|
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATE PROCEDURE); GENERAL ANESTHESIA
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 27606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$260.40 |
| 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 |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| 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) |
$286.44
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$260.40
|
| 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
|
|
|
TENOTOMY, PERCUTANEOUS, TOE; MULTIPLE TENDONS
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 28011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$268.48 |
| 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 |
$1,444.32
|
| Rate for Payer: BCN Commercial |
$1,444.32
|
| 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) |
$295.33
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$268.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
TENOTOMY, PERCUTANEOUS, TOE; SINGLE TENDON
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 28010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$163.83 |
| 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 |
$163.83
|
| Rate for Payer: BCN Commercial |
$163.83
|
| 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) |
$219.26
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$199.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
TENOTOMY, SHOULDER AREA; SINGLE TENDON
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 23405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$596.30 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$3,038.28
|
| Rate for Payer: BCN Commercial |
$3,038.28
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$655.93
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$596.30
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$44,245.82
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,468.16 |
| Max. Negotiated Rate |
$39,821.24 |
| Rate for Payer: Aetna American Axle |
$28,759.78
|
| Rate for Payer: Aetna Commercial |
$37,608.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,759.78
|
| Rate for Payer: Cash Price |
$35,396.66
|
| Rate for Payer: Cofinity Commercial |
$30,972.07
|
| Rate for Payer: Cofinity Commercial |
$38,051.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$30,972.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,396.66
|
| Rate for Payer: Healthscope Commercial |
$39,821.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,972.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33,184.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,608.95
|
| Rate for Payer: PHP Commercial |
$37,608.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,759.78
|
| Rate for Payer: Priority Health SBD |
$27,874.87
|
| Rate for Payer: UMR Bronson Commercial |
$19,468.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33,184.36
|
|
|
TEPROTUMUMAB-TRBW 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$44,245.82
|
|
|
Service Code
|
HCPCS J3241
|
| Hospital Charge Code |
192660
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.05 |
| Max. Negotiated Rate |
$39,821.24 |
| Rate for Payer: Aetna American Axle |
$28,759.78
|
| Rate for Payer: Aetna Commercial |
$37,608.95
|
| Rate for Payer: Aetna Medicare |
$360.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,759.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$433.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$433.88
|
| Rate for Payer: BCBS Complete |
$195.35
|
| Rate for Payer: BCBS MAPPO |
$347.10
|
| Rate for Payer: BCBS Trust/PPO |
$927.22
|
| Rate for Payer: BCN Commercial |
$927.22
|
| Rate for Payer: BCN Medicare Advantage |
$347.10
|
| Rate for Payer: Cash Price |
$35,396.66
|
| Rate for Payer: Cash Price |
$35,396.66
|
| Rate for Payer: Cofinity Commercial |
$38,051.41
|
| Rate for Payer: Cofinity Commercial |
$30,972.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$30,972.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,396.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.10
|
| Rate for Payer: Healthscope Commercial |
$39,821.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,972.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33,184.36
|
| Rate for Payer: Mclaren Medicaid |
$186.05
|
| Rate for Payer: Mclaren Medicare |
$347.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$364.46
|
| Rate for Payer: Meridian Medicaid |
$195.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,608.95
|
| Rate for Payer: Nomi Health Commercial |
$1,041.30
|
| Rate for Payer: PACE Medicare |
$329.74
|
| Rate for Payer: PACE SWMI |
$347.10
|
| Rate for Payer: PHP Commercial |
$37,608.95
|
| Rate for Payer: PHP Medicare Advantage |
$347.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,759.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$989.72
|
| Rate for Payer: Priority Health Medicare |
$347.10
|
| Rate for Payer: Priority Health Narrow Network |
$791.78
|
| Rate for Payer: Priority Health SBD |
$27,874.87
|
| Rate for Payer: Railroad Medicare Medicare |
$347.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$977.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$347.10
|
| Rate for Payer: UHC Exchange |
$663.34
|
| Rate for Payer: UHC Medicare Advantage |
$347.10
|
| Rate for Payer: UHCCP Medicaid |
$186.05
|
| Rate for Payer: UMR Bronson Commercial |
$16,370.95
|
| Rate for Payer: VA VA |
$347.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33,184.36
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$31.29
|
|
|
Service Code
|
NDC 51672208002
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna American Axle |
$20.34
|
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Medicare |
$15.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.34
|
| Rate for Payer: BCBS Complete |
$12.52
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$26.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$28.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: Priority Health SBD |
$19.71
|
| Rate for Payer: UMR Bronson Commercial |
$11.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.47
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$31.29
|
|
|
Service Code
|
NDC 51672208002
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$28.16 |
| Rate for Payer: Aetna American Axle |
$20.34
|
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.34
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$26.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$28.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: PHP Commercial |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: Priority Health SBD |
$19.71
|
| Rate for Payer: UMR Bronson Commercial |
$13.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.47
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
NDC 96295013323
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$11.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
OP
|
$23.90
|
|
|
Service Code
|
NDC 51672208001
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$21.51 |
| Rate for Payer: Aetna American Axle |
$15.54
|
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$11.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: BCBS Complete |
$9.56
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$16.73
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health SBD |
$15.06
|
| Rate for Payer: UMR Bronson Commercial |
$8.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.92
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
NDC 96295013323
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
TERBINAFINE HCL 1 % TOPICAL CREAM
|
Facility
|
IP
|
$23.90
|
|
|
Service Code
|
NDC 51672208001
|
| Hospital Charge Code |
27023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$21.51 |
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health SBD |
$15.06
|
| Rate for Payer: UMR Bronson Commercial |
$10.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.92
|
| Rate for Payer: Aetna American Axle |
$15.54
|
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$16.73
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
OP
|
$67.83
|
|
|
Service Code
|
NDC 65862007930
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.10 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna American Axle |
$44.09
|
| Rate for Payer: Aetna Commercial |
$57.66
|
| Rate for Payer: Aetna Medicare |
$33.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.09
|
| Rate for Payer: BCBS Complete |
$27.13
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cofinity Commercial |
$47.48
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.26
|
| Rate for Payer: Healthscope Commercial |
$61.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.66
|
| Rate for Payer: PHP Commercial |
$57.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.09
|
| Rate for Payer: Priority Health SBD |
$42.73
|
| Rate for Payer: UMR Bronson Commercial |
$25.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.87
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
OP
|
$90.24
|
|
|
Service Code
|
NDC 51991052633
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.39 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna American Axle |
$58.66
|
| Rate for Payer: Aetna Commercial |
$76.70
|
| Rate for Payer: Aetna Medicare |
$45.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.66
|
| Rate for Payer: BCBS Complete |
$36.10
|
| Rate for Payer: Cash Price |
$72.19
|
| Rate for Payer: Cofinity Commercial |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$77.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.70
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.66
|
| Rate for Payer: Priority Health SBD |
$56.85
|
| Rate for Payer: UMR Bronson Commercial |
$33.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.68
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$92.36
|
|
|
Service Code
|
NDC 69097085902
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.64 |
| Max. Negotiated Rate |
$83.12 |
| Rate for Payer: Aetna American Axle |
$60.03
|
| Rate for Payer: Aetna Commercial |
$78.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.03
|
| Rate for Payer: Cash Price |
$73.89
|
| Rate for Payer: Cofinity Commercial |
$64.65
|
| Rate for Payer: Cofinity Commercial |
$79.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.89
|
| Rate for Payer: Healthscope Commercial |
$83.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.51
|
| Rate for Payer: PHP Commercial |
$78.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.03
|
| Rate for Payer: Priority Health SBD |
$58.19
|
| Rate for Payer: UMR Bronson Commercial |
$40.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.27
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
OP
|
$68.39
|
|
|
Service Code
|
NDC 69097073102
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$61.55 |
| Rate for Payer: Aetna American Axle |
$44.45
|
| Rate for Payer: Aetna Commercial |
$58.13
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.45
|
| Rate for Payer: BCBS Complete |
$27.36
|
| Rate for Payer: Cash Price |
$54.71
|
| Rate for Payer: Cofinity Commercial |
$47.87
|
| Rate for Payer: Cofinity Commercial |
$58.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.71
|
| Rate for Payer: Healthscope Commercial |
$61.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.13
|
| Rate for Payer: PHP Commercial |
$58.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.45
|
| Rate for Payer: Priority Health SBD |
$43.09
|
| Rate for Payer: UMR Bronson Commercial |
$25.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.29
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$68.39
|
|
|
Service Code
|
NDC 69097073102
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$61.55 |
| Rate for Payer: Aetna American Axle |
$44.45
|
| Rate for Payer: Aetna Commercial |
$58.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.45
|
| Rate for Payer: Cash Price |
$54.71
|
| Rate for Payer: Cofinity Commercial |
$47.87
|
| Rate for Payer: Cofinity Commercial |
$58.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.71
|
| Rate for Payer: Healthscope Commercial |
$61.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.13
|
| Rate for Payer: PHP Commercial |
$58.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.45
|
| Rate for Payer: Priority Health SBD |
$43.09
|
| Rate for Payer: UMR Bronson Commercial |
$30.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.29
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
OP
|
$92.36
|
|
|
Service Code
|
NDC 69097085902
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.17 |
| Max. Negotiated Rate |
$83.12 |
| Rate for Payer: Aetna American Axle |
$60.03
|
| Rate for Payer: Aetna Commercial |
$78.51
|
| Rate for Payer: Aetna Medicare |
$46.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.03
|
| Rate for Payer: BCBS Complete |
$36.94
|
| Rate for Payer: Cash Price |
$73.89
|
| Rate for Payer: Cofinity Commercial |
$64.65
|
| Rate for Payer: Cofinity Commercial |
$79.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.89
|
| Rate for Payer: Healthscope Commercial |
$83.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.51
|
| Rate for Payer: PHP Commercial |
$78.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.03
|
| Rate for Payer: Priority Health SBD |
$58.19
|
| Rate for Payer: UMR Bronson Commercial |
$34.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.27
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$67.83
|
|
|
Service Code
|
NDC 65862007930
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna American Axle |
$44.09
|
| Rate for Payer: Aetna Commercial |
$57.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.09
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cofinity Commercial |
$47.48
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.26
|
| Rate for Payer: Healthscope Commercial |
$61.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.66
|
| Rate for Payer: PHP Commercial |
$57.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.09
|
| Rate for Payer: Priority Health SBD |
$42.73
|
| Rate for Payer: UMR Bronson Commercial |
$29.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.87
|
|
|
TERBINAFINE HCL 250 MG TABLET
|
Facility
|
IP
|
$90.24
|
|
|
Service Code
|
NDC 51991052633
|
| Hospital Charge Code |
12724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.71 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna American Axle |
$58.66
|
| Rate for Payer: Aetna Commercial |
$76.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.66
|
| Rate for Payer: Cash Price |
$72.19
|
| Rate for Payer: Cofinity Commercial |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$77.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.70
|
| Rate for Payer: PHP Commercial |
$76.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.66
|
| Rate for Payer: Priority Health SBD |
$56.85
|
| Rate for Payer: UMR Bronson Commercial |
$39.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.68
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$24.05
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna American Axle |
$15.63
|
| Rate for Payer: Aetna American Axle |
$13.86
|
| Rate for Payer: Aetna American Axle |
$10.99
|
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna Commercial |
$14.37
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Medicare |
$10.66
|
| Rate for Payer: Aetna Medicare |
$8.46
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Complete |
$6.76
|
| Rate for Payer: BCBS Trust/PPO |
$6.09
|
| Rate for Payer: BCBS Trust/PPO |
$6.09
|
| Rate for Payer: BCBS Trust/PPO |
$6.09
|
| Rate for Payer: BCN Commercial |
$6.09
|
| Rate for Payer: BCN Commercial |
$6.09
|
| Rate for Payer: BCN Commercial |
$6.09
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$19.19
|
| Rate for Payer: Healthscope Commercial |
$15.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: PHP Commercial |
$14.37
|
| Rate for Payer: PHP Commercial |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health SBD |
$13.43
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: Priority Health SBD |
$10.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.90
|
| Rate for Payer: UMR Bronson Commercial |
$6.26
|
| Rate for Payer: UMR Bronson Commercial |
$7.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.04
|
|
|
TERBUTALINE 1 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$21.32
|
|
|
Service Code
|
HCPCS J3105
|
| Hospital Charge Code |
11507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$19.19 |
| Rate for Payer: Aetna American Axle |
$13.86
|
| Rate for Payer: Aetna American Axle |
$10.99
|
| Rate for Payer: Aetna American Axle |
$15.63
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Commercial |
$14.37
|
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.99
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$15.22
|
| Rate for Payer: Healthscope Commercial |
$19.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: PHP Commercial |
$14.37
|
| Rate for Payer: PHP Commercial |
$20.44
|
| Rate for Payer: PHP Commercial |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health SBD |
$13.43
|
| Rate for Payer: Priority Health SBD |
$10.65
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
| Rate for Payer: UMR Bronson Commercial |
$9.38
|
| Rate for Payer: UMR Bronson Commercial |
$7.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.99
|
|
|
TESTOSTERONE 1 % (25 MG/2.5 GRAM) TRANSDERMAL GEL PACKET
|
Facility
|
OP
|
$64.11
|
|
|
Service Code
|
NDC 00051842530
|
| Hospital Charge Code |
109728
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.72 |
| Max. Negotiated Rate |
$57.70 |
| Rate for Payer: Aetna American Axle |
$41.67
|
| Rate for Payer: Aetna Commercial |
$54.49
|
| Rate for Payer: Aetna Medicare |
$32.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.67
|
| Rate for Payer: BCBS Complete |
$25.64
|
| Rate for Payer: Cash Price |
$51.29
|
| Rate for Payer: Cofinity Commercial |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$55.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.29
|
| Rate for Payer: Healthscope Commercial |
$57.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.49
|
| Rate for Payer: PHP Commercial |
$54.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.67
|
| Rate for Payer: Priority Health SBD |
$40.39
|
| Rate for Payer: UMR Bronson Commercial |
$23.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.08
|
|
|
TESTOSTERONE 1 % (25 MG/2.5 GRAM) TRANSDERMAL GEL PACKET
|
Facility
|
IP
|
$64.11
|
|
|
Service Code
|
NDC 00051842530
|
| Hospital Charge Code |
109728
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$57.70 |
| Rate for Payer: Aetna American Axle |
$41.67
|
| Rate for Payer: Aetna Commercial |
$54.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.67
|
| Rate for Payer: Cash Price |
$51.29
|
| Rate for Payer: Cofinity Commercial |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$55.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.29
|
| Rate for Payer: Healthscope Commercial |
$57.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.49
|
| Rate for Payer: PHP Commercial |
$54.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.67
|
| Rate for Payer: Priority Health SBD |
$40.39
|
| Rate for Payer: UMR Bronson Commercial |
$28.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.08
|
|
|
TESTOSTERONE 1 % (50 MG/5 GRAM) TRANSDERMAL GEL PACKET
|
Facility
|
IP
|
$65.89
|
|
|
Service Code
|
NDC 00051845030
|
| Hospital Charge Code |
36093
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna American Axle |
$42.83
|
| Rate for Payer: Aetna Commercial |
$56.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.83
|
| Rate for Payer: Cash Price |
$52.71
|
| Rate for Payer: Cofinity Commercial |
$46.12
|
| Rate for Payer: Cofinity Commercial |
$56.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.71
|
| Rate for Payer: Healthscope Commercial |
$59.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.01
|
| Rate for Payer: PHP Commercial |
$56.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.83
|
| Rate for Payer: Priority Health SBD |
$41.51
|
| Rate for Payer: UMR Bronson Commercial |
$28.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.42
|
|
