|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$80.50
|
|
|
Service Code
|
NDC 00228202910
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna American Axle |
$52.33
|
| Rate for Payer: Aetna Commercial |
$68.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.33
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: Cofinity Advantage |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$69.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.40
|
| Rate for Payer: Healthscope Commercial |
$72.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.38
|
| Rate for Payer: PHP Commercial |
$68.42
|
| Rate for Payer: Priority Health SBD |
$50.72
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.38
|
|
|
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 Advantage |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$79.77
|
| 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: MI Amish Medical Board Commercial |
$74.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.56
|
| Rate for Payer: PHP Commercial |
$78.84
|
| Rate for Payer: Priority Health SBD |
$58.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.29
|
| Rate for Payer: UHC Core |
$48.32
|
| Rate for Payer: UHC Exchange |
$36.45
|
| 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
|
IP
|
$402.50
|
|
|
Service Code
|
NDC 00228202950
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna American Axle |
$261.62
|
| Rate for Payer: Aetna Commercial |
$342.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.62
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cofinity Advantage |
$281.75
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.00
|
| Rate for Payer: Healthscope Commercial |
$362.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.88
|
| Rate for Payer: PHP Commercial |
$342.12
|
| Rate for Payer: Priority Health SBD |
$253.57
|
| Rate for Payer: UMR Bronson Commercial |
$177.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.88
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$68.25
|
|
|
Service Code
|
NDC 65862067701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna American Axle |
$44.36
|
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.36
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Advantage |
$47.77
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.19
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health SBD |
$43.00
|
| Rate for Payer: UMR Bronson Commercial |
$30.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.19
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$253.75
|
|
|
Service Code
|
NDC 65862067705
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.65 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna American Axle |
$164.94
|
| Rate for Payer: Aetna Commercial |
$215.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.94
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Advantage |
$177.62
|
| Rate for Payer: Cofinity Commercial |
$218.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$228.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.31
|
| Rate for Payer: PHP Commercial |
$215.69
|
| Rate for Payer: Priority Health SBD |
$159.86
|
| Rate for Payer: UMR Bronson Commercial |
$111.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.31
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$80.50
|
|
|
Service Code
|
NDC 00228202910
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.79 |
| Max. Negotiated Rate |
$72.45 |
| Rate for Payer: Aetna American Axle |
$52.33
|
| Rate for Payer: Aetna Commercial |
$68.42
|
| Rate for Payer: Aetna Medicare |
$40.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.33
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: Cash Price |
$64.40
|
| Rate for Payer: Cofinity Advantage |
$56.35
|
| Rate for Payer: Cofinity Commercial |
$69.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.40
|
| Rate for Payer: Healthscope Commercial |
$72.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.38
|
| Rate for Payer: PHP Commercial |
$68.42
|
| Rate for Payer: Priority Health SBD |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.33
|
| Rate for Payer: UHC Core |
$41.94
|
| Rate for Payer: UHC Exchange |
$31.64
|
| Rate for Payer: UMR Bronson Commercial |
$29.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.38
|
|
|
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 Advantage |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| 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: MI Amish Medical Board Commercial |
$43.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.69
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health SBD |
$34.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.26
|
| Rate for Payer: UHC Core |
$28.26
|
| Rate for Payer: UHC Exchange |
$21.32
|
| 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
|
OP
|
$253.75
|
|
|
Service Code
|
NDC 65862067705
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.89 |
| Max. Negotiated Rate |
$228.38 |
| Rate for Payer: Aetna American Axle |
$164.94
|
| Rate for Payer: Aetna Commercial |
$215.69
|
| Rate for Payer: Aetna Medicare |
$126.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.94
|
| Rate for Payer: BCBS Complete |
$101.50
|
| Rate for Payer: Cash Price |
$203.00
|
| Rate for Payer: Cofinity Advantage |
$177.62
|
| Rate for Payer: Cofinity Commercial |
$218.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.00
|
| Rate for Payer: Healthscope Commercial |
$228.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.31
|
| Rate for Payer: PHP Commercial |
$215.69
|
| Rate for Payer: Priority Health SBD |
$159.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.94
|
| Rate for Payer: UHC Core |
$132.20
|
| Rate for Payer: UHC Exchange |
$99.72
|
| Rate for Payer: UMR Bronson Commercial |
$93.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.31
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$68.25
|
|
|
Service Code
|
NDC 65862067701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$61.42 |
| Rate for Payer: Aetna American Axle |
$44.36
|
| Rate for Payer: Aetna Commercial |
$58.01
|
| Rate for Payer: Aetna Medicare |
$34.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.36
|
| Rate for Payer: BCBS Complete |
$27.30
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cofinity Advantage |
$47.77
|
| Rate for Payer: Cofinity Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$61.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.19
|
| Rate for Payer: PHP Commercial |
$58.01
|
| Rate for Payer: Priority Health SBD |
$43.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.36
|
| Rate for Payer: UHC Core |
$35.56
|
| Rate for Payer: UHC Exchange |
$26.82
|
| Rate for Payer: UMR Bronson Commercial |
$25.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.19
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
IP
|
$54.25
|
|
|
Service Code
|
NDC 00781107701
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.87 |
| Max. Negotiated Rate |
$48.83 |
| Rate for Payer: Aetna American Axle |
$35.26
|
| Rate for Payer: Aetna Commercial |
$46.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.26
|
| Rate for Payer: Cash Price |
$43.40
|
| Rate for Payer: Cofinity Advantage |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| 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: Opus (Opus Packaging Group) HMA |
$40.69
|
| Rate for Payer: PHP Commercial |
$46.11
|
| Rate for Payer: Priority Health SBD |
$34.18
|
| Rate for Payer: UMR Bronson Commercial |
$23.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.69
|
|
|
ALPRAZOLAM 0.5 MG TABLET
|
Facility
|
OP
|
$402.50
|
|
|
Service Code
|
NDC 00228202950
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.93 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna American Axle |
$261.62
|
| Rate for Payer: Aetna Commercial |
$342.12
|
| Rate for Payer: Aetna Medicare |
$201.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.62
|
| Rate for Payer: BCBS Complete |
$161.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cofinity Advantage |
$281.75
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.00
|
| Rate for Payer: Healthscope Commercial |
$362.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.88
|
| Rate for Payer: PHP Commercial |
$342.12
|
| Rate for Payer: Priority Health SBD |
$253.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.62
|
| Rate for Payer: UHC Core |
$209.70
|
| Rate for Payer: UHC Exchange |
$158.18
|
| Rate for Payer: UMR Bronson Commercial |
$148.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.88
|
|
|
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 Advantage |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| 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: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| 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
|
OP
|
$70.00
|
|
|
Service Code
|
NDC 47335060488
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Advantage |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| 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: MI Amish Medical Board Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.50
|
| Rate for Payer: UHC Core |
$36.47
|
| Rate for Payer: UHC Exchange |
$27.51
|
| Rate for Payer: UMR Bronson Commercial |
$25.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
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 Advantage |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$79.77
|
| 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: Opus (Opus Packaging Group) HMA |
$69.56
|
| Rate for Payer: PHP Commercial |
$78.84
|
| 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
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 51079078901
|
| Hospital Charge Code |
325
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna American Axle |
$0.60
|
| Rate for Payer: Aetna Commercial |
$0.79
|
| Rate for Payer: Aetna Medicare |
$0.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.60
|
| Rate for Payer: BCBS Complete |
$0.37
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cofinity Advantage |
$0.65
|
| Rate for Payer: Cofinity Commercial |
$0.80
|
| 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: MI Amish Medical Board Commercial |
$0.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.70
|
| Rate for Payer: PHP Commercial |
$0.79
|
| Rate for Payer: Priority Health SBD |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.60
|
| Rate for Payer: UHC Core |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.37
|
| Rate for Payer: UMR Bronson Commercial |
$0.34
|
| 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 |
$0.79 |
| 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: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$342.28
|
| Rate for Payer: Cash Price |
$342.28
|
| Rate for Payer: Cofinity Advantage |
$299.50
|
| Rate for Payer: Cofinity Commercial |
$367.95
|
| 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: MI Amish Medical Board Commercial |
$342.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.89
|
| Rate for Payer: PHP Commercial |
$363.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.89
|
| Rate for Payer: Priority Health SBD |
$269.55
|
| Rate for Payer: Priority Health Tiered Network |
$8.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.79
|
| Rate for Payer: UHC Core |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| 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 Advantage |
$299.50
|
| Rate for Payer: Cofinity Commercial |
$367.95
|
| 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: Opus (Opus Packaging Group) HMA |
$320.89
|
| Rate for Payer: PHP Commercial |
$363.67
|
| 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
|
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 Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Advantage |
$201.85
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Cofinity Commercial |
$247.99
|
| 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 |
$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: Multiplan/Beech St/PHCS Commercial |
$245.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PHP Commercial |
$245.11
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: Priority Health SBD |
$181.67
|
| 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 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| 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 |
$98.89
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$304.26
|
| Rate for Payer: BCBS Trust/PPO |
$304.26
|
| Rate for Payer: BCN Commercial |
$304.26
|
| Rate for Payer: BCN Commercial |
$304.26
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| 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 Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Advantage |
$201.85
|
| Rate for Payer: Cofinity Commercial |
$247.99
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$259.52
|
| Rate for Payer: Healthscope Commercial |
$25,952.40
|
| 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 |
$95.09
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.27
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$245.11
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$181.67
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: UMR Bronson Commercial |
$106.69
|
| Rate for Payer: UMR Bronson Commercial |
$10,669.32
|
| Rate for Payer: VA VA |
$95.09
|
| Rate for Payer: VA VA |
$95.09
|
| 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 IV INFUSION FOR STROKE
|
Facility
|
OP
|
$28,836.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
150807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| 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 |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$304.26
|
| Rate for Payer: BCN Commercial |
$304.26
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| 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 |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: UMR Bronson Commercial |
$10,669.32
|
| Rate for Payer: VA VA |
$95.09
|
| 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 Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| 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: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| 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
|
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 Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| 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: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| 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 |
$49.73 |
| 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 |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,743.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$304.26
|
| Rate for Payer: BCN Commercial |
$304.26
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cash Price |
$23,068.80
|
| Rate for Payer: Cofinity Advantage |
$20,185.20
|
| Rate for Payer: Cofinity Commercial |
$24,798.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,068.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| 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 |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,510.60
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,627.00
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$24,510.60
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$18,166.68
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: UMR Bronson Commercial |
$10,669.32
|
| Rate for Payer: VA VA |
$95.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,627.00
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
OP
|
$672.98
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$605.68 |
| Rate for Payer: Aetna American Axle |
$437.44
|
| Rate for Payer: Aetna Commercial |
$572.03
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$304.26
|
| Rate for Payer: BCN Commercial |
$304.26
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$538.38
|
| Rate for Payer: Cash Price |
$538.38
|
| Rate for Payer: Cofinity Advantage |
$471.09
|
| Rate for Payer: Cofinity Commercial |
$578.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$605.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$471.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.74
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.03
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.74
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$572.03
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$423.98
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: UMR Bronson Commercial |
$249.00
|
| Rate for Payer: VA VA |
$95.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.74
|
|
|
ALTEPLASE 2 MG INTRA-CATHETER SOLUTION
|
Facility
|
IP
|
$672.98
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
31310
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$296.11 |
| Max. Negotiated Rate |
$605.68 |
| Rate for Payer: Aetna American Axle |
$437.44
|
| Rate for Payer: Aetna Commercial |
$572.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.44
|
| Rate for Payer: Cash Price |
$538.38
|
| Rate for Payer: Cofinity Advantage |
$471.09
|
| Rate for Payer: Cofinity Commercial |
$578.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.38
|
| Rate for Payer: Healthscope Commercial |
$605.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$471.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.74
|
| Rate for Payer: PHP Commercial |
$572.03
|
| Rate for Payer: Priority Health SBD |
$423.98
|
| Rate for Payer: UMR Bronson Commercial |
$296.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.74
|
|
