|
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH LIMITED NECK DISSECTION
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 60252
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,284.01 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$8,636.85
|
| Rate for Payer: BCN Commercial |
$8,636.85
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,412.41
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,284.01
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH RADICAL NECK DISSECTION
|
Facility
|
OP
|
$6,070.99
|
|
|
Service Code
|
CPT 60254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,621.55 |
| Max. Negotiated Rate |
$6,070.99 |
| Rate for Payer: BCBS Trust/PPO |
$6,070.99
|
| Rate for Payer: BCN Commercial |
$6,070.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,783.70
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Exchange |
$1,621.55
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
|
IP
|
$472.80
|
|
|
Service Code
|
NDC 00456045801
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.03 |
| Max. Negotiated Rate |
$425.52 |
| Rate for Payer: Aetna American Axle |
$307.32
|
| Rate for Payer: Aetna Commercial |
$401.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.32
|
| Rate for Payer: Cash Price |
$378.24
|
| Rate for Payer: Cofinity Commercial |
$330.96
|
| Rate for Payer: Cofinity Commercial |
$406.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$330.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.24
|
| Rate for Payer: Healthscope Commercial |
$425.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$330.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.88
|
| Rate for Payer: PHP Commercial |
$401.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.32
|
| Rate for Payer: Priority Health SBD |
$297.86
|
| Rate for Payer: UMR Bronson Commercial |
$208.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.60
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
|
IP
|
$330.24
|
|
|
Service Code
|
NDC 42192032901
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$297.22 |
| Rate for Payer: Aetna American Axle |
$214.66
|
| Rate for Payer: Aetna Commercial |
$280.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.66
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cofinity Commercial |
$231.17
|
| Rate for Payer: Cofinity Commercial |
$284.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.19
|
| Rate for Payer: Healthscope Commercial |
$297.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.70
|
| Rate for Payer: PHP Commercial |
$280.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.66
|
| Rate for Payer: Priority Health SBD |
$208.05
|
| Rate for Payer: UMR Bronson Commercial |
$145.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.68
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
|
OP
|
$472.80
|
|
|
Service Code
|
NDC 00456045801
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.94 |
| Max. Negotiated Rate |
$425.52 |
| Rate for Payer: Aetna American Axle |
$307.32
|
| Rate for Payer: Aetna Commercial |
$401.88
|
| Rate for Payer: Aetna Medicare |
$236.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.32
|
| Rate for Payer: BCBS Complete |
$189.12
|
| Rate for Payer: Cash Price |
$378.24
|
| Rate for Payer: Cofinity Commercial |
$330.96
|
| Rate for Payer: Cofinity Commercial |
$406.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$330.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.24
|
| Rate for Payer: Healthscope Commercial |
$425.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$330.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.88
|
| Rate for Payer: PHP Commercial |
$401.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.32
|
| Rate for Payer: Priority Health SBD |
$297.86
|
| Rate for Payer: UMR Bronson Commercial |
$174.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.60
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
|
IP
|
$277.44
|
|
|
Service Code
|
NDC 62559074101
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.07 |
| Max. Negotiated Rate |
$249.70 |
| Rate for Payer: Aetna American Axle |
$180.34
|
| Rate for Payer: Aetna Commercial |
$235.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.34
|
| Rate for Payer: Cash Price |
$221.95
|
| Rate for Payer: Cofinity Commercial |
$194.21
|
| Rate for Payer: Cofinity Commercial |
$238.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.95
|
| Rate for Payer: Healthscope Commercial |
$249.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.82
|
| Rate for Payer: PHP Commercial |
$235.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.34
|
| Rate for Payer: Priority Health SBD |
$174.79
|
| Rate for Payer: UMR Bronson Commercial |
$122.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.08
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
|
OP
|
$277.44
|
|
|
Service Code
|
NDC 62559074101
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.65 |
| Max. Negotiated Rate |
$249.70 |
| Rate for Payer: Aetna American Axle |
$180.34
|
| Rate for Payer: Aetna Commercial |
$235.82
|
| Rate for Payer: Aetna Medicare |
$138.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.34
|
| Rate for Payer: BCBS Complete |
$110.98
|
| Rate for Payer: Cash Price |
$221.95
|
| Rate for Payer: Cofinity Commercial |
$194.21
|
| Rate for Payer: Cofinity Commercial |
$238.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.95
|
| Rate for Payer: Healthscope Commercial |
$249.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.82
|
| Rate for Payer: PHP Commercial |
$235.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.34
|
| Rate for Payer: Priority Health SBD |
$174.79
|
| Rate for Payer: UMR Bronson Commercial |
$102.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.08
|
|
|
THYROID (PORK) 30 MG TABLET
|
Facility
|
OP
|
$330.24
|
|
|
Service Code
|
NDC 42192032901
|
| Hospital Charge Code |
119104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.19 |
| Max. Negotiated Rate |
$297.22 |
| Rate for Payer: Aetna American Axle |
$214.66
|
| Rate for Payer: Aetna Commercial |
$280.70
|
| Rate for Payer: Aetna Medicare |
$165.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.66
|
| Rate for Payer: BCBS Complete |
$132.10
|
| Rate for Payer: Cash Price |
$264.19
|
| Rate for Payer: Cofinity Commercial |
$231.17
|
| Rate for Payer: Cofinity Commercial |
$284.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.19
|
| Rate for Payer: Healthscope Commercial |
$297.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.70
|
| Rate for Payer: PHP Commercial |
$280.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.66
|
| Rate for Payer: Priority Health SBD |
$208.05
|
| Rate for Payer: UMR Bronson Commercial |
$122.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.68
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
IP
|
$366.72
|
|
|
Service Code
|
NDC 42192033001
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.36 |
| Max. Negotiated Rate |
$330.05 |
| Rate for Payer: Aetna American Axle |
$238.37
|
| Rate for Payer: Aetna Commercial |
$311.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.37
|
| Rate for Payer: Cash Price |
$293.38
|
| Rate for Payer: Cofinity Commercial |
$256.70
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.38
|
| Rate for Payer: Healthscope Commercial |
$330.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.71
|
| Rate for Payer: PHP Commercial |
$311.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.37
|
| Rate for Payer: Priority Health SBD |
$231.03
|
| Rate for Payer: UMR Bronson Commercial |
$161.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.04
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
IP
|
$525.60
|
|
|
Service Code
|
NDC 00456045901
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.26 |
| Max. Negotiated Rate |
$473.04 |
| Rate for Payer: Aetna American Axle |
$341.64
|
| Rate for Payer: Aetna Commercial |
$446.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.64
|
| Rate for Payer: Cash Price |
$420.48
|
| Rate for Payer: Cofinity Commercial |
$367.92
|
| Rate for Payer: Cofinity Commercial |
$452.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$367.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.48
|
| Rate for Payer: Healthscope Commercial |
$473.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.76
|
| Rate for Payer: PHP Commercial |
$446.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.64
|
| Rate for Payer: Priority Health SBD |
$331.13
|
| Rate for Payer: UMR Bronson Commercial |
$231.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.20
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
OP
|
$366.72
|
|
|
Service Code
|
NDC 42192033001
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.69 |
| Max. Negotiated Rate |
$330.05 |
| Rate for Payer: Aetna American Axle |
$238.37
|
| Rate for Payer: Aetna Commercial |
$311.71
|
| Rate for Payer: Aetna Medicare |
$183.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.37
|
| Rate for Payer: BCBS Complete |
$146.69
|
| Rate for Payer: Cash Price |
$293.38
|
| Rate for Payer: Cofinity Commercial |
$256.70
|
| Rate for Payer: Cofinity Commercial |
$315.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.38
|
| Rate for Payer: Healthscope Commercial |
$330.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.71
|
| Rate for Payer: PHP Commercial |
$311.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.37
|
| Rate for Payer: Priority Health SBD |
$231.03
|
| Rate for Payer: UMR Bronson Commercial |
$135.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.04
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
OP
|
$307.20
|
|
|
Service Code
|
NDC 62559074201
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.66 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna American Axle |
$199.68
|
| Rate for Payer: Aetna Commercial |
$261.12
|
| Rate for Payer: Aetna Medicare |
$153.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.68
|
| Rate for Payer: BCBS Complete |
$122.88
|
| Rate for Payer: Cash Price |
$245.76
|
| Rate for Payer: Cofinity Commercial |
$215.04
|
| Rate for Payer: Cofinity Commercial |
$264.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.76
|
| Rate for Payer: Healthscope Commercial |
$276.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.12
|
| Rate for Payer: PHP Commercial |
$261.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.68
|
| Rate for Payer: Priority Health SBD |
$193.54
|
| Rate for Payer: UMR Bronson Commercial |
$113.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.40
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
OP
|
$525.60
|
|
|
Service Code
|
NDC 00456045901
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.47 |
| Max. Negotiated Rate |
$473.04 |
| Rate for Payer: Aetna American Axle |
$341.64
|
| Rate for Payer: Aetna Commercial |
$446.76
|
| Rate for Payer: Aetna Medicare |
$262.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.64
|
| Rate for Payer: BCBS Complete |
$210.24
|
| Rate for Payer: Cash Price |
$420.48
|
| Rate for Payer: Cofinity Commercial |
$367.92
|
| Rate for Payer: Cofinity Commercial |
$452.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$367.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.48
|
| Rate for Payer: Healthscope Commercial |
$473.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$394.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.76
|
| Rate for Payer: PHP Commercial |
$446.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.64
|
| Rate for Payer: Priority Health SBD |
$331.13
|
| Rate for Payer: UMR Bronson Commercial |
$194.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$394.20
|
|
|
THYROID (PORK) 60 MG TABLET
|
Facility
|
IP
|
$307.20
|
|
|
Service Code
|
NDC 62559074201
|
| Hospital Charge Code |
119105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.17 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna American Axle |
$199.68
|
| Rate for Payer: Aetna Commercial |
$261.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.68
|
| Rate for Payer: Cash Price |
$245.76
|
| Rate for Payer: Cofinity Commercial |
$215.04
|
| Rate for Payer: Cofinity Commercial |
$264.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.76
|
| Rate for Payer: Healthscope Commercial |
$276.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.12
|
| Rate for Payer: PHP Commercial |
$261.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.68
|
| Rate for Payer: Priority Health SBD |
$193.54
|
| Rate for Payer: UMR Bronson Commercial |
$135.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.40
|
|
|
THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$6,327.17
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
196901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$6,203.73 |
| Rate for Payer: Aetna Medicare |
$2,150.63
|
| Rate for Payer: Aetna American Axle |
$4,112.66
|
| Rate for Payer: Aetna Commercial |
$5,378.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,112.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,584.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,584.89
|
| Rate for Payer: BCBS Complete |
$1,163.82
|
| Rate for Payer: BCBS MAPPO |
$2,067.91
|
| Rate for Payer: BCBS Trust/PPO |
$5,590.41
|
| Rate for Payer: BCN Commercial |
$5,590.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,067.91
|
| Rate for Payer: Cash Price |
$5,061.74
|
| Rate for Payer: Cash Price |
$5,061.74
|
| Rate for Payer: Cofinity Commercial |
$5,441.37
|
| Rate for Payer: Cofinity Commercial |
$4,429.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,429.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,061.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,067.91
|
| Rate for Payer: Healthscope Commercial |
$5,694.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,429.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,745.38
|
| Rate for Payer: Mclaren Medicaid |
$1,108.40
|
| Rate for Payer: Mclaren Medicare |
$2,067.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,171.31
|
| Rate for Payer: Meridian Medicaid |
$1,163.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,378.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,378.09
|
| Rate for Payer: Nomi Health Commercial |
$6,203.73
|
| Rate for Payer: PACE Medicare |
$1,964.51
|
| Rate for Payer: PACE SWMI |
$2,067.91
|
| Rate for Payer: PHP Commercial |
$5,378.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,067.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,108.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,112.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,967.11
|
| Rate for Payer: Priority Health Medicare |
$2,067.91
|
| Rate for Payer: Priority Health Narrow Network |
$4,773.69
|
| Rate for Payer: Priority Health SBD |
$3,986.12
|
| Rate for Payer: Railroad Medicare Medicare |
$2,067.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,820.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,067.91
|
| Rate for Payer: UHC Exchange |
$3,951.98
|
| Rate for Payer: UHC Medicare Advantage |
$2,067.91
|
| Rate for Payer: UHCCP Medicaid |
$1,108.40
|
| Rate for Payer: UMR Bronson Commercial |
$2,341.05
|
| Rate for Payer: VA VA |
$2,067.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,745.38
|
|
|
THYROTROPIN ALFA 0.9 MG INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$6,327.17
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
196901
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,783.95 |
| Max. Negotiated Rate |
$5,694.45 |
| Rate for Payer: Aetna American Axle |
$4,112.66
|
| Rate for Payer: Aetna Commercial |
$5,378.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,112.66
|
| Rate for Payer: Cash Price |
$5,061.74
|
| Rate for Payer: Cofinity Commercial |
$4,429.02
|
| Rate for Payer: Cofinity Commercial |
$5,441.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,429.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,061.74
|
| Rate for Payer: Healthscope Commercial |
$5,694.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,429.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,745.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,378.09
|
| Rate for Payer: PHP Commercial |
$5,378.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,112.66
|
| Rate for Payer: Priority Health SBD |
$3,986.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,783.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,745.38
|
|
|
TIAGABINE 4 MG TABLET
|
Facility
|
OP
|
$314.02
|
|
|
Service Code
|
NDC 00093503156
|
| Hospital Charge Code |
21827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.19 |
| Max. Negotiated Rate |
$282.62 |
| Rate for Payer: Aetna American Axle |
$204.11
|
| Rate for Payer: Aetna Commercial |
$266.92
|
| Rate for Payer: Aetna Medicare |
$157.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.11
|
| Rate for Payer: BCBS Complete |
$125.61
|
| Rate for Payer: Cash Price |
$251.22
|
| Rate for Payer: Cofinity Commercial |
$219.81
|
| Rate for Payer: Cofinity Commercial |
$270.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.22
|
| Rate for Payer: Healthscope Commercial |
$282.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.92
|
| Rate for Payer: PHP Commercial |
$266.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.11
|
| Rate for Payer: Priority Health SBD |
$197.83
|
| Rate for Payer: UMR Bronson Commercial |
$116.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.52
|
|
|
TIAGABINE 4 MG TABLET
|
Facility
|
IP
|
$1,229.44
|
|
|
Service Code
|
NDC 63459040430
|
| Hospital Charge Code |
21827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$540.95 |
| Max. Negotiated Rate |
$1,106.50 |
| Rate for Payer: Cofinity Commercial |
$1,057.32
|
| Rate for Payer: Cofinity Commercial |
$860.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$860.61
|
| Rate for Payer: Aetna American Axle |
$799.14
|
| Rate for Payer: Aetna Commercial |
$1,045.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$799.14
|
| Rate for Payer: Cash Price |
$983.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$983.55
|
| Rate for Payer: Healthscope Commercial |
$1,106.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$860.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$922.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,045.02
|
| Rate for Payer: PHP Commercial |
$1,045.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$799.14
|
| Rate for Payer: Priority Health SBD |
$774.55
|
| Rate for Payer: UMR Bronson Commercial |
$540.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$922.08
|
|
|
TIAGABINE 4 MG TABLET
|
Facility
|
IP
|
$314.02
|
|
|
Service Code
|
NDC 00093503156
|
| Hospital Charge Code |
21827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.17 |
| Max. Negotiated Rate |
$282.62 |
| Rate for Payer: Aetna American Axle |
$204.11
|
| Rate for Payer: Aetna Commercial |
$266.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.11
|
| Rate for Payer: Cash Price |
$251.22
|
| Rate for Payer: Cofinity Commercial |
$219.81
|
| Rate for Payer: Cofinity Commercial |
$270.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.22
|
| Rate for Payer: Healthscope Commercial |
$282.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.92
|
| Rate for Payer: PHP Commercial |
$266.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.11
|
| Rate for Payer: Priority Health SBD |
$197.83
|
| Rate for Payer: UMR Bronson Commercial |
$138.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.52
|
|
|
TIAGABINE 4 MG TABLET
|
Facility
|
OP
|
$655.24
|
|
|
Service Code
|
NDC 62756022483
|
| Hospital Charge Code |
21827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$589.72 |
| Rate for Payer: Aetna American Axle |
$425.91
|
| Rate for Payer: Aetna Commercial |
$556.95
|
| Rate for Payer: Aetna Medicare |
$327.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.91
|
| Rate for Payer: BCBS Complete |
$262.10
|
| Rate for Payer: Cash Price |
$524.19
|
| Rate for Payer: Cofinity Commercial |
$458.67
|
| Rate for Payer: Cofinity Commercial |
$563.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$458.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.19
|
| Rate for Payer: Healthscope Commercial |
$589.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$458.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$491.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.95
|
| Rate for Payer: PHP Commercial |
$556.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.91
|
| Rate for Payer: Priority Health SBD |
$412.80
|
| Rate for Payer: UMR Bronson Commercial |
$242.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$491.43
|
|
|
TIAGABINE 4 MG TABLET
|
Facility
|
OP
|
$1,229.44
|
|
|
Service Code
|
NDC 63459040430
|
| Hospital Charge Code |
21827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$454.89 |
| Max. Negotiated Rate |
$1,106.50 |
| Rate for Payer: Aetna American Axle |
$799.14
|
| Rate for Payer: Aetna Commercial |
$1,045.02
|
| Rate for Payer: Aetna Medicare |
$614.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$799.14
|
| Rate for Payer: BCBS Complete |
$491.78
|
| Rate for Payer: Cash Price |
$983.55
|
| Rate for Payer: Cofinity Commercial |
$1,057.32
|
| Rate for Payer: Cofinity Commercial |
$860.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$860.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$983.55
|
| Rate for Payer: Healthscope Commercial |
$1,106.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$860.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$922.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,045.02
|
| Rate for Payer: PHP Commercial |
$1,045.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$799.14
|
| Rate for Payer: Priority Health SBD |
$774.55
|
| Rate for Payer: UMR Bronson Commercial |
$454.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$922.08
|
|
|
TIAGABINE 4 MG TABLET
|
Facility
|
IP
|
$655.24
|
|
|
Service Code
|
NDC 62756022483
|
| Hospital Charge Code |
21827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.31 |
| Max. Negotiated Rate |
$589.72 |
| Rate for Payer: Aetna American Axle |
$425.91
|
| Rate for Payer: Aetna Commercial |
$556.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.91
|
| Rate for Payer: Cash Price |
$524.19
|
| Rate for Payer: Cofinity Commercial |
$458.67
|
| Rate for Payer: Cofinity Commercial |
$563.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$458.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$524.19
|
| Rate for Payer: Healthscope Commercial |
$589.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$458.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$491.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.95
|
| Rate for Payer: PHP Commercial |
$556.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.91
|
| Rate for Payer: Priority Health SBD |
$412.80
|
| Rate for Payer: UMR Bronson Commercial |
$288.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$491.43
|
|
|
TICAGRELOR 60 MG TABLET
|
Facility
|
OP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077660
|
| Hospital Charge Code |
175597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$617.28 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna American Axle |
$1,084.41
|
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna Medicare |
$834.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.41
|
| Rate for Payer: BCBS Complete |
$667.33
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,167.83
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,167.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,167.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: Priority Health SBD |
$1,051.05
|
| Rate for Payer: UMR Bronson Commercial |
$617.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.25
|
|
|
TICAGRELOR 60 MG TABLET
|
Facility
|
IP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077660
|
| Hospital Charge Code |
175597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$734.07 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna American Axle |
$1,084.41
|
| Rate for Payer: Aetna Commercial |
$1,418.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.41
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,167.83
|
| Rate for Payer: Cofinity Commercial |
$1,434.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,167.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,501.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,167.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: PHP Commercial |
$1,418.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: Priority Health SBD |
$1,051.05
|
| Rate for Payer: UMR Bronson Commercial |
$734.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.25
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$2,780.18
|
|
|
Service Code
|
NDC 00186077739
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,028.67 |
| Max. Negotiated Rate |
$2,502.16 |
| Rate for Payer: Aetna American Axle |
$1,807.12
|
| Rate for Payer: Aetna Commercial |
$2,363.15
|
| Rate for Payer: Aetna Medicare |
$1,390.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,807.12
|
| Rate for Payer: BCBS Complete |
$1,112.07
|
| Rate for Payer: Cash Price |
$2,224.14
|
| Rate for Payer: Cofinity Commercial |
$1,946.13
|
| Rate for Payer: Cofinity Commercial |
$2,390.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,946.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.14
|
| Rate for Payer: Healthscope Commercial |
$2,502.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,946.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,085.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.15
|
| Rate for Payer: PHP Commercial |
$2,363.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.12
|
| Rate for Payer: Priority Health SBD |
$1,751.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,028.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,085.14
|
|
