
| Rate for Payer: UMR Bronson Commercial |
$357.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.64
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$9,078.96
|
|
|
Service Code
|
NDC 00406991501
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,994.74 |
| Max. Negotiated Rate |
$8,171.06 |
| Rate for Payer: Aetna American Axle |
$5,901.32
|
| Rate for Payer: Aetna Commercial |
$7,717.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,901.32
|
| Rate for Payer: Cash Price |
$7,263.17
|
| Rate for Payer: Cofinity Commercial |
$6,355.27
|
| Rate for Payer: Cofinity Commercial |
$7,807.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,355.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,263.17
|
| Rate for Payer: Healthscope Commercial |
$8,171.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,355.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,809.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,717.12
|
| Rate for Payer: PHP Commercial |
$7,717.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,901.32
|
| Rate for Payer: Priority Health SBD |
$5,719.74
|
| Rate for Payer: UMR Bronson Commercial |
$3,994.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,809.22
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$2,127.84
|
|
|
Service Code
|
NDC 00378311001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$936.25 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna American Axle |
$1,383.10
|
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.10
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Commercial |
$1,489.49
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,489.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,489.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,595.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.66
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.10
|
| Rate for Payer: Priority Health SBD |
$1,340.54
|
| Rate for Payer: UMR Bronson Commercial |
$936.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,595.88
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$9,078.96
|
|
|
Service Code
|
NDC 00406991501
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,359.22 |
| Max. Negotiated Rate |
$8,171.06 |
| Rate for Payer: Aetna American Axle |
$5,901.32
|
| Rate for Payer: Aetna Commercial |
$7,717.12
|
| Rate for Payer: Aetna Medicare |
$4,539.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,901.32
|
| Rate for Payer: BCBS Complete |
$3,631.58
|
| Rate for Payer: Cash Price |
$7,263.17
|
| Rate for Payer: Cofinity Commercial |
$6,355.27
|
| Rate for Payer: Cofinity Commercial |
$7,807.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,355.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,263.17
|
| Rate for Payer: Healthscope Commercial |
$8,171.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,355.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,809.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,717.12
|
| Rate for Payer: PHP Commercial |
$7,717.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,901.32
|
| Rate for Payer: Priority Health SBD |
$5,719.74
|
| Rate for Payer: UMR Bronson Commercial |
$3,359.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,809.22
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$308.18
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$277.36 |
| Rate for Payer: Aetna American Axle |
$200.32
|
| Rate for Payer: Aetna Commercial |
$261.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.32
|
| Rate for Payer: Cash Price |
$246.54
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Cofinity Commercial |
$265.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.54
|
| Rate for Payer: Healthscope Commercial |
$277.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.95
|
| Rate for Payer: PHP Commercial |
$261.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.32
|
| Rate for Payer: Priority Health SBD |
$194.15
|
| Rate for Payer: UMR Bronson Commercial |
$135.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.14
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$308.18
|
|
|
Service Code
|
NDC 00904643604
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.03 |
| Max. Negotiated Rate |
$277.36 |
| Rate for Payer: Aetna American Axle |
$200.32
|
| Rate for Payer: Aetna Commercial |
$261.95
|
| Rate for Payer: Aetna Medicare |
$154.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.32
|
| Rate for Payer: BCBS Complete |
$123.27
|
| Rate for Payer: Cash Price |
$246.54
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Cofinity Commercial |
$265.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.54
|
| Rate for Payer: Healthscope Commercial |
$277.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.95
|
| Rate for Payer: PHP Commercial |
$261.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.32
|
| Rate for Payer: Priority Health SBD |
$194.15
|
| Rate for Payer: UMR Bronson Commercial |
$114.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.14
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$964.86
|
|
|
Service Code
|
NDC 00406996001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$424.54 |
| Max. Negotiated Rate |
$868.37 |
| Rate for Payer: Aetna American Axle |
$627.16
|
| Rate for Payer: Aetna Commercial |
$820.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.16
|
| Rate for Payer: Cash Price |
$771.89
|
| Rate for Payer: Cofinity Commercial |
$675.40
|
| Rate for Payer: Cofinity Commercial |
$829.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$675.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.89
|
| Rate for Payer: Healthscope Commercial |
$868.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.13
|
| Rate for Payer: PHP Commercial |
$820.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.16
|
| Rate for Payer: Priority Health SBD |
$607.86
|
| Rate for Payer: UMR Bronson Commercial |
$424.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.64
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
OP
|
$2,127.84
|
|
|
Service Code
|
NDC 00378311001
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$787.30 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna American Axle |
$1,383.10
|
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: Aetna Medicare |
$1,063.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.10
|
| Rate for Payer: BCBS Complete |
$851.14
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Commercial |
$1,489.49
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,489.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,489.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,595.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.66
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.10
|
| Rate for Payer: Priority Health SBD |
$1,340.54
|
| Rate for Payer: UMR Bronson Commercial |
$787.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,595.88
|
|
|
TEMOZOLOMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$298.32
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
25894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.26 |
| Max. Negotiated Rate |
$268.49 |
| Rate for Payer: Aetna American Axle |
$193.91
|
| Rate for Payer: Aetna American Axle |
$143.58
|
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna Commercial |
$253.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.91
|
| Rate for Payer: Cash Price |
$176.71
|
| Rate for Payer: Cash Price |
$238.66
|
| Rate for Payer: Cofinity Commercial |
$256.56
|
| Rate for Payer: Cofinity Commercial |
$208.82
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Cofinity Commercial |
$154.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.66
|
| Rate for Payer: Healthscope Commercial |
$198.80
|
| Rate for Payer: Healthscope Commercial |
$268.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.57
|
| Rate for Payer: PHP Commercial |
$253.57
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.91
|
| Rate for Payer: Priority Health SBD |
$187.94
|
| Rate for Payer: Priority Health SBD |
$139.16
|
| Rate for Payer: UMR Bronson Commercial |
$97.19
|
| Rate for Payer: UMR Bronson Commercial |
$131.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.74
|
|
|
TEMOZOLOMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$220.89
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
25894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$198.80 |
| Rate for Payer: Aetna American Axle |
$143.58
|
| Rate for Payer: Aetna American Axle |
$193.91
|
| Rate for Payer: Aetna Commercial |
$253.57
|
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: Aetna Medicare |
$110.44
|
| Rate for Payer: Aetna Medicare |
$149.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.91
|
| Rate for Payer: BCBS Complete |
$119.33
|
| Rate for Payer: BCBS Complete |
$88.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$238.66
|
| Rate for Payer: Cash Price |
$238.66
|
| Rate for Payer: Cash Price |
$176.71
|
| Rate for Payer: Cash Price |
$176.71
|
| Rate for Payer: Cofinity Commercial |
$256.56
|
| Rate for Payer: Cofinity Commercial |
$154.62
|
| Rate for Payer: Cofinity Commercial |
$208.82
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.71
|
| Rate for Payer: Healthscope Commercial |
$268.49
|
| Rate for Payer: Healthscope Commercial |
$198.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.57
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: PHP Commercial |
$253.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.91
|
| Rate for Payer: Priority Health SBD |
$187.94
|
| Rate for Payer: Priority Health SBD |
$139.16
|
| Rate for Payer: UMR Bronson Commercial |
$81.73
|
| Rate for Payer: UMR Bronson Commercial |
$110.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.67
|
|
|
TEMOZOLOMIDE 140 MG CAPSULE
|
Facility
|
IP
|
$622.83
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
81461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$274.05 |
| Max. Negotiated Rate |
$560.55 |
| Rate for Payer: Aetna American Axle |
$404.84
|
| Rate for Payer: Aetna American Axle |
$80.97
|
| Rate for Payer: Aetna American Axle |
$1,214.51
|
| Rate for Payer: Aetna American Axle |
$568.33
|
| Rate for Payer: Aetna American Axle |
$190.48
|
| Rate for Payer: Aetna Commercial |
$529.41
|
| Rate for Payer: Aetna Commercial |
$1,588.20
|
| Rate for Payer: Aetna Commercial |
$105.88
|
| Rate for Payer: Aetna Commercial |
$743.20
|
| Rate for Payer: Aetna Commercial |
$249.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.51
|
| Rate for Payer: Cash Price |
$498.26
|
| Rate for Payer: Cash Price |
$699.48
|
| Rate for Payer: Cash Price |
$1,494.78
|
| Rate for Payer: Cash Price |
$234.43
|
| Rate for Payer: Cash Price |
$99.66
|
| Rate for Payer: Cofinity Commercial |
$612.04
|
| Rate for Payer: Cofinity Commercial |
$107.13
|
| Rate for Payer: Cofinity Commercial |
$535.63
|
| Rate for Payer: Cofinity Commercial |
$435.98
|
| Rate for Payer: Cofinity Commercial |
$205.13
|
| Rate for Payer: Cofinity Commercial |
$1,307.93
|
| Rate for Payer: Cofinity Commercial |
$1,606.88
|
| Rate for Payer: Cofinity Commercial |
$252.01
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$751.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,307.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$612.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,494.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.43
|
| Rate for Payer: Healthscope Commercial |
$1,681.62
|
| Rate for Payer: Healthscope Commercial |
$560.55
|
| Rate for Payer: Healthscope Commercial |
$263.74
|
| Rate for Payer: Healthscope Commercial |
$786.92
|
| Rate for Payer: Healthscope Commercial |
$112.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,307.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,401.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$467.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,588.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.88
|
| Rate for Payer: PHP Commercial |
$105.88
|
| Rate for Payer: PHP Commercial |
$743.20
|
| Rate for Payer: PHP Commercial |
$249.08
|
| Rate for Payer: PHP Commercial |
$529.41
|
| Rate for Payer: PHP Commercial |
$1,588.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,214.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.97
|
| Rate for Payer: Priority Health SBD |
$550.84
|
| Rate for Payer: Priority Health SBD |
$184.62
|
| Rate for Payer: Priority Health SBD |
$1,177.14
|
| Rate for Payer: Priority Health SBD |
$78.48
|
| Rate for Payer: Priority Health SBD |
$392.38
|
| Rate for Payer: UMR Bronson Commercial |
$54.81
|
| Rate for Payer: UMR Bronson Commercial |
$822.13
|
| Rate for Payer: UMR Bronson Commercial |
$274.05
|
| Rate for Payer: UMR Bronson Commercial |
$384.71
|
| Rate for Payer: UMR Bronson Commercial |
$128.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,401.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$467.12
|
|
|
TEMOZOLOMIDE 140 MG CAPSULE
|
Facility
|
OP
|
$1,868.47
|
|
|
Service Code
|
HCPCS J8700
|
| Hospital Charge Code |
81461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1,681.62 |
| Rate for Payer: Aetna American Axle |
$1,214.51
|
| Rate for Payer: Aetna American Axle |
$404.84
|
| Rate for Payer: Aetna American Axle |
$190.48
|
| Rate for Payer: Aetna American Axle |
$80.97
|
| Rate for Payer: Aetna American Axle |
$568.33
|
| Rate for Payer: Aetna Commercial |
$1,588.20
|
| Rate for Payer: Aetna Commercial |
$105.88
|
| Rate for Payer: Aetna Commercial |
$743.20
|
| Rate for Payer: Aetna Commercial |
$249.08
|
| Rate for Payer: Aetna Commercial |
$529.41
|
| Rate for Payer: Aetna Medicare |
$146.52
|
| Rate for Payer: Aetna Medicare |
$311.42
|
| Rate for Payer: Aetna Medicare |
$934.24
|
| Rate for Payer: Aetna Medicare |
$62.28
|
| Rate for Payer: Aetna Medicare |
$437.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.48
|
| Rate for Payer: BCBS Complete |
$747.39
|
| Rate for Payer: BCBS Complete |
$49.83
|
| Rate for Payer: BCBS Complete |
$249.13
|
| Rate for Payer: BCBS Complete |
$349.74
|
| Rate for Payer: BCBS Complete |
$117.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: BCN Commercial |
$0.71
|
| Rate for Payer: Cash Price |
$1,494.78
|
| Rate for Payer: Cash Price |
$234.43
|
| Rate for Payer: Cash Price |
$99.66
|
| Rate for Payer: Cash Price |
$1,494.78
|
| Rate for Payer: Cash Price |
$99.66
|
| Rate for Payer: Cash Price |
$234.43
|
| Rate for Payer: Cash Price |
$699.48
|
| Rate for Payer: Cash Price |
$699.48
|
| Rate for Payer: Cash Price |
$498.26
|
| Rate for Payer: Cash Price |
$498.26
|
| Rate for Payer: Cofinity Commercial |
$1,307.93
|
| Rate for Payer: Cofinity Commercial |
$751.94
|
| Rate for Payer: Cofinity Commercial |
$107.13
|
| Rate for Payer: Cofinity Commercial |
$252.01
|
| Rate for Payer: Cofinity Commercial |
$205.13
|
| Rate for Payer: Cofinity Commercial |
$612.04
|
| Rate for Payer: Cofinity Commercial |
$535.63
|
| Rate for Payer: Cofinity Commercial |
$435.98
|
| Rate for Payer: Cofinity Commercial |
$1,606.88
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$612.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,307.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,494.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.26
|
| Rate for Payer: Healthscope Commercial |
$560.55
|
| Rate for Payer: Healthscope Commercial |
$112.11
|
| Rate for Payer: Healthscope Commercial |
$1,681.62
|
| Rate for Payer: Healthscope Commercial |
$263.74
|
| Rate for Payer: Healthscope Commercial |
$786.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,307.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$612.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,401.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$467.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,588.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.88
|
| Rate for Payer: PHP Commercial |
$743.20
|
| Rate for Payer: PHP Commercial |
$529.41
|
| Rate for Payer: PHP Commercial |
$1,588.20
|
| Rate for Payer: PHP Commercial |
$105.88
|
| Rate for Payer: PHP Commercial |
$249.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,214.51
|
| Rate for Payer: Priority Health SBD |
$1,177.14
|
| Rate for Payer: Priority Health SBD |
$550.84
|
| Rate for Payer: Priority Health SBD |
$392.38
|
| Rate for Payer: Priority Health SBD |
$78.48
|
| Rate for Payer: Priority Health SBD |
$184.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.09
|
| Rate for Payer: UMR Bronson Commercial |
$108.42
|
| Rate for Payer: UMR Bronson Commercial |
$691.33
|
| Rate for Payer: UMR Bronson Commercial |
$230.45
|
| Rate for Payer: UMR Bronson Commercial |
$323.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,401.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$467.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.43
|
|
|
TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST SUTURE)
|
Facility
|
OP
|
$2,982.54
|
|
|
Service Code
|
CPT 67875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$89.68 |
| Max. Negotiated Rate |
$2,982.54 |
| Rate for Payer: Aetna Medicare |
$986.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,186.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,186.20
|
| Rate for Payer: BCBS Complete |
$534.07
|
| Rate for Payer: BCBS MAPPO |
$948.96
|
| Rate for Payer: BCBS Trust/PPO |
$760.57
|
| Rate for Payer: BCN Commercial |
$760.57
|
| Rate for Payer: BCN Medicare Advantage |
$948.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$948.96
|
| Rate for Payer: Mclaren Medicaid |
$508.64
|
| Rate for Payer: Mclaren Medicare |
$948.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$996.41
|
| Rate for Payer: Meridian Medicaid |
$534.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,091.30
|
| Rate for Payer: Nomi Health Commercial |
$1,992.82
|
| Rate for Payer: PACE Medicare |
$901.51
|
| Rate for Payer: PACE SWMI |
$948.96
|
| Rate for Payer: PHP Medicare Advantage |
$948.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,982.54
|
| Rate for Payer: Priority Health Medicare |
$948.96
|
| Rate for Payer: Priority Health Narrow Network |
$2,386.03
|
| Rate for Payer: Railroad Medicare Medicare |
$948.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.65
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$948.96
|
| Rate for Payer: UHC Exchange |
$89.68
|
| Rate for Payer: UHC Medicare Advantage |
$948.96
|
| Rate for Payer: UHCCP Medicaid |
$508.64
|
| Rate for Payer: VA VA |
$948.96
|
|
|
TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN
|
Facility
|
IP
|
$2,755.83
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
82228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,212.57 |
| Max. Negotiated Rate |
$2,480.25 |
| Rate for Payer: Aetna American Axle |
$1,791.29
|
| Rate for Payer: Aetna American Axle |
$1,980.23
|
| Rate for Payer: Aetna American Axle |
$5,060.62
|
| Rate for Payer: Aetna Commercial |
$6,617.73
|
| Rate for Payer: Aetna Commercial |
$2,589.53
|
| Rate for Payer: Aetna Commercial |
$2,342.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,791.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,980.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,060.62
|
| Rate for Payer: Cash Price |
$2,437.21
|
| Rate for Payer: Cash Price |
$2,204.66
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cofinity Commercial |
$5,449.90
|
| Rate for Payer: Cofinity Commercial |
$2,370.01
|
| Rate for Payer: Cofinity Commercial |
$1,929.08
|
| Rate for Payer: Cofinity Commercial |
$6,695.59
|
| Rate for Payer: Cofinity Commercial |
$2,132.56
|
| Rate for Payer: Cofinity Commercial |
$2,620.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,449.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,132.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,929.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,437.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,228.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.66
|
| Rate for Payer: Healthscope Commercial |
$2,480.25
|
| Rate for Payer: Healthscope Commercial |
$2,741.86
|
| Rate for Payer: Healthscope Commercial |
$7,007.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,449.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,929.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,132.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,284.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,839.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,066.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,617.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,589.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.46
|
| Rate for Payer: PHP Commercial |
$6,617.73
|
| Rate for Payer: PHP Commercial |
$2,342.46
|
| Rate for Payer: PHP Commercial |
$2,589.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,980.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,060.62
|
| Rate for Payer: Priority Health SBD |
$4,904.91
|
| Rate for Payer: Priority Health SBD |
$1,919.30
|
| Rate for Payer: Priority Health SBD |
$1,736.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,340.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,212.57
|
| Rate for Payer: UMR Bronson Commercial |
$3,425.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,066.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,839.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,284.88
|
|
|
TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN
|
Facility
|
OP
|
$2,755.83
|
|
|
Service Code
|
HCPCS J9330
|
| Hospital Charge Code |
82228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.82 |
| Max. Negotiated Rate |
$2,480.25 |
| Rate for Payer: Aetna American Axle |
$1,791.29
|
| Rate for Payer: Aetna American Axle |
$1,980.23
|
| Rate for Payer: Aetna American Axle |
$5,060.62
|
| Rate for Payer: Aetna Commercial |
$6,617.73
|
| Rate for Payer: Aetna Commercial |
$2,342.46
|
| Rate for Payer: Aetna Commercial |
$2,589.53
|
| Rate for Payer: Aetna Medicare |
$30.70
|
| Rate for Payer: Aetna Medicare |
$30.70
|
| Rate for Payer: Aetna Medicare |
$30.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,980.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,791.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,060.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.90
|
| Rate for Payer: BCBS Complete |
$16.61
|
| Rate for Payer: BCBS Complete |
$16.61
|
| Rate for Payer: BCBS Complete |
$16.61
|
| Rate for Payer: BCBS MAPPO |
$29.52
|
| Rate for Payer: BCBS MAPPO |
$29.52
|
| Rate for Payer: BCBS MAPPO |
$29.52
|
| Rate for Payer: BCBS Trust/PPO |
$86.83
|
| Rate for Payer: BCBS Trust/PPO |
$86.83
|
| Rate for Payer: BCBS Trust/PPO |
$86.83
|
| Rate for Payer: BCN Commercial |
$86.83
|
| Rate for Payer: BCN Commercial |
$86.83
|
| Rate for Payer: BCN Commercial |
$86.83
|
| Rate for Payer: BCN Medicare Advantage |
$29.52
|
| Rate for Payer: BCN Medicare Advantage |
$29.52
|
| Rate for Payer: BCN Medicare Advantage |
$29.52
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cash Price |
$2,204.66
|
| Rate for Payer: Cash Price |
$2,204.66
|
| Rate for Payer: Cash Price |
$6,228.46
|
| Rate for Payer: Cash Price |
$2,437.21
|
| Rate for Payer: Cash Price |
$2,437.21
|
| Rate for Payer: Cofinity Commercial |
$6,695.59
|
| Rate for Payer: Cofinity Commercial |
$2,370.01
|
| Rate for Payer: Cofinity Commercial |
$1,929.08
|
| Rate for Payer: Cofinity Commercial |
$2,620.00
|
| Rate for Payer: Cofinity Commercial |
$2,132.56
|
| Rate for Payer: Cofinity Commercial |
$5,449.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,449.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,132.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,929.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,437.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,228.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.52
|
| Rate for Payer: Healthscope Commercial |
$2,480.25
|
| Rate for Payer: Healthscope Commercial |
$7,007.01
|
| Rate for Payer: Healthscope Commercial |
$2,741.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,449.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,132.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,929.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,839.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,284.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,066.87
|
| Rate for Payer: Mclaren Medicaid |
$15.82
|
| Rate for Payer: Mclaren Medicaid |
$15.82
|
| Rate for Payer: Mclaren Medicaid |
$15.82
|
| Rate for Payer: Mclaren Medicare |
$29.52
|
| Rate for Payer: Mclaren Medicare |
$29.52
|
| Rate for Payer: Mclaren Medicare |
$29.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.00
|
| Rate for Payer: Meridian Medicaid |
$16.61
|
| Rate for Payer: Meridian Medicaid |
$16.61
|
| Rate for Payer: Meridian Medicaid |
$16.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,617.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,589.53
|
| Rate for Payer: Nomi Health Commercial |
$88.56
|
| Rate for Payer: Nomi Health Commercial |
$88.56
|
| Rate for Payer: Nomi Health Commercial |
$88.56
|
| Rate for Payer: PACE Medicare |
$28.04
|
| Rate for Payer: PACE Medicare |
$28.04
|
| Rate for Payer: PACE Medicare |
$28.04
|
| Rate for Payer: PACE SWMI |
$29.52
|
| Rate for Payer: PACE SWMI |
$29.52
|
| Rate for Payer: PACE SWMI |
$29.52
|
| Rate for Payer: PHP Commercial |
$2,589.53
|
| Rate for Payer: PHP Commercial |
$2,342.46
|
| Rate for Payer: PHP Commercial |
$6,617.73
|
| Rate for Payer: PHP Medicare Advantage |
$29.52
|
| Rate for Payer: PHP Medicare Advantage |
$29.52
|
| Rate for Payer: PHP Medicare Advantage |
$29.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,060.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,980.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.69
|
| Rate for Payer: Priority Health Medicare |
$29.52
|
| Rate for Payer: Priority Health Medicare |
$29.52
|
| Rate for Payer: Priority Health Medicare |
$29.52
|
| Rate for Payer: Priority Health Narrow Network |
$74.15
|
| Rate for Payer: Priority Health Narrow Network |
$74.15
|
| Rate for Payer: Priority Health Narrow Network |
$74.15
|
| Rate for Payer: Priority Health SBD |
$1,736.17
|
| Rate for Payer: Priority Health SBD |
$1,919.30
|
| Rate for Payer: Priority Health SBD |
$4,904.91
|
| Rate for Payer: Railroad Medicare Medicare |
$29.52
|
| Rate for Payer: Railroad Medicare Medicare |
$29.52
|
| Rate for Payer: Railroad Medicare Medicare |
$29.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.52
|
| Rate for Payer: UHC Exchange |
$56.42
|
| Rate for Payer: UHC Exchange |
$56.42
|
| Rate for Payer: UHC Exchange |
$56.42
|
| Rate for Payer: UHC Medicare Advantage |
$29.52
|
| Rate for Payer: UHC Medicare Advantage |
$29.52
|
| Rate for Payer: UHC Medicare Advantage |
$29.52
|
| Rate for Payer: UHCCP Medicaid |
$15.82
|
| Rate for Payer: UHCCP Medicaid |
$15.82
|
| Rate for Payer: UHCCP Medicaid |
$15.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,019.66
|
| Rate for Payer: UMR Bronson Commercial |
$2,880.66
|
| Rate for Payer: VA VA |
$29.52
|
| Rate for Payer: VA VA |
$29.52
|
| Rate for Payer: VA VA |
$29.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,066.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,839.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,284.88
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$282.00 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,537.86
|
| Rate for Payer: BCN Commercial |
$1,537.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.20
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$282.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TENDON
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 25310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$603.06 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,641.30
|
| Rate for Payer: BCN Commercial |
$2,641.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.37
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$603.06
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
