|
TRIHEXYPHENIDYL 2 MG TABLET
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
NDC 00591533501
|
| Hospital Charge Code |
8166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$296.10 |
| Rate for Payer: Aetna American Axle |
$213.85
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Advantage |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.20
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.75
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: UMR Bronson Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.75
|
|
|
TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$200.51
|
|
|
Service Code
|
HCPCS J3250
|
| Hospital Charge Code |
108755
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.19 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: Aetna American Axle |
$130.33
|
| Rate for Payer: Aetna Commercial |
$170.43
|
| Rate for Payer: Aetna Medicare |
$100.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.33
|
| Rate for Payer: BCBS Complete |
$80.20
|
| Rate for Payer: BCBS Trust/PPO |
$186.75
|
| Rate for Payer: BCN Commercial |
$186.75
|
| Rate for Payer: Cash Price |
$160.41
|
| Rate for Payer: Cash Price |
$160.41
|
| Rate for Payer: Cofinity Advantage |
$140.36
|
| Rate for Payer: Cofinity Commercial |
$172.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.41
|
| Rate for Payer: Healthscope Commercial |
$180.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.38
|
| Rate for Payer: PHP Commercial |
$170.43
|
| Rate for Payer: Priority Health SBD |
$126.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.04
|
| Rate for Payer: UHC Core |
$95.04
|
| Rate for Payer: UHC Exchange |
$95.04
|
| Rate for Payer: UMR Bronson Commercial |
$74.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.38
|
|
|
TRIMETHOBENZAMIDE 100 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$200.51
|
|
|
Service Code
|
HCPCS J3250
|
| Hospital Charge Code |
108755
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.22 |
| Max. Negotiated Rate |
$180.46 |
| Rate for Payer: Aetna American Axle |
$130.33
|
| Rate for Payer: Aetna Commercial |
$170.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.33
|
| Rate for Payer: Cash Price |
$160.41
|
| Rate for Payer: Cofinity Advantage |
$140.36
|
| Rate for Payer: Cofinity Commercial |
$172.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.41
|
| Rate for Payer: Healthscope Commercial |
$180.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.38
|
| Rate for Payer: PHP Commercial |
$170.43
|
| Rate for Payer: Priority Health SBD |
$126.32
|
| Rate for Payer: UMR Bronson Commercial |
$88.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.38
|
|
|
TRIMETHOPRIM 100 MG TABLET
|
Facility
|
OP
|
$595.68
|
|
|
Service Code
|
NDC 51862048601
|
| Hospital Charge Code |
8182
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.40 |
| Max. Negotiated Rate |
$536.11 |
| Rate for Payer: Aetna American Axle |
$387.19
|
| Rate for Payer: Aetna Commercial |
$506.33
|
| Rate for Payer: Aetna Medicare |
$297.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.19
|
| Rate for Payer: BCBS Complete |
$238.27
|
| Rate for Payer: Cash Price |
$476.54
|
| Rate for Payer: Cofinity Advantage |
$416.98
|
| Rate for Payer: Cofinity Commercial |
$512.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.54
|
| Rate for Payer: Healthscope Commercial |
$536.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$476.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.76
|
| Rate for Payer: PHP Commercial |
$506.33
|
| Rate for Payer: Priority Health SBD |
$375.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.19
|
| Rate for Payer: UHC Core |
$310.35
|
| Rate for Payer: UHC Exchange |
$234.10
|
| Rate for Payer: UMR Bronson Commercial |
$220.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.76
|
|
|
TRIMETHOPRIM 100 MG TABLET
|
Facility
|
IP
|
$595.68
|
|
|
Service Code
|
NDC 51862048601
|
| Hospital Charge Code |
8182
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.10 |
| Max. Negotiated Rate |
$536.11 |
| Rate for Payer: Aetna American Axle |
$387.19
|
| Rate for Payer: Aetna Commercial |
$506.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.19
|
| Rate for Payer: Cash Price |
$476.54
|
| Rate for Payer: Cofinity Advantage |
$416.98
|
| Rate for Payer: Cofinity Commercial |
$512.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.54
|
| Rate for Payer: Healthscope Commercial |
$536.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.76
|
| Rate for Payer: PHP Commercial |
$506.33
|
| Rate for Payer: Priority Health SBD |
$375.28
|
| Rate for Payer: UMR Bronson Commercial |
$262.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.76
|
|
|
TRIPTORELIN PAMOATE 22.5 MG IM SUSPENSION
|
Facility
|
IP
|
$18,614.70
|
|
|
Service Code
|
HCPCS J3315
|
| Hospital Charge Code |
119655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,190.47 |
| Max. Negotiated Rate |
$16,753.23 |
| Rate for Payer: Aetna American Axle |
$12,099.56
|
| Rate for Payer: Aetna Commercial |
$15,822.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,099.56
|
| Rate for Payer: Cash Price |
$14,891.76
|
| Rate for Payer: Cofinity Advantage |
$13,030.29
|
| Rate for Payer: Cofinity Commercial |
$16,008.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,891.76
|
| Rate for Payer: Healthscope Commercial |
$16,753.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,030.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,961.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,822.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,961.02
|
| Rate for Payer: PHP Commercial |
$15,822.50
|
| Rate for Payer: Priority Health SBD |
$11,727.26
|
| Rate for Payer: UMR Bronson Commercial |
$8,190.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,961.02
|
|
|
TRIPTORELIN PAMOATE 22.5 MG IM SUSPENSION
|
Facility
|
OP
|
$18,614.70
|
|
|
Service Code
|
HCPCS J3315
|
| Hospital Charge Code |
119655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$16,753.23 |
| Rate for Payer: Aetna American Axle |
$12,099.56
|
| Rate for Payer: Aetna Commercial |
$15,822.50
|
| Rate for Payer: Aetna Medicare |
$488.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,099.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$586.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$586.73
|
| Rate for Payer: BCBS Complete |
$257.78
|
| Rate for Payer: BCBS MAPPO |
$469.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,501.96
|
| Rate for Payer: BCN Commercial |
$1,501.96
|
| Rate for Payer: BCN Medicare Advantage |
$469.38
|
| Rate for Payer: Cash Price |
$14,891.76
|
| Rate for Payer: Cash Price |
$14,891.76
|
| Rate for Payer: Cofinity Advantage |
$13,030.29
|
| Rate for Payer: Cofinity Commercial |
$16,008.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,891.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$469.38
|
| Rate for Payer: Healthscope Commercial |
$16,753.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,030.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,961.02
|
| Rate for Payer: Mclaren Medicaid |
$469.38
|
| Rate for Payer: Mclaren Medicare |
$469.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$492.85
|
| Rate for Payer: Meridian Medicaid |
$492.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$539.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$516.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,822.50
|
| Rate for Payer: Nomi Health Commercial |
$1,408.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,961.02
|
| Rate for Payer: PACE Medicare |
$445.91
|
| Rate for Payer: PACE SWMI |
$469.38
|
| Rate for Payer: PHP Commercial |
$15,822.50
|
| Rate for Payer: PHP Medicare Advantage |
$469.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,497.62
|
| Rate for Payer: Priority Health Medicare |
$469.38
|
| Rate for Payer: Priority Health SBD |
$11,727.26
|
| Rate for Payer: Priority Health Tiered Network |
$1,198.10
|
| Rate for Payer: Railroad Medicare Medicare |
$469.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.28
|
| Rate for Payer: UHC Core |
$764.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$469.38
|
| Rate for Payer: UHC Exchange |
$764.28
|
| Rate for Payer: UHC Medicaid |
$245.49
|
| Rate for Payer: UHCCP Medicaid |
$245.49
|
| Rate for Payer: UMR Bronson Commercial |
$6,887.44
|
| Rate for Payer: VA VA |
$469.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,961.02
|
|
|
TRIPTORELIN PAMOATE 3.75 MG IM SUSPENSION
|
Facility
|
IP
|
$2,683.20
|
|
|
Service Code
|
HCPCS J3315
|
| Hospital Charge Code |
28558
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,180.61 |
| Max. Negotiated Rate |
$2,414.88 |
| Rate for Payer: Aetna American Axle |
$1,744.08
|
| Rate for Payer: Aetna Commercial |
$2,280.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.08
|
| Rate for Payer: Cash Price |
$2,146.56
|
| Rate for Payer: Cofinity Advantage |
$1,878.24
|
| Rate for Payer: Cofinity Commercial |
$2,307.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,146.56
|
| Rate for Payer: Healthscope Commercial |
$2,414.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,878.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,012.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,280.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,012.40
|
| Rate for Payer: PHP Commercial |
$2,280.72
|
| Rate for Payer: Priority Health SBD |
$1,690.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,180.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,012.40
|
|
|
TRIPTORELIN PAMOATE 3.75 MG IM SUSPENSION
|
Facility
|
OP
|
$2,683.20
|
|
|
Service Code
|
HCPCS J3315
|
| Hospital Charge Code |
28558
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$2,414.88 |
| Rate for Payer: Aetna American Axle |
$1,744.08
|
| Rate for Payer: Aetna Commercial |
$2,280.72
|
| Rate for Payer: Aetna Medicare |
$488.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$586.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$586.73
|
| Rate for Payer: BCBS Complete |
$257.78
|
| Rate for Payer: BCBS MAPPO |
$469.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,501.96
|
| Rate for Payer: BCN Commercial |
$1,501.96
|
| Rate for Payer: BCN Medicare Advantage |
$469.38
|
| Rate for Payer: Cash Price |
$2,146.56
|
| Rate for Payer: Cash Price |
$2,146.56
|
| Rate for Payer: Cofinity Advantage |
$1,878.24
|
| Rate for Payer: Cofinity Commercial |
$2,307.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,146.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$469.38
|
| Rate for Payer: Healthscope Commercial |
$2,414.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,878.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,012.40
|
| Rate for Payer: Mclaren Medicaid |
$469.38
|
| Rate for Payer: Mclaren Medicare |
$469.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$492.85
|
| Rate for Payer: Meridian Medicaid |
$492.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$539.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$516.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,280.72
|
| Rate for Payer: Nomi Health Commercial |
$1,408.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,012.40
|
| Rate for Payer: PACE Medicare |
$445.91
|
| Rate for Payer: PACE SWMI |
$469.38
|
| Rate for Payer: PHP Commercial |
$2,280.72
|
| Rate for Payer: PHP Medicare Advantage |
$469.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,497.62
|
| Rate for Payer: Priority Health Medicare |
$469.38
|
| Rate for Payer: Priority Health SBD |
$1,690.42
|
| Rate for Payer: Priority Health Tiered Network |
$1,198.10
|
| Rate for Payer: Railroad Medicare Medicare |
$469.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.28
|
| Rate for Payer: UHC Core |
$764.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$469.38
|
| Rate for Payer: UHC Exchange |
$764.28
|
| Rate for Payer: UHC Medicaid |
$245.49
|
| Rate for Payer: UHCCP Medicaid |
$245.49
|
| Rate for Payer: UMR Bronson Commercial |
$992.78
|
| Rate for Payer: VA VA |
$469.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,012.40
|
|
|
TROPICAMIDE 0.02%/ PHENYLEPHRINE 0.31%/ LIDOCAINE 1% FORMULATION INTRACAMERAL INJECTION 0.8 ML SYRINGE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
NDC 09900001996
|
| Hospital Charge Code |
301844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Advantage |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UMR Bronson Commercial |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
TROPICAMIDE 0.02%/ PHENYLEPHRINE 0.31%/ LIDOCAINE 1% FORMULATION INTRACAMERAL INJECTION 0.8 ML SYRINGE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
NDC 09900001996
|
| Hospital Charge Code |
301844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna American Axle |
$32.50
|
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Advantage |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health SBD |
$31.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.50
|
| Rate for Payer: UHC Core |
$26.05
|
| Rate for Payer: UHC Exchange |
$19.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
TROPICAMIDE 0.5 % EYE DROPS
|
Facility
|
OP
|
$21.84
|
|
|
Service Code
|
NDC 17478010112
|
| Hospital Charge Code |
8249
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna American Axle |
$14.20
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: BCBS Complete |
$8.74
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: Cofinity Advantage |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.38
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health SBD |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.20
|
| Rate for Payer: UHC Core |
$11.38
|
| Rate for Payer: UHC Exchange |
$8.58
|
| Rate for Payer: UMR Bronson Commercial |
$8.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.38
|
|
|
TROPICAMIDE 0.5 % EYE DROPS
|
Facility
|
OP
|
$69.62
|
|
|
Service Code
|
NDC 61314035401
|
| Hospital Charge Code |
8249
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$62.66 |
| Rate for Payer: Aetna American Axle |
$45.25
|
| Rate for Payer: Aetna Commercial |
$59.18
|
| Rate for Payer: Aetna Medicare |
$34.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.25
|
| Rate for Payer: BCBS Complete |
$27.85
|
| Rate for Payer: Cash Price |
$55.70
|
| Rate for Payer: Cofinity Advantage |
$48.73
|
| Rate for Payer: Cofinity Commercial |
$59.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.70
|
| Rate for Payer: Healthscope Commercial |
$62.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.22
|
| Rate for Payer: PHP Commercial |
$59.18
|
| Rate for Payer: Priority Health SBD |
$43.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.25
|
| Rate for Payer: UHC Core |
$36.27
|
| Rate for Payer: UHC Exchange |
$27.36
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.22
|
|
|
TROPICAMIDE 0.5 % EYE DROPS
|
Facility
|
IP
|
$69.62
|
|
|
Service Code
|
NDC 61314035401
|
| Hospital Charge Code |
8249
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.63 |
| Max. Negotiated Rate |
$62.66 |
| Rate for Payer: Aetna American Axle |
$45.25
|
| Rate for Payer: Aetna Commercial |
$59.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.25
|
| Rate for Payer: Cash Price |
$55.70
|
| Rate for Payer: Cofinity Advantage |
$48.73
|
| Rate for Payer: Cofinity Commercial |
$59.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.70
|
| Rate for Payer: Healthscope Commercial |
$62.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.22
|
| Rate for Payer: PHP Commercial |
$59.18
|
| Rate for Payer: Priority Health SBD |
$43.86
|
| Rate for Payer: UMR Bronson Commercial |
$30.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.22
|
|
|
TROPICAMIDE 0.5 % EYE DROPS
|
Facility
|
IP
|
$21.84
|
|
|
Service Code
|
NDC 17478010112
|
| Hospital Charge Code |
8249
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna American Axle |
$14.20
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: Cash Price |
$17.47
|
| Rate for Payer: Cofinity Advantage |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.47
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.38
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health SBD |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$9.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.38
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
IP
|
$33.71
|
|
|
Service Code
|
NDC 61314035501
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: Aetna American Axle |
$21.91
|
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.91
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Cofinity Advantage |
$23.60
|
| Rate for Payer: Cofinity Commercial |
$28.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.97
|
| Rate for Payer: Healthscope Commercial |
$30.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.28
|
| Rate for Payer: PHP Commercial |
$28.65
|
| Rate for Payer: Priority Health SBD |
$21.24
|
| Rate for Payer: UMR Bronson Commercial |
$14.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.28
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
IP
|
$26.20
|
|
|
Service Code
|
NDC 17478010212
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$23.58 |
| Rate for Payer: Aetna American Axle |
$17.03
|
| Rate for Payer: Aetna Commercial |
$22.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.03
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Advantage |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$22.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$23.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.65
|
| Rate for Payer: PHP Commercial |
$22.27
|
| Rate for Payer: Priority Health SBD |
$16.51
|
| Rate for Payer: UMR Bronson Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.65
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
OP
|
$26.20
|
|
|
Service Code
|
NDC 17478010212
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$23.58 |
| Rate for Payer: Aetna American Axle |
$17.03
|
| Rate for Payer: Aetna Commercial |
$22.27
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.03
|
| Rate for Payer: BCBS Complete |
$10.48
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Advantage |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$22.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$23.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.65
|
| Rate for Payer: PHP Commercial |
$22.27
|
| Rate for Payer: Priority Health SBD |
$16.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.03
|
| Rate for Payer: UHC Core |
$13.65
|
| Rate for Payer: UHC Exchange |
$10.30
|
| Rate for Payer: UMR Bronson Commercial |
$9.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.65
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
OP
|
$33.71
|
|
|
Service Code
|
NDC 61314035501
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$30.34 |
| Rate for Payer: Aetna American Axle |
$21.91
|
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Medicare |
$16.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.91
|
| Rate for Payer: BCBS Complete |
$13.48
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Cofinity Advantage |
$23.60
|
| Rate for Payer: Cofinity Commercial |
$28.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.97
|
| Rate for Payer: Healthscope Commercial |
$30.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.28
|
| Rate for Payer: PHP Commercial |
$28.65
|
| Rate for Payer: Priority Health SBD |
$21.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.91
|
| Rate for Payer: UHC Core |
$17.56
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.28
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE
|
Facility
|
OP
|
$182.04
|
|
|
Service Code
|
NDC 68803061210
|
| Hospital Charge Code |
88317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$67.35 |
| Max. Negotiated Rate |
$163.84 |
| Rate for Payer: Aetna American Axle |
$118.33
|
| Rate for Payer: Aetna Commercial |
$154.73
|
| Rate for Payer: Aetna Medicare |
$91.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.33
|
| Rate for Payer: BCBS Complete |
$72.82
|
| Rate for Payer: Cash Price |
$145.63
|
| Rate for Payer: Cofinity Advantage |
$127.43
|
| Rate for Payer: Cofinity Commercial |
$156.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.63
|
| Rate for Payer: Healthscope Commercial |
$163.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.53
|
| Rate for Payer: PHP Commercial |
$154.73
|
| Rate for Payer: Priority Health SBD |
$114.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.33
|
| Rate for Payer: UHC Core |
$94.84
|
| Rate for Payer: UHC Exchange |
$71.54
|
| Rate for Payer: UMR Bronson Commercial |
$67.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.53
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE
|
Facility
|
IP
|
$182.04
|
|
|
Service Code
|
NDC 68803061210
|
| Hospital Charge Code |
88317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.10 |
| Max. Negotiated Rate |
$163.84 |
| Rate for Payer: Aetna American Axle |
$118.33
|
| Rate for Payer: Aetna Commercial |
$154.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.33
|
| Rate for Payer: Cash Price |
$145.63
|
| Rate for Payer: Cofinity Advantage |
$127.43
|
| Rate for Payer: Cofinity Commercial |
$156.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.63
|
| Rate for Payer: Healthscope Commercial |
$163.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.53
|
| Rate for Payer: PHP Commercial |
$154.73
|
| Rate for Payer: Priority Health SBD |
$114.69
|
| Rate for Payer: UMR Bronson Commercial |
$80.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.53
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
|
OP
|
$304.45
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna American Axle |
$197.89
|
| Rate for Payer: Aetna American Axle |
$1,053.47
|
| Rate for Payer: Aetna American Axle |
$270.42
|
| Rate for Payer: Aetna Commercial |
$1,377.61
|
| Rate for Payer: Aetna Commercial |
$258.78
|
| Rate for Payer: Aetna Commercial |
$353.63
|
| Rate for Payer: Aetna Medicare |
$29.97
|
| Rate for Payer: Aetna Medicare |
$29.97
|
| Rate for Payer: Aetna Medicare |
$29.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,053.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$18.48
|
| Rate for Payer: BCBS Trust/PPO |
$18.48
|
| Rate for Payer: BCBS Trust/PPO |
$18.48
|
| Rate for Payer: BCN Commercial |
$18.48
|
| Rate for Payer: BCN Commercial |
$18.48
|
| Rate for Payer: BCN Commercial |
$18.48
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: Cash Price |
$243.56
|
| Rate for Payer: Cash Price |
$332.82
|
| Rate for Payer: Cash Price |
$1,296.58
|
| Rate for Payer: Cash Price |
$332.82
|
| Rate for Payer: Cash Price |
$1,296.58
|
| Rate for Payer: Cash Price |
$243.56
|
| Rate for Payer: Cofinity Advantage |
$1,134.50
|
| Rate for Payer: Cofinity Advantage |
$213.12
|
| Rate for Payer: Cofinity Advantage |
$291.22
|
| Rate for Payer: Cofinity Commercial |
$261.83
|
| Rate for Payer: Cofinity Commercial |
$357.79
|
| Rate for Payer: Cofinity Commercial |
$1,393.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,296.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$274.00
|
| Rate for Payer: Healthscope Commercial |
$374.43
|
| Rate for Payer: Healthscope Commercial |
$1,458.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,134.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,215.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.02
|
| Rate for Payer: Mclaren Medicaid |
$28.82
|
| Rate for Payer: Mclaren Medicaid |
$28.82
|
| Rate for Payer: Mclaren Medicaid |
$28.82
|
| Rate for Payer: Mclaren Medicare |
$28.82
|
| Rate for Payer: Mclaren Medicare |
$28.82
|
| Rate for Payer: Mclaren Medicare |
$28.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$30.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,377.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.78
|
| Rate for Payer: Nomi Health Commercial |
$86.46
|
| Rate for Payer: Nomi Health Commercial |
$86.46
|
| Rate for Payer: Nomi Health Commercial |
$86.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,215.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.02
|
| Rate for Payer: PACE Medicare |
$27.38
|
| Rate for Payer: PACE Medicare |
$27.38
|
| Rate for Payer: PACE Medicare |
$27.38
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PHP Commercial |
$1,377.61
|
| Rate for Payer: PHP Commercial |
$353.63
|
| Rate for Payer: PHP Commercial |
$258.78
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$93.19
|
| Rate for Payer: Priority Health Medicare |
$28.82
|
| Rate for Payer: Priority Health Medicare |
$28.82
|
| Rate for Payer: Priority Health Medicare |
$28.82
|
| Rate for Payer: Priority Health SBD |
$262.10
|
| Rate for Payer: Priority Health SBD |
$1,021.05
|
| Rate for Payer: Priority Health SBD |
$191.80
|
| Rate for Payer: Priority Health Tiered Network |
$74.55
|
| Rate for Payer: Priority Health Tiered Network |
$74.55
|
| Rate for Payer: Priority Health Tiered Network |
$74.55
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.82
|
| Rate for Payer: UHC Medicaid |
$15.07
|
| Rate for Payer: UHC Medicaid |
$15.07
|
| Rate for Payer: UHC Medicaid |
$15.07
|
| Rate for Payer: UHCCP Medicaid |
$15.07
|
| Rate for Payer: UHCCP Medicaid |
$15.07
|
| Rate for Payer: UHCCP Medicaid |
$15.07
|
| Rate for Payer: UMR Bronson Commercial |
$112.65
|
| Rate for Payer: UMR Bronson Commercial |
$599.67
|
| Rate for Payer: UMR Bronson Commercial |
$153.93
|
| Rate for Payer: VA VA |
$28.82
|
| Rate for Payer: VA VA |
$28.82
|
| Rate for Payer: VA VA |
$28.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,215.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.34
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
|
IP
|
$1,620.72
|
|
|
Service Code
|
HCPCS 86580
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$713.12 |
| Max. Negotiated Rate |
$1,458.65 |
| Rate for Payer: Aetna American Axle |
$1,053.47
|
| Rate for Payer: Aetna American Axle |
$270.42
|
| Rate for Payer: Aetna American Axle |
$197.89
|
| Rate for Payer: Aetna Commercial |
$258.78
|
| Rate for Payer: Aetna Commercial |
$1,377.61
|
| Rate for Payer: Aetna Commercial |
$353.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,053.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.89
|
| Rate for Payer: Cash Price |
$243.56
|
| Rate for Payer: Cash Price |
$1,296.58
|
| Rate for Payer: Cash Price |
$332.82
|
| Rate for Payer: Cofinity Advantage |
$291.22
|
| Rate for Payer: Cofinity Advantage |
$1,134.50
|
| Rate for Payer: Cofinity Advantage |
$213.12
|
| Rate for Payer: Cofinity Commercial |
$357.79
|
| Rate for Payer: Cofinity Commercial |
$1,393.82
|
| Rate for Payer: Cofinity Commercial |
$261.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,296.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.82
|
| Rate for Payer: Healthscope Commercial |
$274.00
|
| Rate for Payer: Healthscope Commercial |
$374.43
|
| Rate for Payer: Healthscope Commercial |
$1,458.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,134.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,215.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,377.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,215.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.02
|
| Rate for Payer: PHP Commercial |
$258.78
|
| Rate for Payer: PHP Commercial |
$1,377.61
|
| Rate for Payer: PHP Commercial |
$353.63
|
| Rate for Payer: Priority Health SBD |
$1,021.05
|
| Rate for Payer: Priority Health SBD |
$191.80
|
| Rate for Payer: Priority Health SBD |
$262.10
|
| Rate for Payer: UMR Bronson Commercial |
$713.12
|
| Rate for Payer: UMR Bronson Commercial |
$183.05
|
| Rate for Payer: UMR Bronson Commercial |
$133.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,215.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.02
|
|
|
TUBE THORACOSTOMY, INCLUDES CONNECTION TO DRAINAGE SYSTEM (EG, WATER SEAL), WHEN PERFORMED, OPEN (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,072.36
|
|
|
Service Code
|
CPT 32551
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$820.32 |
| Max. Negotiated Rate |
$5,072.36 |
| Rate for Payer: Aetna Medicare |
$1,631.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.61
|
| Rate for Payer: BCBS Complete |
$861.41
|
| Rate for Payer: BCBS MAPPO |
$1,568.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.59
|
| Rate for Payer: BCN Commercial |
$1,055.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.49
|
| Rate for Payer: Mclaren Medicaid |
$1,568.49
|
| Rate for Payer: Mclaren Medicare |
$1,568.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.91
|
| Rate for Payer: Meridian Medicaid |
$1,646.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,725.34
|
| Rate for Payer: Nomi Health Commercial |
$4,705.47
|
| Rate for Payer: PACE Medicare |
$1,490.07
|
| Rate for Payer: PACE SWMI |
$1,568.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,072.36
|
| Rate for Payer: Priority Health Medicare |
$1,568.49
|
| Rate for Payer: Priority Health Tiered Network |
$4,057.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,568.49
|
| Rate for Payer: UHC Medicaid |
$820.32
|
| Rate for Payer: UHCCP Medicaid |
$820.32
|
| Rate for Payer: VA VA |
$1,568.49
|
|
|
TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION OF PERFORATION FOR CLOSURE, WITH OR WITHOUT PATCH
|
Facility
|
OP
|
$4,999.64
|
|
|
Service Code
|
CPT 69610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$333.30 |
| Max. Negotiated Rate |
$4,999.64 |
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$333.30
|
| Rate for Payer: BCN Commercial |
$333.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Mclaren Medicaid |
$1,546.00
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
|
