|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$56,045.23
|
|
|
Service Code
|
APR-DRG 0071
|
| Min. Negotiated Rate |
$53,376.41 |
| Max. Negotiated Rate |
$56,045.23 |
| Rate for Payer: BCBS Complete |
$56,045.23
|
| Rate for Payer: Mclaren Medicaid |
$53,376.41
|
| Rate for Payer: Meridian Medicaid |
$56,045.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$53,376.41
|
| Rate for Payer: UHC Medicaid |
$53,376.41
|
| Rate for Payer: UHCCP Medicaid |
$53,376.41
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$65,387.81
|
|
|
Service Code
|
APR-DRG 0072
|
| Min. Negotiated Rate |
$62,274.11 |
| Max. Negotiated Rate |
$65,387.81 |
| Rate for Payer: BCBS Complete |
$65,387.81
|
| Rate for Payer: Mclaren Medicaid |
$62,274.11
|
| Rate for Payer: Meridian Medicaid |
$65,387.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$62,274.11
|
| Rate for Payer: UHC Medicaid |
$62,274.11
|
| Rate for Payer: UHCCP Medicaid |
$62,274.11
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$142,744.71
|
|
|
Service Code
|
APR-DRG 0074
|
| Min. Negotiated Rate |
$135,947.35 |
| Max. Negotiated Rate |
$142,744.71 |
| Rate for Payer: BCBS Complete |
$142,744.71
|
| Rate for Payer: Mclaren Medicaid |
$135,947.35
|
| Rate for Payer: Meridian Medicaid |
$142,744.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$135,947.35
|
| Rate for Payer: UHC Medicaid |
$135,947.35
|
| Rate for Payer: UHCCP Medicaid |
$135,947.35
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$383,910.47
|
|
|
Service Code
|
MSDRG 014
|
| Min. Negotiated Rate |
$96,040.23 |
| Max. Negotiated Rate |
$383,910.47 |
| Rate for Payer: Aetna Medicare |
$105,138.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126,368.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126,368.73
|
| Rate for Payer: BCBS MAPPO |
$101,094.98
|
| Rate for Payer: BCBS Trust/PPO |
$383,910.47
|
| Rate for Payer: BCN Commercial |
$383,910.47
|
| Rate for Payer: BCN Medicare Advantage |
$101,094.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101,094.98
|
| Rate for Payer: Mclaren Medicare |
$101,094.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106,149.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116,259.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$111,204.48
|
| Rate for Payer: Nomi Health Commercial |
$155,030.91
|
| Rate for Payer: PACE Medicare |
$96,040.23
|
| Rate for Payer: PACE SWMI |
$101,094.98
|
| Rate for Payer: PHP Medicare Advantage |
$101,094.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$193,754.27
|
| Rate for Payer: Priority Health Medicare |
$101,094.98
|
| Rate for Payer: Priority Health Tiered Network |
$155,003.39
|
| Rate for Payer: Railroad Medicare Medicare |
$101,094.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101,094.98
|
| Rate for Payer: VA VA |
$101,094.98
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
|
IP
|
$68,056.08
|
|
|
Service Code
|
APR-DRG 0073
|
| Min. Negotiated Rate |
$64,815.32 |
| Max. Negotiated Rate |
$68,056.08 |
| Rate for Payer: BCBS Complete |
$68,056.08
|
| Rate for Payer: Mclaren Medicaid |
$64,815.32
|
| Rate for Payer: Meridian Medicaid |
$68,056.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$64,815.32
|
| Rate for Payer: UHC Medicaid |
$64,815.32
|
| Rate for Payer: UHCCP Medicaid |
$64,815.32
|
|
|
ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$383.49
|
|
|
Service Code
|
CPT 20930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$383.49 |
| Max. Negotiated Rate |
$383.49 |
| Rate for Payer: BCBS Trust/PPO |
$383.49
|
| Rate for Payer: BCN Commercial |
$383.49
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.11 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Advantage |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.78
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UMR Bronson Commercial |
$86.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
NDC 23155069301
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.47 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna American Axle |
$155.81
|
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.81
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Advantage |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: Priority Health SBD |
$151.01
|
| Rate for Payer: UMR Bronson Commercial |
$105.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Advantage |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.66
|
| Rate for Payer: UHC Core |
$1.33
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.41 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$97.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Advantage |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.78
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.20
|
| Rate for Payer: UHC Core |
$101.96
|
| Rate for Payer: UHC Exchange |
$76.91
|
| Rate for Payer: UMR Bronson Commercial |
$72.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$255.55
|
|
|
Service Code
|
NDC 51079020520
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.55 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna American Axle |
$166.11
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna Medicare |
$127.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: BCBS Complete |
$102.22
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cofinity Advantage |
$178.88
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.66
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.11
|
| Rate for Payer: UHC Core |
$133.14
|
| Rate for Payer: UHC Exchange |
$100.43
|
| Rate for Payer: UMR Bronson Commercial |
$94.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$255.55
|
|
|
Service Code
|
NDC 51079020520
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.44 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna American Axle |
$166.11
|
| Rate for Payer: Aetna Commercial |
$217.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.11
|
| Rate for Payer: Cash Price |
$204.44
|
| Rate for Payer: Cofinity Advantage |
$178.88
|
| Rate for Payer: Cofinity Commercial |
$219.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.44
|
| Rate for Payer: Healthscope Commercial |
$230.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.66
|
| Rate for Payer: PHP Commercial |
$217.22
|
| Rate for Payer: Priority Health SBD |
$161.00
|
| Rate for Payer: UMR Bronson Commercial |
$112.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.66
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$216.20
|
|
|
Service Code
|
NDC 00603211521
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna American Axle |
$140.53
|
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Medicare |
$108.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.53
|
| Rate for Payer: BCBS Complete |
$86.48
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Advantage |
$151.34
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: Priority Health SBD |
$136.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.53
|
| Rate for Payer: UHC Core |
$112.64
|
| Rate for Payer: UHC Exchange |
$84.97
|
| Rate for Payer: UMR Bronson Commercial |
$79.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.15
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
NDC 23155069301
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna American Axle |
$155.81
|
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna Medicare |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.81
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Advantage |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: Priority Health SBD |
$151.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.81
|
| Rate for Payer: UHC Core |
$124.88
|
| Rate for Payer: UHC Exchange |
$94.20
|
| Rate for Payer: UMR Bronson Commercial |
$88.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.56
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cofinity Advantage |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.92
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$216.20
|
|
|
Service Code
|
NDC 00603211521
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.13 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna American Axle |
$140.53
|
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.53
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Advantage |
$151.34
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: Priority Health SBD |
$136.21
|
| Rate for Payer: UMR Bronson Commercial |
$95.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.15
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$377.15
|
|
|
Service Code
|
NDC 00904657261
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.95 |
| Max. Negotiated Rate |
$339.44 |
| Rate for Payer: Aetna American Axle |
$245.15
|
| Rate for Payer: Aetna Commercial |
$320.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.15
|
| Rate for Payer: Cash Price |
$301.72
|
| Rate for Payer: Cofinity Advantage |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$324.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.72
|
| Rate for Payer: Healthscope Commercial |
$339.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.86
|
| Rate for Payer: PHP Commercial |
$320.58
|
| Rate for Payer: Priority Health SBD |
$237.60
|
| Rate for Payer: UMR Bronson Commercial |
$165.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.86
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$259.68
|
|
|
Service Code
|
NDC 51079020620
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.08 |
| Max. Negotiated Rate |
$233.71 |
| Rate for Payer: Aetna American Axle |
$168.79
|
| Rate for Payer: Aetna Commercial |
$220.73
|
| Rate for Payer: Aetna Medicare |
$129.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.79
|
| Rate for Payer: BCBS Complete |
$103.87
|
| Rate for Payer: Cash Price |
$207.74
|
| Rate for Payer: Cofinity Advantage |
$181.78
|
| Rate for Payer: Cofinity Commercial |
$223.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.74
|
| Rate for Payer: Healthscope Commercial |
$233.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.76
|
| Rate for Payer: PHP Commercial |
$220.73
|
| Rate for Payer: Priority Health SBD |
$163.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.79
|
| Rate for Payer: UHC Core |
$135.29
|
| Rate for Payer: UHC Exchange |
$102.05
|
| Rate for Payer: UMR Bronson Commercial |
$96.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.76
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$449.35
|
|
|
Service Code
|
NDC 63739079610
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna American Axle |
$292.08
|
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: Aetna Medicare |
$224.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.08
|
| Rate for Payer: BCBS Complete |
$179.74
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Advantage |
$314.55
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$359.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.01
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: Priority Health SBD |
$283.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.08
|
| Rate for Payer: UHC Core |
$234.11
|
| Rate for Payer: UHC Exchange |
$176.59
|
| Rate for Payer: UMR Bronson Commercial |
$166.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$377.15
|
|
|
Service Code
|
NDC 00904657261
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.55 |
| Max. Negotiated Rate |
$339.44 |
| Rate for Payer: Aetna American Axle |
$245.15
|
| Rate for Payer: Aetna Commercial |
$320.58
|
| Rate for Payer: Aetna Medicare |
$188.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.15
|
| Rate for Payer: BCBS Complete |
$150.86
|
| Rate for Payer: Cash Price |
$301.72
|
| Rate for Payer: Cofinity Advantage |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$324.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.72
|
| Rate for Payer: Healthscope Commercial |
$339.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$301.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.86
|
| Rate for Payer: PHP Commercial |
$320.58
|
| Rate for Payer: Priority Health SBD |
$237.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.15
|
| Rate for Payer: UHC Core |
$196.50
|
| Rate for Payer: UHC Exchange |
$148.22
|
| Rate for Payer: UMR Bronson Commercial |
$139.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.86
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$449.35
|
|
|
Service Code
|
NDC 63739079610
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.71 |
| Max. Negotiated Rate |
$404.42 |
| Rate for Payer: Aetna American Axle |
$292.08
|
| Rate for Payer: Aetna Commercial |
$381.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.08
|
| Rate for Payer: Cash Price |
$359.48
|
| Rate for Payer: Cofinity Advantage |
$314.55
|
| Rate for Payer: Cofinity Commercial |
$386.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.48
|
| Rate for Payer: Healthscope Commercial |
$404.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.01
|
| Rate for Payer: PHP Commercial |
$381.95
|
| Rate for Payer: Priority Health SBD |
$283.09
|
| Rate for Payer: UMR Bronson Commercial |
$197.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.01
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
NDC 51079020601
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna American Axle |
$1.69
|
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Advantage |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.95
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
NDC 51079020601
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna American Axle |
$1.69
|
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.69
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Advantage |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.95
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health SBD |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.69
|
| Rate for Payer: UHC Core |
$1.35
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UMR Bronson Commercial |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
ALLOPURINOL 300 MG TABLET
|
Facility
|
IP
|
$259.68
|
|
|
Service Code
|
NDC 51079020620
|
| Hospital Charge Code |
311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.26 |
| Max. Negotiated Rate |
$233.71 |
| Rate for Payer: Aetna American Axle |
$168.79
|
| Rate for Payer: Aetna Commercial |
$220.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.79
|
| Rate for Payer: Cash Price |
$207.74
|
| Rate for Payer: Cofinity Advantage |
$181.78
|
| Rate for Payer: Cofinity Commercial |
$223.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.74
|
| Rate for Payer: Healthscope Commercial |
$233.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.76
|
| Rate for Payer: PHP Commercial |
$220.73
|
| Rate for Payer: Priority Health SBD |
$163.60
|
| Rate for Payer: UMR Bronson Commercial |
$114.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.76
|
|
|
ALLOPURINOL 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$4,338.98
|
|
|
Service Code
|
HCPCS J0206
|
| Hospital Charge Code |
25408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,909.15 |
| Max. Negotiated Rate |
$3,905.08 |
| Rate for Payer: Aetna American Axle |
$2,820.34
|
| Rate for Payer: Aetna American Axle |
$3,732.79
|
| Rate for Payer: Aetna American Axle |
$3,348.41
|
| Rate for Payer: Aetna Commercial |
$4,378.69
|
| Rate for Payer: Aetna Commercial |
$3,688.13
|
| Rate for Payer: Aetna Commercial |
$4,881.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,732.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,820.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,348.41
|
| Rate for Payer: Cash Price |
$4,121.12
|
| Rate for Payer: Cash Price |
$3,471.18
|
| Rate for Payer: Cash Price |
$4,594.20
|
| Rate for Payer: Cofinity Advantage |
$4,019.93
|
| Rate for Payer: Cofinity Advantage |
$3,037.29
|
| Rate for Payer: Cofinity Advantage |
$3,605.98
|
| Rate for Payer: Cofinity Commercial |
$4,938.77
|
| Rate for Payer: Cofinity Commercial |
$3,731.52
|
| Rate for Payer: Cofinity Commercial |
$4,430.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,471.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,121.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,594.20
|
| Rate for Payer: Healthscope Commercial |
$4,636.26
|
| Rate for Payer: Healthscope Commercial |
$5,168.48
|
| Rate for Payer: Healthscope Commercial |
$3,905.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,605.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,037.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,019.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,307.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,254.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,863.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,688.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,378.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,881.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,254.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,863.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,307.06
|
| Rate for Payer: PHP Commercial |
$4,378.69
|
| Rate for Payer: PHP Commercial |
$3,688.13
|
| Rate for Payer: PHP Commercial |
$4,881.34
|
| Rate for Payer: Priority Health SBD |
$2,733.56
|
| Rate for Payer: Priority Health SBD |
$3,245.38
|
| Rate for Payer: Priority Health SBD |
$3,617.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,909.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,526.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,266.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,863.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,254.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,307.06
|
|
