|
TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE
|
Facility
|
OP
|
$1,688.45
|
|
|
Service Code
|
CPT 93303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$200.67 |
| Max. Negotiated Rate |
$1,688.45 |
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$673.72
|
| Rate for Payer: BCN Commercial |
$673.72
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$200.67
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$537.21
|
|
|
TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY GENERATED WATER VAPOR THERMOTHERAPY
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 53854
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$365.99 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,359.45
|
| Rate for Payer: BCN Commercial |
$1,359.45
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.59
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$365.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY THERMOTHERAPY
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 53852
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$365.99 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,011.52
|
| Rate for Payer: BCN Commercial |
$2,011.52
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.59
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$365.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
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
|
$15,654.68
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.37 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$4,085.73
|
| Rate for Payer: BCN Commercial |
$4,085.73
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.41
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$700.37
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 52500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$474.47 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,145.77
|
| Rate for Payer: BCN Commercial |
$2,145.77
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$521.92
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$474.47
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 52640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$309.48 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,839.21
|
| Rate for Payer: BCN Commercial |
$1,839.21
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.43
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$309.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
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
|
$15,654.68
|
|
|
Service Code
|
CPT 52630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.79 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,488.96
|
| Rate for Payer: BCN Commercial |
$2,488.96
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$428.77
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$389.79
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) BILATERAL; BY INJECTIONS (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
|
Facility
|
OP
|
$1,457.26
|
|
|
Service Code
|
CPT 64488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$66.33 |
| Max. Negotiated Rate |
$1,457.26 |
| Rate for Payer: BCBS Trust/PPO |
$1,457.26
|
| Rate for Payer: BCN Commercial |
$1,457.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.96
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$66.33
|
|
|
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 |
$41.30 |
| 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 |
$80.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,548.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.31
|
| Rate for Payer: BCBS Complete |
$43.36
|
| Rate for Payer: BCBS MAPPO |
$77.05
|
| Rate for Payer: BCBS Trust/PPO |
$210.15
|
| Rate for Payer: BCN Commercial |
$210.15
|
| Rate for Payer: BCN Medicare Advantage |
$77.05
|
| Rate for Payer: Cash Price |
$5,597.85
|
| Rate for Payer: Cash Price |
$5,597.85
|
| Rate for Payer: Cofinity Commercial |
$6,017.69
|
| Rate for Payer: Cofinity Commercial |
$4,898.12
|
| 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 |
$77.05
|
| 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 |
$41.30
|
| Rate for Payer: Mclaren Medicare |
$77.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.90
|
| Rate for Payer: Meridian Medicaid |
$43.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,947.71
|
| Rate for Payer: Nomi Health Commercial |
$231.15
|
| Rate for Payer: PACE Medicare |
$73.20
|
| Rate for Payer: PACE SWMI |
$77.05
|
| Rate for Payer: PHP Commercial |
$5,947.71
|
| Rate for Payer: PHP Medicare Advantage |
$77.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,548.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.32
|
| Rate for Payer: Priority Health Medicare |
$77.05
|
| Rate for Payer: Priority Health Narrow Network |
$179.46
|
| Rate for Payer: Priority Health SBD |
$4,408.31
|
| Rate for Payer: Railroad Medicare Medicare |
$77.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.05
|
| Rate for Payer: UHC Exchange |
$147.25
|
| Rate for Payer: UHC Medicare Advantage |
$77.05
|
| Rate for Payer: UHCCP Medicaid |
$41.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,589.00
|
| Rate for Payer: VA VA |
$77.05
|
| 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 |
$33.80 |
| 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 |
$65.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,644.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.82
|
| Rate for Payer: BCBS Complete |
$35.49
|
| Rate for Payer: BCBS MAPPO |
$63.06
|
| Rate for Payer: BCBS Trust/PPO |
$171.99
|
| Rate for Payer: BCN Commercial |
$171.99
|
| Rate for Payer: BCN Medicare Advantage |
$63.06
|
| Rate for Payer: Cash Price |
$16,793.46
|
| Rate for Payer: Cash Price |
$16,793.46
|
| Rate for Payer: Cofinity Commercial |
$18,052.97
|
| Rate for Payer: Cofinity Commercial |
$14,694.28
|
| 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 |
$63.06
|
| 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 |
$33.80
|
| Rate for Payer: Mclaren Medicare |
$63.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.21
|
| Rate for Payer: Meridian Medicaid |
$35.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,843.06
|
| Rate for Payer: Nomi Health Commercial |
$189.18
|
| Rate for Payer: PACE Medicare |
$59.91
|
| Rate for Payer: PACE SWMI |
$63.06
|
| Rate for Payer: PHP Commercial |
$17,843.06
|
| Rate for Payer: PHP Medicare Advantage |
$63.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,644.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.57
|
| Rate for Payer: Priority Health Medicare |
$63.06
|
| Rate for Payer: Priority Health Narrow Network |
$146.86
|
| Rate for Payer: Priority Health SBD |
$13,224.85
|
| Rate for Payer: Railroad Medicare Medicare |
$63.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.06
|
| Rate for Payer: UHC Exchange |
$120.51
|
| Rate for Payer: UHC Medicare Advantage |
$63.06
|
| Rate for Payer: UHCCP Medicaid |
$33.80
|
| Rate for Payer: UMR Bronson Commercial |
$7,766.98
|
| Rate for Payer: VA VA |
$63.06
|
| 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 |
$18.59 |
| 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 |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,619.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.36
|
| Rate for Payer: BCBS Complete |
$19.52
|
| Rate for Payer: BCBS MAPPO |
$34.69
|
| Rate for Payer: BCBS Trust/PPO |
$82.51
|
| Rate for Payer: BCN Commercial |
$82.51
|
| Rate for Payer: BCN Medicare Advantage |
$34.69
|
| Rate for Payer: Cash Price |
$13,070.29
|
| Rate for Payer: Cash Price |
$13,070.29
|
| Rate for Payer: Cofinity Commercial |
$14,050.56
|
| Rate for Payer: Cofinity Commercial |
$11,436.50
|
| 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 |
$34.69
|
| 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 |
$18.59
|
| Rate for Payer: Mclaren Medicare |
$34.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.42
|
| Rate for Payer: Meridian Medicaid |
$19.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,887.18
|
| Rate for Payer: Nomi Health Commercial |
$104.07
|
| Rate for Payer: PACE Medicare |
$32.96
|
| Rate for Payer: PACE SWMI |
$34.69
|
| Rate for Payer: PHP Commercial |
$13,887.18
|
| Rate for Payer: PHP Medicare Advantage |
$34.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,619.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.03
|
| Rate for Payer: Priority Health Medicare |
$34.69
|
| Rate for Payer: Priority Health Narrow Network |
$56.02
|
| Rate for Payer: Priority Health SBD |
$10,292.85
|
| Rate for Payer: Railroad Medicare Medicare |
$34.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.69
|
| Rate for Payer: UHC Exchange |
$66.30
|
| Rate for Payer: UHC Medicare Advantage |
$34.69
|
| Rate for Payer: UHCCP Medicaid |
$18.59
|
| Rate for Payer: UMR Bronson Commercial |
$6,045.01
|
| Rate for Payer: VA VA |
$34.69
|
| 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 |
$27.79 |
| 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 |
$53.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,871.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.80
|
| Rate for Payer: BCBS Complete |
$29.18
|
| Rate for Payer: BCBS MAPPO |
$51.84
|
| Rate for Payer: BCBS Trust/PPO |
$137.96
|
| Rate for Payer: BCN Commercial |
$137.96
|
| Rate for Payer: BCN Medicare Advantage |
$51.84
|
| 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 |
$51.84
|
| 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 |
$27.79
|
| Rate for Payer: Mclaren Medicare |
$51.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$29.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,986.45
|
| Rate for Payer: Nomi Health Commercial |
$155.52
|
| Rate for Payer: PACE Medicare |
$49.25
|
| Rate for Payer: PACE SWMI |
$51.84
|
| Rate for Payer: PHP Commercial |
$8,986.45
|
| Rate for Payer: PHP Medicare Advantage |
$51.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,871.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.88
|
| Rate for Payer: Priority Health Medicare |
$51.84
|
| Rate for Payer: Priority Health Narrow Network |
$124.70
|
| Rate for Payer: Priority Health SBD |
$6,660.54
|
| Rate for Payer: Railroad Medicare Medicare |
$51.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.84
|
| Rate for Payer: UHC Exchange |
$99.07
|
| Rate for Payer: UHC Medicare Advantage |
$51.84
|
| Rate for Payer: UHCCP Medicaid |
$27.79
|
| Rate for Payer: UMR Bronson Commercial |
$3,911.75
|
| Rate for Payer: VA VA |
$51.84
|
| 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 |
$38.58 |
| Max. Negotiated Rate |
$15,472.30 |
| Rate for Payer: Aetna American Axle |
$11,174.44
|
| Rate for Payer: Aetna Commercial |
$14,612.73
|
| Rate for Payer: Aetna Medicare |
$74.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,174.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.98
|
| Rate for Payer: BCBS Complete |
$40.51
|
| Rate for Payer: BCBS MAPPO |
$71.98
|
| Rate for Payer: BCBS Trust/PPO |
$189.09
|
| Rate for Payer: BCN Commercial |
$189.09
|
| Rate for Payer: BCN Medicare Advantage |
$71.98
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cash Price |
$13,753.16
|
| Rate for Payer: Cofinity Commercial |
$14,784.65
|
| Rate for Payer: Cofinity Commercial |
$12,034.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,034.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,753.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.98
|
| Rate for Payer: Healthscope Commercial |
$15,472.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,034.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,893.59
|
| Rate for Payer: Mclaren Medicaid |
$38.58
|
| Rate for Payer: Mclaren Medicare |
$71.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.58
|
| Rate for Payer: Meridian Medicaid |
$40.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,612.73
|
| Rate for Payer: Nomi Health Commercial |
$215.94
|
| Rate for Payer: PACE Medicare |
$68.38
|
| Rate for Payer: PACE SWMI |
$71.98
|
| Rate for Payer: PHP Commercial |
$14,612.73
|
| Rate for Payer: PHP Medicare Advantage |
$71.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,174.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.94
|
| Rate for Payer: Priority Health Medicare |
$71.98
|
| Rate for Payer: Priority Health Narrow Network |
$139.15
|
| Rate for Payer: Priority Health SBD |
$10,830.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.98
|
| Rate for Payer: UHC Exchange |
$137.56
|
| Rate for Payer: UHC Medicare Advantage |
$71.98
|
| Rate for Payer: UHCCP Medicaid |
$38.58
|
| Rate for Payer: UMR Bronson Commercial |
$6,360.84
|
| Rate for Payer: VA VA |
$71.98
|
| 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 |
$10.17 |
| 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 |
$19.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,140.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.71
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS MAPPO |
$18.97
|
| Rate for Payer: BCBS Trust/PPO |
$104.48
|
| Rate for Payer: BCN Commercial |
$104.48
|
| Rate for Payer: BCN Medicare Advantage |
$18.97
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cash Price |
$8,788.44
|
| Rate for Payer: Cofinity Commercial |
$9,447.57
|
| Rate for Payer: Cofinity Commercial |
$7,689.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,689.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,788.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.97
|
| Rate for Payer: Healthscope Commercial |
$9,887.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,689.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,239.16
|
| Rate for Payer: Mclaren Medicaid |
$10.17
|
| Rate for Payer: Mclaren Medicare |
$18.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.92
|
| Rate for Payer: Meridian Medicaid |
$10.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,337.72
|
| Rate for Payer: Nomi Health Commercial |
$56.91
|
| Rate for Payer: PACE Medicare |
$18.02
|
| Rate for Payer: PACE SWMI |
$18.97
|
| Rate for Payer: PHP Commercial |
$9,337.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,140.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.18
|
| Rate for Payer: Priority Health Medicare |
$18.97
|
| Rate for Payer: Priority Health Narrow Network |
$44.14
|
| Rate for Payer: Priority Health SBD |
$6,920.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.97
|
| Rate for Payer: UHC Exchange |
$36.25
|
| Rate for Payer: UHC Medicare Advantage |
$18.97
|
| Rate for Payer: UHCCP Medicaid |
$10.17
|
| Rate for Payer: UMR Bronson Commercial |
$4,064.65
|
| Rate for Payer: VA VA |
$18.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,239.16
|
|
|
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 |
$95.16
|
| 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
|
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
|
|
|
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
|
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
|
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
|
|
|
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 |
$274.46 |
| 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 |
$213.46
|
| Rate for Payer: Cofinity Commercial |
$262.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.96
|
| Rate for Payer: Healthscope Commercial |
$274.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.46
|
| 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
|
$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
|
OP
|
$3.55
|
|
|
Service Code
|
NDC 68084060811
|
| Hospital Charge Code |
8084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna American Axle |
$2.31
|
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| 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 |
$3.20
|
| 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
|
$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
|
|
