|
THIORIDAZINE 25 MG TABLET
|
Facility
|
OP
|
$299.04
|
|
|
Service Code
|
NDC 00378061401
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.64 |
| Max. Negotiated Rate |
$269.14 |
| Rate for Payer: Aetna American Axle |
$194.38
|
| Rate for Payer: Aetna Commercial |
$254.18
|
| Rate for Payer: Aetna Medicare |
$149.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.38
|
| Rate for Payer: BCBS Complete |
$119.62
|
| Rate for Payer: Cash Price |
$239.23
|
| Rate for Payer: Cofinity Commercial |
$209.33
|
| Rate for Payer: Cofinity Commercial |
$257.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.23
|
| Rate for Payer: Healthscope Commercial |
$269.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.18
|
| Rate for Payer: PHP Commercial |
$254.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.38
|
| Rate for Payer: Priority Health SBD |
$188.40
|
| Rate for Payer: UMR Bronson Commercial |
$110.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.28
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
OP
|
$468.35
|
|
|
Service Code
|
NDC 51079056620
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.29 |
| Max. Negotiated Rate |
$421.52 |
| Rate for Payer: Aetna American Axle |
$304.43
|
| Rate for Payer: Aetna Commercial |
$398.10
|
| Rate for Payer: Aetna Medicare |
$234.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.43
|
| Rate for Payer: BCBS Complete |
$187.34
|
| Rate for Payer: Cash Price |
$374.68
|
| Rate for Payer: Cofinity Commercial |
$327.84
|
| Rate for Payer: Cofinity Commercial |
$402.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.68
|
| Rate for Payer: Healthscope Commercial |
$421.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.10
|
| Rate for Payer: PHP Commercial |
$398.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.43
|
| Rate for Payer: Priority Health SBD |
$295.06
|
| Rate for Payer: UMR Bronson Commercial |
$173.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.26
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$299.04
|
|
|
Service Code
|
NDC 00378061401
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.58 |
| Max. Negotiated Rate |
$269.14 |
| Rate for Payer: Aetna American Axle |
$194.38
|
| Rate for Payer: Aetna Commercial |
$254.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.38
|
| Rate for Payer: Cash Price |
$239.23
|
| Rate for Payer: Cofinity Commercial |
$209.33
|
| Rate for Payer: Cofinity Commercial |
$257.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.23
|
| Rate for Payer: Healthscope Commercial |
$269.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.18
|
| Rate for Payer: PHP Commercial |
$254.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.38
|
| Rate for Payer: Priority Health SBD |
$188.40
|
| Rate for Payer: UMR Bronson Commercial |
$131.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.28
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 51079056601
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna American Axle |
$3.05
|
| Rate for Payer: Aetna Commercial |
$3.99
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.05
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$4.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.99
|
| Rate for Payer: PHP Commercial |
$3.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.05
|
| Rate for Payer: Priority Health SBD |
$2.95
|
| Rate for Payer: UMR Bronson Commercial |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.52
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$468.35
|
|
|
Service Code
|
NDC 51079056620
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.07 |
| Max. Negotiated Rate |
$421.52 |
| Rate for Payer: Aetna American Axle |
$304.43
|
| Rate for Payer: Aetna Commercial |
$398.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.43
|
| Rate for Payer: Cash Price |
$374.68
|
| Rate for Payer: Cofinity Commercial |
$327.84
|
| Rate for Payer: Cofinity Commercial |
$402.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.68
|
| Rate for Payer: Healthscope Commercial |
$421.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.10
|
| Rate for Payer: PHP Commercial |
$398.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.43
|
| Rate for Payer: Priority Health SBD |
$295.06
|
| Rate for Payer: UMR Bronson Commercial |
$206.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.26
|
|
|
THIOTEPA 15 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$767.25
|
|
|
Service Code
|
HCPCS J9340
|
| Hospital Charge Code |
7901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$337.59 |
| Max. Negotiated Rate |
$690.52 |
| Rate for Payer: Aetna American Axle |
$498.71
|
| Rate for Payer: Aetna Commercial |
$652.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.71
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cofinity Commercial |
$537.08
|
| Rate for Payer: Cofinity Commercial |
$659.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$537.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$613.80
|
| Rate for Payer: Healthscope Commercial |
$690.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$537.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$575.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.16
|
| Rate for Payer: PHP Commercial |
$652.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.71
|
| Rate for Payer: Priority Health SBD |
$483.37
|
| Rate for Payer: UMR Bronson Commercial |
$337.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$575.44
|
|
|
THIOTEPA 15 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$767.25
|
|
|
Service Code
|
HCPCS J9340
|
| Hospital Charge Code |
7901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.86 |
| Max. Negotiated Rate |
$690.52 |
| Rate for Payer: Aetna American Axle |
$498.71
|
| Rate for Payer: Aetna Commercial |
$652.16
|
| Rate for Payer: Aetna Medicare |
$230.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$277.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$277.19
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$221.75
|
| Rate for Payer: BCBS Trust/PPO |
$563.55
|
| Rate for Payer: BCN Commercial |
$563.55
|
| Rate for Payer: BCN Medicare Advantage |
$221.75
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cofinity Commercial |
$659.84
|
| Rate for Payer: Cofinity Commercial |
$537.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$537.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$613.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.75
|
| Rate for Payer: Healthscope Commercial |
$690.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$537.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$575.44
|
| Rate for Payer: Mclaren Medicaid |
$118.86
|
| Rate for Payer: Mclaren Medicare |
$221.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.84
|
| Rate for Payer: Meridian Medicaid |
$124.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$255.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.16
|
| Rate for Payer: Nomi Health Commercial |
$665.25
|
| Rate for Payer: PACE Medicare |
$210.66
|
| Rate for Payer: PACE SWMI |
$221.75
|
| Rate for Payer: PHP Commercial |
$652.16
|
| Rate for Payer: PHP Medicare Advantage |
$221.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.54
|
| Rate for Payer: Priority Health Medicare |
$221.75
|
| Rate for Payer: Priority Health Narrow Network |
$481.23
|
| Rate for Payer: Priority Health SBD |
$483.37
|
| Rate for Payer: Railroad Medicare Medicare |
$221.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.75
|
| Rate for Payer: UHC Exchange |
$423.79
|
| Rate for Payer: UHC Medicare Advantage |
$221.75
|
| Rate for Payer: UHCCP Medicaid |
$118.86
|
| Rate for Payer: UMR Bronson Commercial |
$283.88
|
| Rate for Payer: VA VA |
$221.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$575.44
|
|
|
THIOTHIXENE 2 MG CAPSULE
|
Facility
|
IP
|
$413.28
|
|
|
Service Code
|
NDC 70954001510
|
| Hospital Charge Code |
7904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.84 |
| Max. Negotiated Rate |
$371.95 |
| Rate for Payer: Aetna American Axle |
$268.63
|
| Rate for Payer: Aetna Commercial |
$351.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.63
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$289.30
|
| Rate for Payer: Cofinity Commercial |
$355.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Healthscope Commercial |
$371.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.29
|
| Rate for Payer: PHP Commercial |
$351.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.63
|
| Rate for Payer: Priority Health SBD |
$260.37
|
| Rate for Payer: UMR Bronson Commercial |
$181.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.96
|
|
|
THIOTHIXENE 2 MG CAPSULE
|
Facility
|
OP
|
$559.68
|
|
|
Service Code
|
NDC 00378200201
|
| Hospital Charge Code |
7904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.08 |
| Max. Negotiated Rate |
$503.71 |
| Rate for Payer: Aetna American Axle |
$363.79
|
| Rate for Payer: Aetna Commercial |
$475.73
|
| Rate for Payer: Aetna Medicare |
$279.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$363.79
|
| Rate for Payer: BCBS Complete |
$223.87
|
| Rate for Payer: Cash Price |
$447.74
|
| Rate for Payer: Cofinity Commercial |
$391.78
|
| Rate for Payer: Cofinity Commercial |
$481.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$391.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$447.74
|
| Rate for Payer: Healthscope Commercial |
$503.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$391.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$419.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$475.73
|
| Rate for Payer: PHP Commercial |
$475.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.79
|
| Rate for Payer: Priority Health SBD |
$352.60
|
| Rate for Payer: UMR Bronson Commercial |
$207.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$419.76
|
|
|
THIOTHIXENE 2 MG CAPSULE
|
Facility
|
IP
|
$559.68
|
|
|
Service Code
|
NDC 00378200201
|
| Hospital Charge Code |
7904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.26 |
| Max. Negotiated Rate |
$503.71 |
| Rate for Payer: Aetna American Axle |
$363.79
|
| Rate for Payer: Aetna Commercial |
$475.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$363.79
|
| Rate for Payer: Cash Price |
$447.74
|
| Rate for Payer: Cofinity Commercial |
$391.78
|
| Rate for Payer: Cofinity Commercial |
$481.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$391.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$447.74
|
| Rate for Payer: Healthscope Commercial |
$503.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$391.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$419.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$475.73
|
| Rate for Payer: PHP Commercial |
$475.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.79
|
| Rate for Payer: Priority Health SBD |
$352.60
|
| Rate for Payer: UMR Bronson Commercial |
$246.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$419.76
|
|
|
THIOTHIXENE 2 MG CAPSULE
|
Facility
|
OP
|
$413.28
|
|
|
Service Code
|
NDC 70954001510
|
| Hospital Charge Code |
7904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.91 |
| Max. Negotiated Rate |
$371.95 |
| Rate for Payer: Aetna American Axle |
$268.63
|
| Rate for Payer: Aetna Commercial |
$351.29
|
| Rate for Payer: Aetna Medicare |
$206.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.63
|
| Rate for Payer: BCBS Complete |
$165.31
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$289.30
|
| Rate for Payer: Cofinity Commercial |
$355.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Healthscope Commercial |
$371.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.29
|
| Rate for Payer: PHP Commercial |
$351.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.63
|
| Rate for Payer: Priority Health SBD |
$260.37
|
| Rate for Payer: UMR Bronson Commercial |
$152.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.96
|
|
|
THIOTHIXENE 5 MG CAPSULE
|
Facility
|
OP
|
$684.48
|
|
|
Service Code
|
NDC 70954001610
|
| Hospital Charge Code |
7906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.26 |
| Max. Negotiated Rate |
$616.03 |
| Rate for Payer: Aetna American Axle |
$444.91
|
| Rate for Payer: Aetna Commercial |
$581.81
|
| Rate for Payer: Aetna Medicare |
$342.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.91
|
| Rate for Payer: BCBS Complete |
$273.79
|
| Rate for Payer: Cash Price |
$547.58
|
| Rate for Payer: Cofinity Commercial |
$479.14
|
| Rate for Payer: Cofinity Commercial |
$588.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$479.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.58
|
| Rate for Payer: Healthscope Commercial |
$616.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$479.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.81
|
| Rate for Payer: PHP Commercial |
$581.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.91
|
| Rate for Payer: Priority Health SBD |
$431.22
|
| Rate for Payer: UMR Bronson Commercial |
$253.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.36
|
|
|
THIOTHIXENE 5 MG CAPSULE
|
Facility
|
IP
|
$684.48
|
|
|
Service Code
|
NDC 70954001610
|
| Hospital Charge Code |
7906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.17 |
| Max. Negotiated Rate |
$616.03 |
| Rate for Payer: Aetna American Axle |
$444.91
|
| Rate for Payer: Aetna Commercial |
$581.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.91
|
| Rate for Payer: Cash Price |
$547.58
|
| Rate for Payer: Cofinity Commercial |
$479.14
|
| Rate for Payer: Cofinity Commercial |
$588.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$479.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.58
|
| Rate for Payer: Healthscope Commercial |
$616.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$479.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.81
|
| Rate for Payer: PHP Commercial |
$581.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.91
|
| Rate for Payer: Priority Health SBD |
$431.22
|
| Rate for Payer: UMR Bronson Commercial |
$301.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.36
|
|
|
THIOTHIXENE 5 MG CAPSULE
|
Facility
|
IP
|
$9.90
|
|
|
Service Code
|
NDC 51079058801
|
| Hospital Charge Code |
7906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna American Axle |
$6.44
|
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.44
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$6.93
|
| Rate for Payer: Cofinity Commercial |
$8.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$8.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: PHP Commercial |
$8.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.44
|
| Rate for Payer: Priority Health SBD |
$6.24
|
| Rate for Payer: UMR Bronson Commercial |
$4.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.42
|
|
|
THIOTHIXENE 5 MG CAPSULE
|
Facility
|
OP
|
$989.01
|
|
|
Service Code
|
NDC 51079058820
|
| Hospital Charge Code |
7906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$365.93 |
| Max. Negotiated Rate |
$890.11 |
| Rate for Payer: Aetna American Axle |
$642.86
|
| Rate for Payer: Aetna Commercial |
$840.66
|
| Rate for Payer: Aetna Medicare |
$494.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.86
|
| Rate for Payer: BCBS Complete |
$395.60
|
| Rate for Payer: Cash Price |
$791.21
|
| Rate for Payer: Cofinity Commercial |
$692.31
|
| Rate for Payer: Cofinity Commercial |
$850.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$692.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$791.21
|
| Rate for Payer: Healthscope Commercial |
$890.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$692.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$741.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$840.66
|
| Rate for Payer: PHP Commercial |
$840.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.86
|
| Rate for Payer: Priority Health SBD |
$623.08
|
| Rate for Payer: UMR Bronson Commercial |
$365.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$741.76
|
|
|
THIOTHIXENE 5 MG CAPSULE
|
Facility
|
OP
|
$9.90
|
|
|
Service Code
|
NDC 51079058801
|
| Hospital Charge Code |
7906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$8.91 |
| Rate for Payer: Aetna American Axle |
$6.44
|
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.44
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$6.93
|
| Rate for Payer: Cofinity Commercial |
$8.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$8.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: PHP Commercial |
$8.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.44
|
| Rate for Payer: Priority Health SBD |
$6.24
|
| Rate for Payer: UMR Bronson Commercial |
$3.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.42
|
|
|
THIOTHIXENE 5 MG CAPSULE
|
Facility
|
IP
|
$989.01
|
|
|
Service Code
|
NDC 51079058820
|
| Hospital Charge Code |
7906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$435.16 |
| Max. Negotiated Rate |
$890.11 |
| Rate for Payer: Aetna American Axle |
$642.86
|
| Rate for Payer: Aetna Commercial |
$840.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.86
|
| Rate for Payer: Cash Price |
$791.21
|
| Rate for Payer: Cofinity Commercial |
$692.31
|
| Rate for Payer: Cofinity Commercial |
$850.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$692.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$791.21
|
| Rate for Payer: Healthscope Commercial |
$890.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$692.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$741.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$840.66
|
| Rate for Payer: PHP Commercial |
$840.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.86
|
| Rate for Payer: Priority Health SBD |
$623.08
|
| Rate for Payer: UMR Bronson Commercial |
$435.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$741.76
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$1,903.90
|
|
|
Service Code
|
CPT 32555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.96 |
| Max. Negotiated Rate |
$1,903.90 |
| Rate for Payer: Aetna Medicare |
$629.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.20
|
| Rate for Payer: BCBS Complete |
$340.92
|
| Rate for Payer: BCBS MAPPO |
$605.76
|
| Rate for Payer: BCBS Trust/PPO |
$729.49
|
| Rate for Payer: BCN Commercial |
$729.49
|
| Rate for Payer: BCN Medicare Advantage |
$605.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.76
|
| Rate for Payer: Mclaren Medicaid |
$324.69
|
| Rate for Payer: Mclaren Medicare |
$605.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.05
|
| Rate for Payer: Meridian Medicaid |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.62
|
| Rate for Payer: Nomi Health Commercial |
$1,272.10
|
| Rate for Payer: PACE Medicare |
$575.47
|
| Rate for Payer: PACE SWMI |
$605.76
|
| Rate for Payer: PHP Medicare Advantage |
$605.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,903.90
|
| Rate for Payer: Priority Health Medicare |
$605.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,523.12
|
| Rate for Payer: Railroad Medicare Medicare |
$605.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.36
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.76
|
| Rate for Payer: UHC Exchange |
$103.96
|
| Rate for Payer: UHC Medicare Advantage |
$605.76
|
| Rate for Payer: UHCCP Medicaid |
$324.69
|
| Rate for Payer: VA VA |
$605.76
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$1,903.90
|
|
|
Service Code
|
CPT 32554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.96 |
| Max. Negotiated Rate |
$1,903.90 |
| Rate for Payer: Aetna Medicare |
$629.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.20
|
| Rate for Payer: BCBS Complete |
$340.92
|
| Rate for Payer: BCBS MAPPO |
$605.76
|
| Rate for Payer: BCBS Trust/PPO |
$455.29
|
| Rate for Payer: BCN Commercial |
$455.29
|
| Rate for Payer: BCN Medicare Advantage |
$605.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.76
|
| Rate for Payer: Mclaren Medicaid |
$324.69
|
| Rate for Payer: Mclaren Medicare |
$605.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.05
|
| Rate for Payer: Meridian Medicaid |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.62
|
| Rate for Payer: Nomi Health Commercial |
$1,272.10
|
| Rate for Payer: PACE Medicare |
$575.47
|
| Rate for Payer: PACE SWMI |
$605.76
|
| Rate for Payer: PHP Medicare Advantage |
$605.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,903.90
|
| Rate for Payer: Priority Health Medicare |
$605.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,523.12
|
| Rate for Payer: Railroad Medicare Medicare |
$605.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.46
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.76
|
| Rate for Payer: UHC Exchange |
$84.96
|
| Rate for Payer: UHC Medicare Advantage |
$605.76
|
| Rate for Payer: UHCCP Medicaid |
$324.69
|
| Rate for Payer: VA VA |
$605.76
|
|
|
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); MEDIASTINAL SPACE, WITH BIOPSY
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 32606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$447.51 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,921.92
|
| Rate for Payer: BCN Commercial |
$3,921.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.26
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$447.51
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
THORACOSCOPY, SURGICAL; WITH EXCISION OF MEDIASTINAL CYST, TUMOR, OR MASS
|
Facility
|
OP
|
$3,262.30
|
|
|
Service Code
|
CPT 32662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$866.73 |
| Max. Negotiated Rate |
$3,262.30 |
| Rate for Payer: BCBS Trust/PPO |
$3,262.30
|
| Rate for Payer: BCN Commercial |
$3,262.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$953.40
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$866.73
|
|
|
THORACOSCOPY; WITH BIOPSY(IES) OF PLEURA
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 32609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$247.06 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,921.92
|
| Rate for Payer: BCN Commercial |
$3,921.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.77
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$247.06
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
THORACOSCOPY; WITH DIAGNOSTIC BIOPSY(IES) OF LUNG INFILTRATE(S) (EG, WEDGE, INCISIONAL), UNILATERAL
|
Facility
|
OP
|
$32,060.66
|
|
|
Service Code
|
CPT 32607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$297.91 |
| Max. Negotiated Rate |
$32,060.66 |
| Rate for Payer: Aetna Medicare |
$10,608.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,750.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,750.89
|
| Rate for Payer: BCBS Complete |
$5,740.96
|
| Rate for Payer: BCBS MAPPO |
$10,200.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,921.92
|
| Rate for Payer: BCN Commercial |
$3,921.92
|
| Rate for Payer: BCN Medicare Advantage |
$10,200.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,200.71
|
| Rate for Payer: Mclaren Medicaid |
$5,467.58
|
| Rate for Payer: Mclaren Medicare |
$10,200.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,710.75
|
| Rate for Payer: Meridian Medicaid |
$5,740.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,730.82
|
| Rate for Payer: Nomi Health Commercial |
$21,421.49
|
| Rate for Payer: PACE Medicare |
$9,690.67
|
| Rate for Payer: PACE SWMI |
$10,200.71
|
| Rate for Payer: PHP Medicare Advantage |
$10,200.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,467.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,060.66
|
| Rate for Payer: Priority Health Medicare |
$10,200.71
|
| Rate for Payer: Priority Health Narrow Network |
$25,648.53
|
| Rate for Payer: Railroad Medicare Medicare |
$10,200.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.70
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,200.71
|
| Rate for Payer: UHC Exchange |
$297.91
|
| Rate for Payer: UHC Medicare Advantage |
$10,200.71
|
| Rate for Payer: UHCCP Medicaid |
$5,467.58
|
| Rate for Payer: VA VA |
$10,200.71
|
|
|
THORACOTOMY; WITH CARDIAC MASSAGE
|
Facility
|
OP
|
$2,889.57
|
|
|
Service Code
|
CPT 32160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$772.12 |
| Max. Negotiated Rate |
$2,889.57 |
| Rate for Payer: BCBS Trust/PPO |
$2,889.57
|
| Rate for Payer: BCN Commercial |
$2,889.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.33
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$772.12
|
|
|
THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THAN HEMODIALYSIS GRAFT OR FISTULA);
|
Facility
|
OP
|
$16,646.50
|
|
|
Service Code
|
CPT 35875
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$572.12 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,302.89
|
| Rate for Payer: BCN Commercial |
$3,302.89
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.33
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$572.12
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
