|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$92.75
|
|
|
Service Code
|
NDC 51079078920
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$83.47 |
| Rate for Payer: Aetna American Axle |
$60.29
|
| Rate for Payer: Aetna Commercial |
$78.84
|
| Rate for Payer: Aetna Medicare |
$46.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.29
|
| Rate for Payer: BCBS Complete |
$37.10
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cofinity Commercial |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$79.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.20
|
| Rate for Payer: Healthscope Commercial |
$83.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.84
|
| Rate for Payer: PHP Commercial |
$78.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.29
|
| Rate for Payer: Priority Health SBD |
$58.43
|
| Rate for Payer: UMR Bronson Commercial |
$34.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.56
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$78.75
|
|
|
Service Code
|
NDC 00228202910
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$70.88 |
| Rate for Payer: Aetna American Axle |
$51.19
|
| Rate for Payer: Aetna Commercial |
$66.94
|
| Rate for Payer: Aetna Medicare |
$39.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.19
|
| Rate for Payer: BCBS Complete |
$31.50
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$55.12
|
| Rate for Payer: Cofinity Commercial |
$67.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$70.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.94
|
| Rate for Payer: PHP Commercial |
$66.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.19
|
| Rate for Payer: Priority Health SBD |
$49.61
|
| Rate for Payer: UMR Bronson Commercial |
$29.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.06
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$54.25
|
|
|
Service Code
|
NDC 00781107701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.07 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna American Axle |
$35.26
|
| Rate for Payer: Aetna Commercial |
$46.11
|
| Rate for Payer: Aetna Medicare |
$27.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.26
|
| Rate for Payer: BCBS Complete |
$21.70
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cofinity Commercial |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$48.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.26
|
| Rate for Payer: Priority Health SBD |
$34.18
|
| Rate for Payer: UMR Bronson Commercial |
$20.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.69
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$92.75
|
|
|
Service Code
|
NDC 51079078920
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.81 |
| Max. Negotiated Rate |
$83.47 |
| Rate for Payer: Aetna American Axle |
$60.29
|
| Rate for Payer: Aetna Commercial |
$78.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.29
|
| Rate for Payer: Cash Price |
$74.20
|
| Rate for Payer: Cofinity Commercial |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$79.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.20
|
| Rate for Payer: Healthscope Commercial |
$83.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.84
|
| Rate for Payer: PHP Commercial |
$78.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.29
|
| Rate for Payer: Priority Health SBD |
$58.43
|
| Rate for Payer: UMR Bronson Commercial |
$40.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.56
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
NDC 47335060488
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$59.50
|
|
|
Service Code
|
NDC 65862067701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Aetna American Axle |
$38.67
|
| Rate for Payer: Aetna Commercial |
$50.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.67
|
| Rate for Payer: Cash Price |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$41.65
|
| Rate for Payer: Cofinity Commercial |
$51.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.60
|
| Rate for Payer: Healthscope Commercial |
$53.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.58
|
| Rate for Payer: PHP Commercial |
$50.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.67
|
| Rate for Payer: Priority Health SBD |
$37.48
|
| Rate for Payer: UMR Bronson Commercial |
$26.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.62
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 51079078901
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna American Axle |
$0.60
|
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.60
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Commercial |
$0.65
|
| Rate for Payer: Cofinity Commercial |
$0.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.74
|
| Rate for Payer: Healthscope Commercial |
$0.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.79
|
| Rate for Payer: PHP Commercial |
$0.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.60
|
| Rate for Payer: Priority Health SBD |
$0.59
|
| Rate for Payer: UMR Bronson Commercial |
$0.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.70
|
|
|
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$427.85
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
9001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.30 |
| Max. Negotiated Rate |
$385.06 |
| Rate for Payer: Aetna American Axle |
$278.10
|
| Rate for Payer: Aetna Commercial |
$363.67
|
| Rate for Payer: Aetna Medicare |
$213.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.10
|
| Rate for Payer: BCBS Complete |
$171.14
|
| Rate for Payer: Cash Price |
$342.28
|
| Rate for Payer: Cofinity Commercial |
$299.50
|
| Rate for Payer: Cofinity Commercial |
$367.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.28
|
| Rate for Payer: Healthscope Commercial |
$385.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.67
|
| Rate for Payer: PHP Commercial |
$363.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.10
|
| Rate for Payer: Priority Health SBD |
$269.55
|
| Rate for Payer: UMR Bronson Commercial |
$158.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.89
|
|
|
ALPROSTADIL 500 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$427.85
|
|
|
Service Code
|
HCPCS J0270
|
| Hospital Charge Code |
9001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.25 |
| Max. Negotiated Rate |
$385.06 |
| Rate for Payer: Aetna American Axle |
$278.10
|
| Rate for Payer: Aetna Commercial |
$363.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.10
|
| Rate for Payer: Cash Price |
$342.28
|
| Rate for Payer: Cofinity Commercial |
$299.50
|
| Rate for Payer: Cofinity Commercial |
$367.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.28
|
| Rate for Payer: Healthscope Commercial |
$385.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.67
|
| Rate for Payer: PHP Commercial |
$363.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.10
|
| Rate for Payer: Priority Health SBD |
$269.55
|
| Rate for Payer: UMR Bronson Commercial |
$188.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.89
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.63 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna American Axle |
$18,743.40
|
| Rate for Payer: Aetna American Axle |
$187.43
|
| Rate for Payer: Aetna Commercial |
$245.11
|
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.06
|
| Rate for Payer: BCBS Complete |
$53.16
|
| Rate for Payer: BCBS Complete |
$53.16
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$230.69
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$230.69
|
| Rate for Payer: Cofinity Commercial |
$201.85
|
| Rate for Payer: Cofinity Commercial |
$247.99
|
| Rate for Payer: Cofinity Commercial |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,185.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Healthscope Commercial |
$259.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,185.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Mclaren Medicaid |
$50.63
|
| Rate for Payer: Mclaren Medicaid |
$50.63
|
| Rate for Payer: Mclaren Medicare |
$94.45
|
| Rate for Payer: Mclaren Medicare |
$94.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Meridian Medicaid |
$53.16
|
| Rate for Payer: Meridian Medicaid |
$53.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.11
|
| Rate for Payer: PACE Medicare |
$89.73
|
| Rate for Payer: PACE Medicare |
$89.73
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Commercial |
$245.11
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: Priority Health SBD |
$181.67
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: Railroad Medicare Medicare |
$94.45
|
| Rate for Payer: Railroad Medicare Medicare |
$94.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Exchange |
$180.50
|
| Rate for Payer: UHC Exchange |
$180.50
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHCCP Medicaid |
$50.63
|
| Rate for Payer: UHCCP Medicaid |
$50.63
|
| Rate for Payer: UMR Bronson Commercial |
$106.69
|
| Rate for Payer: UMR Bronson Commercial |
$10,669.32
|
| Rate for Payer: VA VA |
$94.45
|
| Rate for Payer: VA VA |
$94.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.27
|
|
|
ALTEPLASE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$288.36
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$259.52 |
| Rate for Payer: Aetna American Axle |
$187.43
|
| Rate for Payer: Aetna American Axle |
$18,743.40
|
| Rate for Payer: Aetna Commercial |
$245.11
|
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Cash Price |
$230.69
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Cofinity Commercial |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$201.85
|
| Rate for Payer: Cofinity Commercial |
$247.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$201.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,185.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$259.52
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$201.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,185.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.11
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Commercial |
$245.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health SBD |
$181.67
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: UMR Bronson Commercial |
$126.88
|
| Rate for Payer: UMR Bronson Commercial |
$12,687.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.63 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna American Axle |
$18,743.40
|
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.06
|
| Rate for Payer: BCBS Complete |
$53.16
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Cofinity Commercial |
$20,185.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,185.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,185.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Mclaren Medicaid |
$50.63
|
| Rate for Payer: Mclaren Medicare |
$94.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Meridian Medicaid |
$53.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: PACE Medicare |
$89.73
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: Railroad Medicare Medicare |
$94.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Exchange |
$180.50
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHCCP Medicaid |
$50.63
|
| Rate for Payer: UMR Bronson Commercial |
$10,669.32
|
| Rate for Payer: VA VA |
$94.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100 MG IV INFUSION FOR STROKE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,687.84 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna American Axle |
$18,743.40
|
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,185.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,185.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: UMR Bronson Commercial |
$12,687.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.63 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna American Axle |
$18,743.40
|
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.06
|
| Rate for Payer: BCBS Complete |
$53.16
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Cofinity Commercial |
$20,185.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,185.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,185.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Mclaren Medicaid |
$50.63
|
| Rate for Payer: Mclaren Medicare |
$94.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Meridian Medicaid |
$53.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: PACE Medicare |
$89.73
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: Railroad Medicare Medicare |
$94.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Exchange |
$180.50
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHCCP Medicaid |
$50.63
|
| Rate for Payer: UMR Bronson Commercial |
$10,669.32
|
| Rate for Payer: VA VA |
$94.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 100MG IV SOLUTION FOR PE
|
Facility
|
IP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,687.84 |
| Max. Negotiated Rate |
$25,952.40 |
| Rate for Payer: Aetna American Axle |
$18,743.40
|
| Rate for Payer: Aetna Commercial |
$24,510.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Commercial |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$20,185.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,185.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,627.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,743.40
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: UMR Bronson Commercial |
$12,687.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
IP
|
$640.92
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$282.00 |
| Max. Negotiated Rate |
$576.83 |
| Rate for Payer: Aetna American Axle |
$416.60
|
| Rate for Payer: Aetna Commercial |
$544.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.60
|
| Rate for Payer: Cash Price |
$512.74
|
| Rate for Payer: Cofinity Commercial |
$448.64
|
| Rate for Payer: Cofinity Commercial |
$551.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$448.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.74
|
| Rate for Payer: Healthscope Commercial |
$576.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.78
|
| Rate for Payer: PHP Commercial |
$544.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.60
|
| Rate for Payer: Priority Health SBD |
$403.78
|
| Rate for Payer: UMR Bronson Commercial |
$282.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.69
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
OP
|
$640.92
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.63 |
| Max. Negotiated Rate |
$576.83 |
| Rate for Payer: Aetna American Axle |
$416.60
|
| Rate for Payer: Aetna Commercial |
$544.78
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.06
|
| Rate for Payer: BCBS Complete |
$53.16
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$512.74
|
| Rate for Payer: Cash Price |
$512.74
|
| Rate for Payer: Cofinity Commercial |
$551.19
|
| Rate for Payer: Cofinity Commercial |
$448.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$448.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$576.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.69
|
| Rate for Payer: Mclaren Medicaid |
$50.63
|
| Rate for Payer: Mclaren Medicare |
$94.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Meridian Medicaid |
$53.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.78
|
| Rate for Payer: PACE Medicare |
$89.73
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Commercial |
$544.78
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.60
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: Priority Health SBD |
$403.78
|
| Rate for Payer: Railroad Medicare Medicare |
$94.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Exchange |
$180.50
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHCCP Medicaid |
$50.63
|
| Rate for Payer: UMR Bronson Commercial |
$237.14
|
| Rate for Payer: VA VA |
$94.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.69
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.63 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.06
|
| Rate for Payer: BCBS Complete |
$53.16
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Cofinity Commercial |
$10,092.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,092.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Mclaren Medicaid |
$50.63
|
| Rate for Payer: Mclaren Medicare |
$94.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Meridian Medicaid |
$53.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: PACE Medicare |
$89.73
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,371.70
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: Railroad Medicare Medicare |
$94.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Exchange |
$180.50
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHCCP Medicaid |
$50.63
|
| Rate for Payer: UMR Bronson Commercial |
$5,334.66
|
| Rate for Payer: VA VA |
$94.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,343.92 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$10,092.60
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,092.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,371.70
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: UMR Bronson Commercial |
$6,343.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE 50 MG IV INFUSION FOR STROKE
|
Facility
|
OP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
301291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.63 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.06
|
| Rate for Payer: BCBS Complete |
$53.16
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Cofinity Commercial |
$10,092.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,092.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Mclaren Medicaid |
$50.63
|
| Rate for Payer: Mclaren Medicare |
$94.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Meridian Medicaid |
$53.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: PACE Medicare |
$89.73
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,371.70
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: Railroad Medicare Medicare |
$94.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Exchange |
$180.50
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHCCP Medicaid |
$50.63
|
| Rate for Payer: UMR Bronson Commercial |
$5,334.66
|
| Rate for Payer: VA VA |
$94.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE 50 MG IV INFUSION FOR STROKE
|
Facility
|
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
301291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,343.92 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$10,092.60
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,092.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,371.70
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: UMR Bronson Commercial |
$6,343.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,343.92 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$10,092.60
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,092.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,371.70
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: UMR Bronson Commercial |
$6,343.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
OP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.63 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.06
|
| Rate for Payer: BCBS Complete |
$53.16
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Cofinity Commercial |
$10,092.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,092.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Mclaren Medicaid |
$50.63
|
| Rate for Payer: Mclaren Medicare |
$94.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Meridian Medicaid |
$53.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: PACE Medicare |
$89.73
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,371.70
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: Railroad Medicare Medicare |
$94.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Exchange |
$180.50
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHCCP Medicaid |
$50.63
|
| Rate for Payer: UMR Bronson Commercial |
$5,334.66
|
| Rate for Payer: VA VA |
$94.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE IV BOLUS (FROM KIT)
|
Facility
|
OP
|
$265.87
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.63 |
| Max. Negotiated Rate |
$265.87 |
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.06
|
| Rate for Payer: BCBS Complete |
$53.16
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Mclaren Medicaid |
$50.63
|
| Rate for Payer: Mclaren Medicare |
$94.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Meridian Medicaid |
$53.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.62
|
| Rate for Payer: PACE Medicare |
$89.73
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.63
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: Railroad Medicare Medicare |
$94.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Exchange |
$180.50
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHCCP Medicaid |
$50.63
|
| Rate for Payer: VA VA |
$94.45
|
|
|
ALUM, AMMONIUM (BULK) POWDER
|
Facility
|
OP
|
$343.57
|
|
|
Service Code
|
NDC 00395004912
|
| Hospital Charge Code |
345
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.12 |
| Max. Negotiated Rate |
$309.21 |
| Rate for Payer: Aetna American Axle |
$223.32
|
| Rate for Payer: Aetna Commercial |
$292.03
|
| Rate for Payer: Aetna Medicare |
$171.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.32
|
| Rate for Payer: BCBS Complete |
$137.43
|
| Rate for Payer: Cash Price |
$274.86
|
| Rate for Payer: Cofinity Commercial |
$240.50
|
| Rate for Payer: Cofinity Commercial |
$295.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$240.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.86
|
| Rate for Payer: Healthscope Commercial |
$309.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.03
|
| Rate for Payer: PHP Commercial |
$292.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.32
|
| Rate for Payer: Priority Health SBD |
$216.45
|
| Rate for Payer: UMR Bronson Commercial |
$127.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.68
|
|
