|
TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$13,956.13
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Exchange |
$9,475.14
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,657.46
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,468.51
|
|
|
Service Code
|
CPT 52500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$6,428.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE
|
Facility
|
OP
|
$9,468.51
|
|
|
Service Code
|
CPT 52640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$6,428.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
TRANSURETHRAL RESECTION; RESIDUAL OR REGROWTH OF OBSTRUCTIVE PROSTATE TISSUE INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$13,956.13
|
|
|
Service Code
|
CPT 52630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Exchange |
$9,475.14
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,657.46
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
TRASTUZUMAB 150 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,997.31
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
183257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$6,297.58 |
| Rate for Payer: Aetna American Axle |
$4,548.25
|
| Rate for Payer: Aetna Commercial |
$5,947.71
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,548.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.79
|
| Rate for Payer: BCBS Complete |
$42.23
|
| Rate for Payer: BCBS MAPPO |
$75.03
|
| Rate for Payer: BCN Medicare Advantage |
$75.03
|
| Rate for Payer: Cash Price |
$5,597.85
|
| Rate for Payer: Cash Price |
$5,597.85
|
| Rate for Payer: Cofinity Commercial |
$4,898.12
|
| Rate for Payer: Cofinity Commercial |
$6,017.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,898.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,597.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.03
|
| Rate for Payer: Healthscope Commercial |
$6,297.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,898.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,247.98
|
| Rate for Payer: Mclaren Medicaid |
$40.22
|
| Rate for Payer: Mclaren Medicare |
$75.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.78
|
| Rate for Payer: Meridian Medicaid |
$42.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,947.71
|
| Rate for Payer: PACE Medicare |
$71.28
|
| Rate for Payer: PACE SWMI |
$75.03
|
| Rate for Payer: PHP Commercial |
$5,947.71
|
| Rate for Payer: PHP Medicare Advantage |
$75.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,548.25
|
| Rate for Payer: Priority Health Medicare |
$75.03
|
| Rate for Payer: Priority Health SBD |
$4,408.31
|
| Rate for Payer: Railroad Medicare Medicare |
$75.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.03
|
| Rate for Payer: UHC Exchange |
$143.39
|
| Rate for Payer: UHC Medicare Advantage |
$75.03
|
| Rate for Payer: UHCCP Medicaid |
$40.22
|
| Rate for Payer: UMR Bronson Commercial |
$2,589.00
|
| Rate for Payer: VA VA |
$75.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,247.98
|
|
|
TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION
|
Facility
|
OP
|
$20,991.83
|
|
|
Service Code
|
HCPCS J9356
|
| Hospital Charge Code |
190129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$18,892.65 |
| Rate for Payer: Aetna American Axle |
$13,644.69
|
| Rate for Payer: Aetna Commercial |
$17,843.06
|
| Rate for Payer: Aetna Medicare |
$63.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,644.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.80
|
| Rate for Payer: BCBS Complete |
$34.58
|
| Rate for Payer: BCBS MAPPO |
$61.44
|
| Rate for Payer: BCN Medicare Advantage |
$61.44
|
| Rate for Payer: Cash Price |
$16,793.46
|
| Rate for Payer: Cash Price |
$16,793.46
|
| Rate for Payer: Cofinity Commercial |
$14,694.28
|
| Rate for Payer: Cofinity Commercial |
$18,052.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,694.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,793.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.44
|
| Rate for Payer: Healthscope Commercial |
$18,892.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,694.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,743.87
|
| Rate for Payer: Mclaren Medicaid |
$32.93
|
| Rate for Payer: Mclaren Medicare |
$61.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.51
|
| Rate for Payer: Meridian Medicaid |
$34.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,843.06
|
| Rate for Payer: PACE Medicare |
$58.37
|
| Rate for Payer: PACE SWMI |
$61.44
|
| Rate for Payer: PHP Commercial |
$17,843.06
|
| Rate for Payer: PHP Medicare Advantage |
$61.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,644.69
|
| Rate for Payer: Priority Health Medicare |
$61.44
|
| Rate for Payer: Priority Health SBD |
$13,224.85
|
| Rate for Payer: Railroad Medicare Medicare |
$61.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.44
|
| Rate for Payer: UHC Exchange |
$117.42
|
| Rate for Payer: UHC Medicare Advantage |
$61.44
|
| Rate for Payer: UHCCP Medicaid |
$32.93
|
| Rate for Payer: UMR Bronson Commercial |
$7,766.98
|
| Rate for Payer: VA VA |
$61.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,743.87
|
|
|
TRASTUZUMAB-ANNS 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,337.86
|
|
|
Service Code
|
HCPCS Q5117
|
| Hospital Charge Code |
190713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$14,704.07 |
| Rate for Payer: Aetna American Axle |
$10,619.61
|
| Rate for Payer: Aetna Commercial |
$13,887.18
|
| Rate for Payer: Aetna Medicare |
$49.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,619.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.44
|
| Rate for Payer: BCBS Complete |
$26.76
|
| Rate for Payer: BCBS MAPPO |
$47.55
|
| Rate for Payer: BCN Medicare Advantage |
$47.55
|
| Rate for Payer: Cash Price |
$13,070.29
|
| Rate for Payer: Cash Price |
$13,070.29
|
| Rate for Payer: Cofinity Commercial |
$11,436.50
|
| Rate for Payer: Cofinity Commercial |
$14,050.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,436.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,070.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.55
|
| Rate for Payer: Healthscope Commercial |
$14,704.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,436.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,253.40
|
| Rate for Payer: Mclaren Medicaid |
$25.49
|
| Rate for Payer: Mclaren Medicare |
$47.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.93
|
| Rate for Payer: Meridian Medicaid |
$26.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,887.18
|
| Rate for Payer: PACE Medicare |
$45.17
|
| Rate for Payer: PACE SWMI |
$47.55
|
| Rate for Payer: PHP Commercial |
$13,887.18
|
| Rate for Payer: PHP Medicare Advantage |
$47.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,619.61
|
| Rate for Payer: Priority Health Medicare |
$47.55
|
| Rate for Payer: Priority Health SBD |
$10,292.85
|
| Rate for Payer: Railroad Medicare Medicare |
$47.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.55
|
| Rate for Payer: UHC Exchange |
$90.87
|
| Rate for Payer: UHC Medicare Advantage |
$47.55
|
| Rate for Payer: UHCCP Medicaid |
$25.49
|
| Rate for Payer: UMR Bronson Commercial |
$6,045.01
|
| Rate for Payer: VA VA |
$47.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,253.40
|
|
|
TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,572.29
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
192041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$9,515.06 |
| Rate for Payer: Aetna American Axle |
$6,871.99
|
| Rate for Payer: Aetna Commercial |
$8,986.45
|
| Rate for Payer: Aetna Medicare |
$41.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,871.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.36
|
| Rate for Payer: BCBS Complete |
$22.68
|
| Rate for Payer: BCBS MAPPO |
$40.29
|
| Rate for Payer: BCN Medicare Advantage |
$40.29
|
| Rate for Payer: Cash Price |
$8,457.83
|
| Rate for Payer: Cash Price |
$8,457.83
|
| Rate for Payer: Cofinity Commercial |
$9,092.17
|
| Rate for Payer: Cofinity Commercial |
$7,400.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,400.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,457.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.29
|
| Rate for Payer: Healthscope Commercial |
$9,515.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,400.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,929.22
|
| Rate for Payer: Mclaren Medicaid |
$21.60
|
| Rate for Payer: Mclaren Medicare |
$40.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.30
|
| Rate for Payer: Meridian Medicaid |
$22.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,986.45
|
| Rate for Payer: PACE Medicare |
$38.28
|
| Rate for Payer: PACE SWMI |
$40.29
|
| Rate for Payer: PHP Commercial |
$8,986.45
|
| Rate for Payer: PHP Medicare Advantage |
$40.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,871.99
|
| Rate for Payer: Priority Health Medicare |
$40.29
|
| Rate for Payer: Priority Health SBD |
$6,660.54
|
| Rate for Payer: Railroad Medicare Medicare |
$40.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.29
|
| Rate for Payer: UHC Exchange |
$77.00
|
| Rate for Payer: UHC Medicare Advantage |
$40.29
|
| Rate for Payer: UHCCP Medicaid |
$21.60
|
| Rate for Payer: UMR Bronson Commercial |
$3,911.75
|
| Rate for Payer: VA VA |
$40.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,929.22
|
|
|
TRASTUZUMAB-DKST 420 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$10,572.29
|
|
|
Service Code
|
HCPCS Q5114
|
| Hospital Charge Code |
192041
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,651.81 |
| Max. Negotiated Rate |
$9,515.06 |
| Rate for Payer: Aetna American Axle |
$6,871.99
|
| Rate for Payer: Aetna Commercial |
$8,986.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,871.99
|
| Rate for Payer: Cash Price |
$8,457.83
|
| Rate for Payer: Cofinity Commercial |
$7,400.60
|
| Rate for Payer: Cofinity Commercial |
$9,092.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,400.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,457.83
|
| Rate for Payer: Healthscope Commercial |
$9,515.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,400.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,929.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,986.45
|
| Rate for Payer: PHP Commercial |
$8,986.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,871.99
|
| Rate for Payer: Priority Health SBD |
$6,660.54
|
| Rate for Payer: UMR Bronson Commercial |
$4,651.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,929.22
|
|
|
TRASTUZUMAB-PKRB 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17,191.45
|
|
|
Service Code
|
HCPCS Q5113
|
| Hospital Charge Code |
192874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$15,472.31 |
| Rate for Payer: Aetna American Axle |
$11,174.44
|
| Rate for Payer: Aetna Commercial |
$14,612.73
|
| Rate for Payer: Aetna Medicare |
$72.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,174.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.71
|
| Rate for Payer: BCBS Complete |
$39.04
|
| Rate for Payer: BCBS MAPPO |
$69.37
|
| Rate for Payer: BCN Medicare Advantage |
$69.37
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cofinity Commercial |
$12,034.01
|
| Rate for Payer: Cofinity Commercial |
$14,784.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,034.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,753.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.37
|
| Rate for Payer: Healthscope Commercial |
$15,472.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,034.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,893.59
|
| Rate for Payer: Mclaren Medicaid |
$37.18
|
| Rate for Payer: Mclaren Medicare |
$69.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.84
|
| Rate for Payer: Meridian Medicaid |
$39.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,612.73
|
| Rate for Payer: PACE Medicare |
$65.90
|
| Rate for Payer: PACE SWMI |
$69.37
|
| Rate for Payer: PHP Commercial |
$14,612.73
|
| Rate for Payer: PHP Medicare Advantage |
$69.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,174.44
|
| Rate for Payer: Priority Health Medicare |
$69.37
|
| Rate for Payer: Priority Health SBD |
$10,830.61
|
| Rate for Payer: Railroad Medicare Medicare |
$69.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.37
|
| Rate for Payer: UHC Exchange |
$132.57
|
| Rate for Payer: UHC Medicare Advantage |
$69.37
|
| Rate for Payer: UHCCP Medicaid |
$37.18
|
| Rate for Payer: UMR Bronson Commercial |
$6,360.84
|
| Rate for Payer: VA VA |
$69.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,893.59
|
|
|
TRASTUZUMAB-QYYP 420 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,985.55
|
|
|
Service Code
|
HCPCS Q5116
|
| Hospital Charge Code |
192875
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$9,887.00 |
| Rate for Payer: Aetna American Axle |
$7,140.61
|
| Rate for Payer: Aetna Commercial |
$9,337.72
|
| Rate for Payer: Aetna Medicare |
$29.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,140.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.99
|
| Rate for Payer: BCBS Complete |
$15.75
|
| Rate for Payer: BCBS MAPPO |
$27.99
|
| Rate for Payer: BCN Medicare Advantage |
$27.99
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cofinity Commercial |
$7,689.89
|
| Rate for Payer: Cofinity Commercial |
$9,447.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,689.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,788.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.99
|
| Rate for Payer: Healthscope Commercial |
$9,887.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,689.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,239.16
|
| Rate for Payer: Mclaren Medicaid |
$15.00
|
| Rate for Payer: Mclaren Medicare |
$27.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.39
|
| Rate for Payer: Meridian Medicaid |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,337.72
|
| Rate for Payer: PACE Medicare |
$26.59
|
| Rate for Payer: PACE SWMI |
$27.99
|
| Rate for Payer: PHP Commercial |
$9,337.72
|
| Rate for Payer: PHP Medicare Advantage |
$27.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,140.61
|
| Rate for Payer: Priority Health Medicare |
$27.99
|
| Rate for Payer: Priority Health SBD |
$6,920.90
|
| Rate for Payer: Railroad Medicare Medicare |
$27.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.99
|
| Rate for Payer: UHC Exchange |
$53.49
|
| Rate for Payer: UHC Medicare Advantage |
$27.99
|
| Rate for Payer: UHCCP Medicaid |
$15.00
|
| Rate for Payer: UMR Bronson Commercial |
$4,064.65
|
| Rate for Payer: VA VA |
$27.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,239.16
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
OP
|
$430.89
|
|
|
Service Code
|
NDC 00781618556
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.43 |
| Max. Negotiated Rate |
$387.80 |
| Rate for Payer: Aetna American Axle |
$280.08
|
| Rate for Payer: Aetna Commercial |
$366.26
|
| Rate for Payer: Aetna Medicare |
$215.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.08
|
| Rate for Payer: BCBS Complete |
$172.36
|
| Rate for Payer: Cash Price |
$344.71
|
| Rate for Payer: Cofinity Commercial |
$301.62
|
| Rate for Payer: Cofinity Commercial |
$370.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.71
|
| Rate for Payer: Healthscope Commercial |
$387.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.26
|
| Rate for Payer: PHP Commercial |
$366.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.08
|
| Rate for Payer: Priority Health SBD |
$271.46
|
| Rate for Payer: UMR Bronson Commercial |
$159.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.17
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
IP
|
$430.89
|
|
|
Service Code
|
NDC 00781618556
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.59 |
| Max. Negotiated Rate |
$387.80 |
| Rate for Payer: Aetna American Axle |
$280.08
|
| Rate for Payer: Aetna Commercial |
$366.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.08
|
| Rate for Payer: Cash Price |
$344.71
|
| Rate for Payer: Cofinity Commercial |
$301.62
|
| Rate for Payer: Cofinity Commercial |
$370.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.71
|
| Rate for Payer: Healthscope Commercial |
$387.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.26
|
| Rate for Payer: PHP Commercial |
$366.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.08
|
| Rate for Payer: Priority Health SBD |
$271.46
|
| Rate for Payer: UMR Bronson Commercial |
$189.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.17
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
IP
|
$190.33
|
|
|
Service Code
|
NDC 42571013027
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.75 |
| Max. Negotiated Rate |
$171.30 |
| Rate for Payer: Aetna American Axle |
$123.71
|
| Rate for Payer: Aetna Commercial |
$161.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.71
|
| Rate for Payer: Cash Price |
$152.26
|
| Rate for Payer: Cofinity Commercial |
$133.23
|
| Rate for Payer: Cofinity Commercial |
$163.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.26
|
| Rate for Payer: Healthscope Commercial |
$171.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.78
|
| Rate for Payer: PHP Commercial |
$161.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.71
|
| Rate for Payer: Priority Health SBD |
$119.91
|
| Rate for Payer: UMR Bronson Commercial |
$83.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.75
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
OP
|
$190.33
|
|
|
Service Code
|
NDC 42571013027
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.42 |
| Max. Negotiated Rate |
$171.30 |
| Rate for Payer: Aetna American Axle |
$123.71
|
| Rate for Payer: Aetna Commercial |
$161.78
|
| Rate for Payer: Aetna Medicare |
$95.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.71
|
| Rate for Payer: BCBS Complete |
$76.13
|
| Rate for Payer: Cash Price |
$152.26
|
| Rate for Payer: Cofinity Commercial |
$133.23
|
| Rate for Payer: Cofinity Commercial |
$163.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.26
|
| Rate for Payer: Healthscope Commercial |
$171.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.78
|
| Rate for Payer: PHP Commercial |
$161.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.71
|
| Rate for Payer: Priority Health SBD |
$119.91
|
| Rate for Payer: UMR Bronson Commercial |
$70.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.75
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
IP
|
$409.36
|
|
|
Service Code
|
NDC 60505059304
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.12 |
| Max. Negotiated Rate |
$368.42 |
| Rate for Payer: Aetna American Axle |
$266.08
|
| Rate for Payer: Aetna Commercial |
$347.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.08
|
| Rate for Payer: Cash Price |
$327.49
|
| Rate for Payer: Cofinity Commercial |
$286.55
|
| Rate for Payer: Cofinity Commercial |
$352.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.49
|
| Rate for Payer: Healthscope Commercial |
$368.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.96
|
| Rate for Payer: PHP Commercial |
$347.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.08
|
| Rate for Payer: Priority Health SBD |
$257.90
|
| Rate for Payer: UMR Bronson Commercial |
$180.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.02
|
|
|
TRAVOPROST 0.004 % EYE DROPS
|
Facility
|
OP
|
$409.36
|
|
|
Service Code
|
NDC 60505059304
|
| Hospital Charge Code |
108556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.46 |
| Max. Negotiated Rate |
$368.42 |
| Rate for Payer: Aetna American Axle |
$266.08
|
| Rate for Payer: Aetna Commercial |
$347.96
|
| Rate for Payer: Aetna Medicare |
$204.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.08
|
| Rate for Payer: BCBS Complete |
$163.74
|
| Rate for Payer: Cash Price |
$327.49
|
| Rate for Payer: Cofinity Commercial |
$286.55
|
| Rate for Payer: Cofinity Commercial |
$352.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.49
|
| Rate for Payer: Healthscope Commercial |
$368.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.96
|
| Rate for Payer: PHP Commercial |
$347.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.08
|
| Rate for Payer: Priority Health SBD |
$257.90
|
| Rate for Payer: UMR Bronson Commercial |
$151.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.02
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
OP
|
$354.35
|
|
|
Service Code
|
NDC 68084060801
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.11 |
| Max. Negotiated Rate |
$318.92 |
| Rate for Payer: Aetna American Axle |
$230.33
|
| Rate for Payer: Aetna Commercial |
$301.20
|
| Rate for Payer: Aetna Medicare |
$177.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.33
|
| Rate for Payer: BCBS Complete |
$141.74
|
| Rate for Payer: Cash Price |
$283.48
|
| Rate for Payer: Cofinity Commercial |
$248.04
|
| Rate for Payer: Cofinity Commercial |
$304.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.48
|
| Rate for Payer: Healthscope Commercial |
$318.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.20
|
| Rate for Payer: PHP Commercial |
$301.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.33
|
| Rate for Payer: Priority Health SBD |
$223.24
|
| Rate for Payer: UMR Bronson Commercial |
$131.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.76
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$3.55
|
|
|
Service Code
|
NDC 68084060811
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna American Axle |
$2.31
|
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.31
|
| Rate for Payer: Priority Health SBD |
$2.24
|
| Rate for Payer: UMR Bronson Commercial |
$1.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.66
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
OP
|
$3.55
|
|
|
Service Code
|
NDC 68084060811
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna American Axle |
$2.31
|
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Medicare |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: BCBS Complete |
$1.42
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.31
|
| Rate for Payer: Priority Health SBD |
$2.24
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.66
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$304.95
|
|
|
Service Code
|
NDC 00904721261
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$274.45 |
| Rate for Payer: Aetna American Axle |
$198.22
|
| Rate for Payer: Aetna Commercial |
$259.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.22
|
| Rate for Payer: Cash Price |
$243.96
|
| Rate for Payer: Cofinity Commercial |
$213.47
|
| Rate for Payer: Cofinity Commercial |
$262.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.96
|
| Rate for Payer: Healthscope Commercial |
$274.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.21
|
| Rate for Payer: PHP Commercial |
$259.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.22
|
| Rate for Payer: Priority Health SBD |
$192.12
|
| Rate for Payer: UMR Bronson Commercial |
$134.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.71
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
OP
|
$304.95
|
|
|
Service Code
|
NDC 00904721261
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.83 |
| Max. Negotiated Rate |
$274.45 |
| Rate for Payer: Aetna American Axle |
$198.22
|
| Rate for Payer: Aetna Commercial |
$259.21
|
| Rate for Payer: Aetna Medicare |
$152.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.22
|
| Rate for Payer: BCBS Complete |
$121.98
|
| Rate for Payer: Cash Price |
$243.96
|
| Rate for Payer: Cofinity Commercial |
$213.47
|
| Rate for Payer: Cofinity Commercial |
$262.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.96
|
| Rate for Payer: Healthscope Commercial |
$274.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.21
|
| Rate for Payer: PHP Commercial |
$259.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.22
|
| Rate for Payer: Priority Health SBD |
$192.12
|
| Rate for Payer: UMR Bronson Commercial |
$112.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.71
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$354.35
|
|
|
Service Code
|
NDC 68084060801
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.91 |
| Max. Negotiated Rate |
$318.92 |
| Rate for Payer: Aetna American Axle |
$230.33
|
| Rate for Payer: Aetna Commercial |
$301.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.33
|
| Rate for Payer: Cash Price |
$283.48
|
| Rate for Payer: Cofinity Commercial |
$248.04
|
| Rate for Payer: Cofinity Commercial |
$304.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.48
|
| Rate for Payer: Healthscope Commercial |
$318.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.20
|
| Rate for Payer: PHP Commercial |
$301.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.33
|
| Rate for Payer: Priority Health SBD |
$223.24
|
| Rate for Payer: UMR Bronson Commercial |
$155.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.76
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
OP
|
$357.20
|
|
|
Service Code
|
NDC 50111045001
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna Medicare |
$178.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: BCBS Complete |
$142.88
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$132.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
TRAZODONE 150 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 50111045001
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.17 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$157.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
