|
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$3,599.42
|
| Rate for Payer: BCN Commercial |
$3,599.42
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
CIRCUMCISION, USING CLAMP OR OTHER DEVICE WITH REGIONAL DORSAL PENILE OR RING BLOCK
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 54150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,306.21
|
| Rate for Payer: BCN Commercial |
$1,306.21
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$17,686.68
|
|
|
Service Code
|
MSDRG 433
|
| Min. Negotiated Rate |
$8,954.37 |
| Max. Negotiated Rate |
$17,686.68 |
| Rate for Payer: Aetna Medicare |
$9,802.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,782.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,782.06
|
| Rate for Payer: BCBS MAPPO |
$9,425.65
|
| Rate for Payer: BCBS Trust/PPO |
$17,686.68
|
| Rate for Payer: BCN Commercial |
$17,686.68
|
| Rate for Payer: BCN Medicare Advantage |
$9,425.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,425.65
|
| Rate for Payer: Mclaren Medicare |
$9,425.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,896.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,839.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,368.22
|
| Rate for Payer: Nomi Health Commercial |
$13,624.98
|
| Rate for Payer: PACE Medicare |
$8,954.37
|
| Rate for Payer: PACE SWMI |
$9,425.65
|
| Rate for Payer: PHP Medicare Advantage |
$9,425.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,028.20
|
| Rate for Payer: Priority Health Medicare |
$9,425.65
|
| Rate for Payer: Priority Health Tiered Network |
$13,622.56
|
| Rate for Payer: Railroad Medicare Medicare |
$9,425.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,216.06
|
| Rate for Payer: UHC Core |
$14,403.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,425.65
|
| Rate for Payer: UHC Exchange |
$11,762.90
|
| Rate for Payer: VA VA |
$9,425.65
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$40,449.05
|
|
|
Service Code
|
MSDRG 432
|
| Min. Negotiated Rate |
$16,199.80 |
| Max. Negotiated Rate |
$40,449.05 |
| Rate for Payer: Aetna Medicare |
$17,734.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,315.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,315.53
|
| Rate for Payer: BCBS MAPPO |
$17,052.42
|
| Rate for Payer: BCBS Trust/PPO |
$40,449.05
|
| Rate for Payer: BCN Commercial |
$40,449.05
|
| Rate for Payer: BCN Medicare Advantage |
$17,052.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,052.42
|
| Rate for Payer: Mclaren Medicare |
$17,052.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,905.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,610.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,757.66
|
| Rate for Payer: Nomi Health Commercial |
$25,389.78
|
| Rate for Payer: PACE Medicare |
$16,199.80
|
| Rate for Payer: PACE SWMI |
$17,052.42
|
| Rate for Payer: PHP Medicare Advantage |
$17,052.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,731.60
|
| Rate for Payer: Priority Health Medicare |
$17,052.42
|
| Rate for Payer: Priority Health Tiered Network |
$25,385.27
|
| Rate for Payer: Railroad Medicare Medicare |
$17,052.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,081.66
|
| Rate for Payer: UHC Core |
$26,840.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,052.42
|
| Rate for Payer: UHC Exchange |
$21,919.84
|
| Rate for Payer: VA VA |
$17,052.42
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,869.81
|
|
|
Service Code
|
MSDRG 434
|
| Min. Negotiated Rate |
$6,223.82 |
| Max. Negotiated Rate |
$11,869.81 |
| Rate for Payer: Aetna Medicare |
$6,813.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,189.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,189.24
|
| Rate for Payer: BCBS MAPPO |
$6,551.39
|
| Rate for Payer: BCBS Trust/PPO |
$11,869.81
|
| Rate for Payer: BCN Commercial |
$11,869.81
|
| Rate for Payer: BCN Medicare Advantage |
$6,551.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,551.39
|
| Rate for Payer: Mclaren Medicare |
$6,551.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,878.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,534.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,206.53
|
| Rate for Payer: Nomi Health Commercial |
$9,191.25
|
| Rate for Payer: PACE Medicare |
$6,223.82
|
| Rate for Payer: PACE SWMI |
$6,551.39
|
| Rate for Payer: PHP Medicare Advantage |
$6,551.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,487.02
|
| Rate for Payer: Priority Health Medicare |
$6,551.39
|
| Rate for Payer: Priority Health Tiered Network |
$9,189.62
|
| Rate for Payer: Railroad Medicare Medicare |
$6,551.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,613.75
|
| Rate for Payer: UHC Core |
$9,716.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,551.39
|
| Rate for Payer: UHC Exchange |
$7,935.11
|
| Rate for Payer: VA VA |
$6,551.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$38.90
|
|
|
Service Code
|
NDC 63323041605
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Aetna American Axle |
$25.29
|
| Rate for Payer: Aetna Commercial |
$33.06
|
| Rate for Payer: Aetna Medicare |
$19.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.29
|
| Rate for Payer: BCBS Complete |
$15.56
|
| Rate for Payer: Cash Price |
$31.12
|
| Rate for Payer: Cofinity Advantage |
$27.23
|
| Rate for Payer: Cofinity Commercial |
$33.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.12
|
| Rate for Payer: Healthscope Commercial |
$35.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.18
|
| Rate for Payer: PHP Commercial |
$33.06
|
| Rate for Payer: Priority Health SBD |
$24.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.29
|
| Rate for Payer: UHC Core |
$20.27
|
| Rate for Payer: UHC Exchange |
$15.29
|
| Rate for Payer: UMR Bronson Commercial |
$14.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.18
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.73
|
|
|
Service Code
|
NDC 00781315075
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna Medicare |
$9.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.80
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$10.28
|
| Rate for Payer: UHC Exchange |
$7.75
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$95.19
|
|
|
Service Code
|
NDC 00703205603
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Advantage |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.87
|
| Rate for Payer: UHC Core |
$49.59
|
| Rate for Payer: UHC Exchange |
$37.41
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$38.90
|
|
|
Service Code
|
NDC 63323041605
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$35.01 |
| Rate for Payer: Aetna American Axle |
$25.29
|
| Rate for Payer: Aetna Commercial |
$33.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.29
|
| Rate for Payer: Cash Price |
$31.12
|
| Rate for Payer: Cofinity Advantage |
$27.23
|
| Rate for Payer: Cofinity Commercial |
$33.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.12
|
| Rate for Payer: Healthscope Commercial |
$35.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.18
|
| Rate for Payer: PHP Commercial |
$33.06
|
| Rate for Payer: Priority Health SBD |
$24.51
|
| Rate for Payer: UMR Bronson Commercial |
$17.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.18
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.73
|
|
|
Service Code
|
NDC 00781315095
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.80
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$95.19
|
|
|
Service Code
|
NDC 00703205601
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Advantage |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$95.19
|
|
|
Service Code
|
NDC 00703205601
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Advantage |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.87
|
| Rate for Payer: UHC Core |
$49.59
|
| Rate for Payer: UHC Exchange |
$37.41
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.26
|
|
|
Service Code
|
NDC 00074437805
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$58.73 |
| Rate for Payer: Aetna American Axle |
$42.42
|
| Rate for Payer: Aetna Commercial |
$55.47
|
| Rate for Payer: Aetna Medicare |
$32.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.42
|
| Rate for Payer: BCBS Complete |
$26.10
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: Cofinity Advantage |
$45.68
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.21
|
| Rate for Payer: Healthscope Commercial |
$58.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.95
|
| Rate for Payer: PHP Commercial |
$55.47
|
| Rate for Payer: Priority Health SBD |
$41.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.42
|
| Rate for Payer: UHC Core |
$34.00
|
| Rate for Payer: UHC Exchange |
$25.65
|
| Rate for Payer: UMR Bronson Commercial |
$24.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.95
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$65.26
|
|
|
Service Code
|
NDC 00074437805
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$58.73 |
| Rate for Payer: Aetna American Axle |
$42.42
|
| Rate for Payer: Aetna Commercial |
$55.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.42
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: Cofinity Advantage |
$45.68
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.21
|
| Rate for Payer: Healthscope Commercial |
$58.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.95
|
| Rate for Payer: PHP Commercial |
$55.47
|
| Rate for Payer: Priority Health SBD |
$41.11
|
| Rate for Payer: UMR Bronson Commercial |
$28.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.95
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.73
|
|
|
Service Code
|
NDC 00781315095
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna Medicare |
$9.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.80
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$10.28
|
| Rate for Payer: UHC Exchange |
$7.75
|
| Rate for Payer: UMR Bronson Commercial |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.73
|
|
|
Service Code
|
NDC 00781315075
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$17.76 |
| Rate for Payer: Aetna American Axle |
$12.82
|
| Rate for Payer: Aetna Commercial |
$16.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.82
|
| Rate for Payer: Cash Price |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$17.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.80
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: Priority Health SBD |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.80
|
|
|
CISATRACURIUM 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$95.19
|
|
|
Service Code
|
NDC 00703205603
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Advantage |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$982.43
|
|
|
Service Code
|
NDC 00074438220
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$363.50 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna American Axle |
$638.58
|
| Rate for Payer: Aetna Commercial |
$835.07
|
| Rate for Payer: Aetna Medicare |
$491.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.58
|
| Rate for Payer: BCBS Complete |
$392.97
|
| Rate for Payer: Cash Price |
$785.94
|
| Rate for Payer: Cofinity Advantage |
$687.70
|
| Rate for Payer: Cofinity Commercial |
$844.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.94
|
| Rate for Payer: Healthscope Commercial |
$884.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$785.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.82
|
| Rate for Payer: PHP Commercial |
$835.07
|
| Rate for Payer: Priority Health SBD |
$618.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$638.58
|
| Rate for Payer: UHC Core |
$511.85
|
| Rate for Payer: UHC Exchange |
$386.09
|
| Rate for Payer: UMR Bronson Commercial |
$363.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.82
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$982.43
|
|
|
Service Code
|
NDC 00074438220
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$432.27 |
| Max. Negotiated Rate |
$884.19 |
| Rate for Payer: Aetna American Axle |
$638.58
|
| Rate for Payer: Aetna Commercial |
$835.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.58
|
| Rate for Payer: Cash Price |
$785.94
|
| Rate for Payer: Cofinity Advantage |
$687.70
|
| Rate for Payer: Cofinity Commercial |
$844.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.94
|
| Rate for Payer: Healthscope Commercial |
$884.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$687.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$736.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.82
|
| Rate for Payer: PHP Commercial |
$835.07
|
| Rate for Payer: Priority Health SBD |
$618.93
|
| Rate for Payer: UMR Bronson Commercial |
$432.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$736.82
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$213.78
|
|
|
Service Code
|
NDC 63323041820
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna American Axle |
$138.96
|
| Rate for Payer: Aetna Commercial |
$181.71
|
| Rate for Payer: Aetna Medicare |
$106.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.96
|
| Rate for Payer: BCBS Complete |
$85.51
|
| Rate for Payer: Cash Price |
$171.02
|
| Rate for Payer: Cofinity Advantage |
$149.65
|
| Rate for Payer: Cofinity Commercial |
$183.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.02
|
| Rate for Payer: Healthscope Commercial |
$192.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.34
|
| Rate for Payer: PHP Commercial |
$181.71
|
| Rate for Payer: Priority Health SBD |
$134.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.96
|
| Rate for Payer: UHC Core |
$111.38
|
| Rate for Payer: UHC Exchange |
$84.02
|
| Rate for Payer: UMR Bronson Commercial |
$79.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.34
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.33
|
|
|
Service Code
|
NDC 00781315395
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna American Axle |
$125.01
|
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Advantage |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.25
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UMR Bronson Commercial |
$84.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.25
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$226.99
|
|
|
Service Code
|
NDC 00409110311
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$204.29 |
| Rate for Payer: Aetna American Axle |
$147.54
|
| Rate for Payer: Aetna Commercial |
$192.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.54
|
| Rate for Payer: Cash Price |
$181.59
|
| Rate for Payer: Cofinity Advantage |
$158.89
|
| Rate for Payer: Cofinity Commercial |
$195.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.59
|
| Rate for Payer: Healthscope Commercial |
$204.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.24
|
| Rate for Payer: PHP Commercial |
$192.94
|
| Rate for Payer: Priority Health SBD |
$143.00
|
| Rate for Payer: UMR Bronson Commercial |
$99.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.24
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$226.99
|
|
|
Service Code
|
NDC 00409110301
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$204.29 |
| Rate for Payer: Aetna American Axle |
$147.54
|
| Rate for Payer: Aetna Commercial |
$192.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.54
|
| Rate for Payer: Cash Price |
$181.59
|
| Rate for Payer: Cofinity Advantage |
$158.89
|
| Rate for Payer: Cofinity Commercial |
$195.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.59
|
| Rate for Payer: Healthscope Commercial |
$204.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.24
|
| Rate for Payer: PHP Commercial |
$192.94
|
| Rate for Payer: Priority Health SBD |
$143.00
|
| Rate for Payer: UMR Bronson Commercial |
$99.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.24
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$226.99
|
|
|
Service Code
|
NDC 00409110311
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.99 |
| Max. Negotiated Rate |
$204.29 |
| Rate for Payer: Aetna American Axle |
$147.54
|
| Rate for Payer: Aetna Commercial |
$192.94
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.54
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: Cash Price |
$181.59
|
| Rate for Payer: Cofinity Advantage |
$158.89
|
| Rate for Payer: Cofinity Commercial |
$195.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.59
|
| Rate for Payer: Healthscope Commercial |
$204.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.24
|
| Rate for Payer: PHP Commercial |
$192.94
|
| Rate for Payer: Priority Health SBD |
$143.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.54
|
| Rate for Payer: UHC Core |
$118.26
|
| Rate for Payer: UHC Exchange |
$89.21
|
| Rate for Payer: UMR Bronson Commercial |
$83.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.24
|
|
|
CISATRACURIUM CONCENTRATE 10 MG/ML (ICU USE ONLY) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$192.33
|
|
|
Service Code
|
NDC 00781315380
|
| Hospital Charge Code |
16169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$173.10 |
| Rate for Payer: Aetna American Axle |
$125.01
|
| Rate for Payer: Aetna Commercial |
$163.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.01
|
| Rate for Payer: Cash Price |
$153.86
|
| Rate for Payer: Cofinity Advantage |
$134.63
|
| Rate for Payer: Cofinity Commercial |
$165.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.86
|
| Rate for Payer: Healthscope Commercial |
$173.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.25
|
| Rate for Payer: PHP Commercial |
$163.48
|
| Rate for Payer: Priority Health SBD |
$121.17
|
| Rate for Payer: UMR Bronson Commercial |
$84.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.25
|
|
