|
DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION
|
Facility
|
IP
|
$49,300.20
|
|
|
Service Code
|
HCPCS J9153
|
| Hospital Charge Code |
184345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21,692.09 |
| Max. Negotiated Rate |
$44,370.18 |
| Rate for Payer: Aetna American Axle |
$32,045.13
|
| Rate for Payer: Aetna Commercial |
$41,905.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,045.13
|
| Rate for Payer: Cash Price |
$39,440.16
|
| Rate for Payer: Cofinity Advantage |
$34,510.14
|
| Rate for Payer: Cofinity Commercial |
$42,398.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.16
|
| Rate for Payer: Healthscope Commercial |
$44,370.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34,510.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36,975.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.15
|
| Rate for Payer: PHP Commercial |
$41,905.17
|
| Rate for Payer: Priority Health SBD |
$31,059.13
|
| Rate for Payer: UMR Bronson Commercial |
$21,692.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36,975.15
|
|
|
DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME IV SOLUTION
|
Facility
|
OP
|
$49,300.20
|
|
|
Service Code
|
HCPCS J9153
|
| Hospital Charge Code |
184345
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.61 |
| Max. Negotiated Rate |
$44,370.18 |
| Rate for Payer: Aetna American Axle |
$32,045.13
|
| Rate for Payer: Aetna Commercial |
$41,905.17
|
| Rate for Payer: Aetna Medicare |
$271.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,045.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$326.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$326.50
|
| Rate for Payer: BCBS Complete |
$143.45
|
| Rate for Payer: BCBS MAPPO |
$261.20
|
| Rate for Payer: BCBS Trust/PPO |
$844.66
|
| Rate for Payer: BCN Commercial |
$844.66
|
| Rate for Payer: BCN Medicare Advantage |
$261.20
|
| Rate for Payer: Cash Price |
$39,440.16
|
| Rate for Payer: Cash Price |
$39,440.16
|
| Rate for Payer: Cofinity Advantage |
$34,510.14
|
| Rate for Payer: Cofinity Commercial |
$42,398.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,440.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$261.20
|
| Rate for Payer: Healthscope Commercial |
$44,370.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34,510.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36,975.15
|
| Rate for Payer: Mclaren Medicaid |
$261.20
|
| Rate for Payer: Mclaren Medicare |
$261.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$274.26
|
| Rate for Payer: Meridian Medicaid |
$274.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$287.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,905.17
|
| Rate for Payer: Nomi Health Commercial |
$783.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36,975.15
|
| Rate for Payer: PACE Medicare |
$248.14
|
| Rate for Payer: PACE SWMI |
$261.20
|
| Rate for Payer: PHP Commercial |
$41,905.17
|
| Rate for Payer: PHP Medicare Advantage |
$261.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$807.70
|
| Rate for Payer: Priority Health Medicare |
$261.20
|
| Rate for Payer: Priority Health SBD |
$31,059.13
|
| Rate for Payer: Priority Health Tiered Network |
$646.16
|
| Rate for Payer: Railroad Medicare Medicare |
$261.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.81
|
| Rate for Payer: UHC Core |
$429.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$261.20
|
| Rate for Payer: UHC Exchange |
$429.81
|
| Rate for Payer: UHC Medicaid |
$136.61
|
| Rate for Payer: UHCCP Medicaid |
$136.61
|
| Rate for Payer: UMR Bronson Commercial |
$18,241.07
|
| Rate for Payer: VA VA |
$261.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36,975.15
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$510.66
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
22661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$459.59 |
| Rate for Payer: Aetna American Axle |
$331.93
|
| Rate for Payer: Aetna American Axle |
$750.07
|
| Rate for Payer: Aetna American Axle |
$734.71
|
| Rate for Payer: Aetna American Axle |
$208.44
|
| Rate for Payer: Aetna Commercial |
$434.06
|
| Rate for Payer: Aetna Commercial |
$980.87
|
| Rate for Payer: Aetna Commercial |
$272.57
|
| Rate for Payer: Aetna Commercial |
$960.77
|
| Rate for Payer: Aetna Medicare |
$255.33
|
| Rate for Payer: Aetna Medicare |
$565.16
|
| Rate for Payer: Aetna Medicare |
$576.98
|
| Rate for Payer: Aetna Medicare |
$160.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.71
|
| Rate for Payer: BCBS Complete |
$452.13
|
| Rate for Payer: BCBS Complete |
$461.58
|
| Rate for Payer: BCBS Complete |
$128.27
|
| Rate for Payer: BCBS Complete |
$204.26
|
| Rate for Payer: BCBS Trust/PPO |
$85.36
|
| Rate for Payer: BCBS Trust/PPO |
$85.36
|
| Rate for Payer: BCBS Trust/PPO |
$85.36
|
| Rate for Payer: BCBS Trust/PPO |
$85.36
|
| Rate for Payer: BCN Commercial |
$85.36
|
| Rate for Payer: BCN Commercial |
$85.36
|
| Rate for Payer: BCN Commercial |
$85.36
|
| Rate for Payer: BCN Commercial |
$85.36
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cash Price |
$408.53
|
| Rate for Payer: Cash Price |
$256.54
|
| Rate for Payer: Cash Price |
$904.26
|
| Rate for Payer: Cash Price |
$256.54
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cash Price |
$904.26
|
| Rate for Payer: Cash Price |
$408.53
|
| Rate for Payer: Cofinity Advantage |
$807.77
|
| Rate for Payer: Cofinity Advantage |
$224.47
|
| Rate for Payer: Cofinity Advantage |
$357.46
|
| Rate for Payer: Cofinity Advantage |
$791.22
|
| Rate for Payer: Cofinity Commercial |
$992.41
|
| Rate for Payer: Cofinity Commercial |
$275.78
|
| Rate for Payer: Cofinity Commercial |
$972.08
|
| Rate for Payer: Cofinity Commercial |
$439.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$904.26
|
| Rate for Payer: Healthscope Commercial |
$459.59
|
| Rate for Payer: Healthscope Commercial |
$1,017.29
|
| Rate for Payer: Healthscope Commercial |
$1,038.56
|
| Rate for Payer: Healthscope Commercial |
$288.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$791.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$807.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$865.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$847.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$904.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$923.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$960.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$980.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$847.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$865.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.50
|
| Rate for Payer: PHP Commercial |
$434.06
|
| Rate for Payer: PHP Commercial |
$272.57
|
| Rate for Payer: PHP Commercial |
$980.87
|
| Rate for Payer: PHP Commercial |
$960.77
|
| Rate for Payer: Priority Health SBD |
$726.99
|
| Rate for Payer: Priority Health SBD |
$321.72
|
| Rate for Payer: Priority Health SBD |
$202.02
|
| Rate for Payer: Priority Health SBD |
$712.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$734.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.44
|
| Rate for Payer: UHC Core |
$167.07
|
| Rate for Payer: UHC Core |
$601.21
|
| Rate for Payer: UHC Core |
$588.90
|
| Rate for Payer: UHC Core |
$266.05
|
| Rate for Payer: UHC Exchange |
$126.02
|
| Rate for Payer: UHC Exchange |
$444.22
|
| Rate for Payer: UHC Exchange |
$453.51
|
| Rate for Payer: UHC Exchange |
$200.69
|
| Rate for Payer: UMR Bronson Commercial |
$188.94
|
| Rate for Payer: UMR Bronson Commercial |
$426.97
|
| Rate for Payer: UMR Bronson Commercial |
$418.22
|
| Rate for Payer: UMR Bronson Commercial |
$118.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$865.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$847.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.00
|
|
|
DAUNORUBICIN 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,130.32
|
|
|
Service Code
|
HCPCS J9150
|
| Hospital Charge Code |
22661
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$497.34 |
| Max. Negotiated Rate |
$1,017.29 |
| Rate for Payer: Aetna American Axle |
$734.71
|
| Rate for Payer: Aetna American Axle |
$331.93
|
| Rate for Payer: Aetna American Axle |
$750.07
|
| Rate for Payer: Aetna American Axle |
$208.44
|
| Rate for Payer: Aetna Commercial |
$980.87
|
| Rate for Payer: Aetna Commercial |
$434.06
|
| Rate for Payer: Aetna Commercial |
$960.77
|
| Rate for Payer: Aetna Commercial |
$272.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.44
|
| Rate for Payer: Cash Price |
$408.53
|
| Rate for Payer: Cash Price |
$256.54
|
| Rate for Payer: Cash Price |
$923.17
|
| Rate for Payer: Cash Price |
$904.26
|
| Rate for Payer: Cofinity Advantage |
$791.22
|
| Rate for Payer: Cofinity Advantage |
$807.77
|
| Rate for Payer: Cofinity Advantage |
$224.47
|
| Rate for Payer: Cofinity Advantage |
$357.46
|
| Rate for Payer: Cofinity Commercial |
$972.08
|
| Rate for Payer: Cofinity Commercial |
$992.41
|
| Rate for Payer: Cofinity Commercial |
$275.78
|
| Rate for Payer: Cofinity Commercial |
$439.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$923.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$904.26
|
| Rate for Payer: Healthscope Commercial |
$1,038.56
|
| Rate for Payer: Healthscope Commercial |
$1,017.29
|
| Rate for Payer: Healthscope Commercial |
$459.59
|
| Rate for Payer: Healthscope Commercial |
$288.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$807.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$791.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$847.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$865.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$980.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$960.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$865.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$847.74
|
| Rate for Payer: PHP Commercial |
$980.87
|
| Rate for Payer: PHP Commercial |
$272.57
|
| Rate for Payer: PHP Commercial |
$960.77
|
| Rate for Payer: PHP Commercial |
$434.06
|
| Rate for Payer: Priority Health SBD |
$712.10
|
| Rate for Payer: Priority Health SBD |
$202.02
|
| Rate for Payer: Priority Health SBD |
$321.72
|
| Rate for Payer: Priority Health SBD |
$726.99
|
| Rate for Payer: UMR Bronson Commercial |
$507.74
|
| Rate for Payer: UMR Bronson Commercial |
$224.69
|
| Rate for Payer: UMR Bronson Commercial |
$141.09
|
| Rate for Payer: UMR Bronson Commercial |
$497.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$847.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$865.47
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC
|
Facility
|
IP
|
$35,351.40
|
|
|
Service Code
|
MSDRG 744
|
| Min. Negotiated Rate |
$16,842.51 |
| Max. Negotiated Rate |
$35,351.40 |
| Rate for Payer: Aetna Medicare |
$18,438.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,161.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,161.20
|
| Rate for Payer: BCBS MAPPO |
$17,728.96
|
| Rate for Payer: BCBS Trust/PPO |
$35,351.40
|
| Rate for Payer: BCN Commercial |
$35,351.40
|
| Rate for Payer: BCN Medicare Advantage |
$17,728.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,728.96
|
| Rate for Payer: Mclaren Medicare |
$17,728.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,615.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,388.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,501.86
|
| Rate for Payer: Nomi Health Commercial |
$26,433.39
|
| Rate for Payer: PACE Medicare |
$16,842.51
|
| Rate for Payer: PACE SWMI |
$17,728.96
|
| Rate for Payer: PHP Medicare Advantage |
$17,728.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,035.88
|
| Rate for Payer: Priority Health Medicare |
$17,728.96
|
| Rate for Payer: Priority Health Tiered Network |
$26,428.70
|
| Rate for Payer: Railroad Medicare Medicare |
$17,728.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,400.33
|
| Rate for Payer: UHC Core |
$27,943.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,728.96
|
| Rate for Payer: UHC Exchange |
$22,820.83
|
| Rate for Payer: VA VA |
$17,728.96
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC
|
Facility
|
IP
|
$28,214.14
|
|
|
Service Code
|
MSDRG 745
|
| Min. Negotiated Rate |
$9,600.25 |
| Max. Negotiated Rate |
$28,214.14 |
| Rate for Payer: Aetna Medicare |
$10,509.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,631.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,631.91
|
| Rate for Payer: BCBS MAPPO |
$10,105.53
|
| Rate for Payer: BCBS Trust/PPO |
$28,214.14
|
| Rate for Payer: BCN Commercial |
$28,214.14
|
| Rate for Payer: BCN Medicare Advantage |
$10,105.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,105.53
|
| Rate for Payer: Mclaren Medicare |
$10,105.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,610.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,621.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,116.08
|
| Rate for Payer: Nomi Health Commercial |
$14,673.75
|
| Rate for Payer: PACE Medicare |
$9,600.25
|
| Rate for Payer: PACE SWMI |
$10,105.53
|
| Rate for Payer: PHP Medicare Advantage |
$10,105.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,338.93
|
| Rate for Payer: Priority Health Medicare |
$10,105.53
|
| Rate for Payer: Priority Health Tiered Network |
$14,671.15
|
| Rate for Payer: Railroad Medicare Medicare |
$10,105.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,541.25
|
| Rate for Payer: UHC Core |
$15,512.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,105.53
|
| Rate for Payer: UHC Exchange |
$12,668.34
|
| Rate for Payer: VA VA |
$10,105.53
|
|
|
DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 11044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,750.47
|
| Rate for Payer: BCN Commercial |
$1,750.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN AND SUBCUTANEOUS TISSUES
|
Facility
|
OP
|
$2,281.79
|
|
|
Service Code
|
CPT 11010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$742.95
|
| Rate for Payer: BCN Commercial |
$742.95
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, AND MUSCLE
|
Facility
|
OP
|
$2,281.79
|
|
|
Service Code
|
CPT 11011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$548.17
|
| Rate for Payer: BCN Commercial |
$548.17
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/OR AN OPEN DISLOCATION (EG, EXCISIONAL DEBRIDEMENT); SKIN, SUBCUTANEOUS TISSUE, MUSCLE FASCIA, MUSCLE, AND BONE
|
Facility
|
OP
|
$9,359.82
|
|
|
Service Code
|
CPT 11012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,513.70 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,940.82
|
| Rate for Payer: BCN Commercial |
$1,940.82
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Mclaren Medicaid |
$2,894.27
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$2,381.49
|
|
|
Service Code
|
CPT 11043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$905.59
|
| Rate for Payer: BCN Commercial |
$905.59
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$177.07
|
|
|
Service Code
|
CPT 11045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$177.07 |
| Max. Negotiated Rate |
$177.07 |
| Rate for Payer: BCBS Trust/PPO |
$177.07
|
| Rate for Payer: BCN Commercial |
$177.07
|
|
|
DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS
|
Facility
|
OP
|
$1,309.90
|
|
|
Service Code
|
CPT 11042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$388.22
|
| Rate for Payer: BCN Commercial |
$388.22
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$901.88
|
|
|
Service Code
|
HCPCS J0893
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$811.69 |
| Rate for Payer: Aetna American Axle |
$586.22
|
| Rate for Payer: Aetna Commercial |
$766.60
|
| Rate for Payer: Aetna Medicare |
$450.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.22
|
| Rate for Payer: BCBS Complete |
$360.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cofinity Advantage |
$631.32
|
| Rate for Payer: Cofinity Commercial |
$775.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.50
|
| Rate for Payer: Healthscope Commercial |
$811.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$631.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$676.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$721.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$676.41
|
| Rate for Payer: PHP Commercial |
$766.60
|
| Rate for Payer: Priority Health SBD |
$568.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$333.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$676.41
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$554.26
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.87 |
| Max. Negotiated Rate |
$498.83 |
| Rate for Payer: Aetna American Axle |
$360.27
|
| Rate for Payer: Aetna American Axle |
$241.65
|
| Rate for Payer: Aetna American Axle |
$300.01
|
| Rate for Payer: Aetna American Axle |
$562.41
|
| Rate for Payer: Aetna American Axle |
$171.29
|
| Rate for Payer: Aetna American Axle |
$598.46
|
| Rate for Payer: Aetna American Axle |
$301.83
|
| Rate for Payer: Aetna American Axle |
$231.13
|
| Rate for Payer: Aetna American Axle |
$206.47
|
| Rate for Payer: Aetna American Axle |
$206.41
|
| Rate for Payer: Aetna Commercial |
$224.00
|
| Rate for Payer: Aetna Commercial |
$735.46
|
| Rate for Payer: Aetna Commercial |
$471.12
|
| Rate for Payer: Aetna Commercial |
$316.00
|
| Rate for Payer: Aetna Commercial |
$392.33
|
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Commercial |
$302.24
|
| Rate for Payer: Aetna Commercial |
$269.92
|
| Rate for Payer: Aetna Commercial |
$782.60
|
| Rate for Payer: Aetna Commercial |
$394.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.65
|
| Rate for Payer: Cash Price |
$297.42
|
| Rate for Payer: Cash Price |
$254.04
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cash Price |
$254.12
|
| Rate for Payer: Cash Price |
$736.56
|
| Rate for Payer: Cash Price |
$692.20
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$371.48
|
| Rate for Payer: Cash Price |
$369.25
|
| Rate for Payer: Cash Price |
$284.46
|
| Rate for Payer: Cofinity Advantage |
$323.09
|
| Rate for Payer: Cofinity Advantage |
$260.24
|
| Rate for Payer: Cofinity Advantage |
$248.91
|
| Rate for Payer: Cofinity Advantage |
$222.28
|
| Rate for Payer: Cofinity Advantage |
$644.49
|
| Rate for Payer: Cofinity Advantage |
$222.35
|
| Rate for Payer: Cofinity Advantage |
$184.47
|
| Rate for Payer: Cofinity Advantage |
$387.98
|
| Rate for Payer: Cofinity Advantage |
$605.67
|
| Rate for Payer: Cofinity Advantage |
$325.05
|
| Rate for Payer: Cofinity Commercial |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$744.12
|
| Rate for Payer: Cofinity Commercial |
$396.94
|
| Rate for Payer: Cofinity Commercial |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$791.80
|
| Rate for Payer: Cofinity Commercial |
$226.64
|
| Rate for Payer: Cofinity Commercial |
$273.09
|
| Rate for Payer: Cofinity Commercial |
$305.80
|
| Rate for Payer: Cofinity Commercial |
$273.18
|
| Rate for Payer: Cofinity Commercial |
$476.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.56
|
| Rate for Payer: Healthscope Commercial |
$415.40
|
| Rate for Payer: Healthscope Commercial |
$417.92
|
| Rate for Payer: Healthscope Commercial |
$320.02
|
| Rate for Payer: Healthscope Commercial |
$285.88
|
| Rate for Payer: Healthscope Commercial |
$334.59
|
| Rate for Payer: Healthscope Commercial |
$778.73
|
| Rate for Payer: Healthscope Commercial |
$498.83
|
| Rate for Payer: Healthscope Commercial |
$828.63
|
| Rate for Payer: Healthscope Commercial |
$285.80
|
| Rate for Payer: Healthscope Commercial |
$237.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$644.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$387.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$690.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$415.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.65
|
| Rate for Payer: PHP Commercial |
$270.00
|
| Rate for Payer: PHP Commercial |
$394.70
|
| Rate for Payer: PHP Commercial |
$302.24
|
| Rate for Payer: PHP Commercial |
$316.00
|
| Rate for Payer: PHP Commercial |
$269.92
|
| Rate for Payer: PHP Commercial |
$735.46
|
| Rate for Payer: PHP Commercial |
$392.33
|
| Rate for Payer: PHP Commercial |
$224.00
|
| Rate for Payer: PHP Commercial |
$782.60
|
| Rate for Payer: PHP Commercial |
$471.12
|
| Rate for Payer: Priority Health SBD |
$292.54
|
| Rate for Payer: Priority Health SBD |
$166.02
|
| Rate for Payer: Priority Health SBD |
$200.06
|
| Rate for Payer: Priority Health SBD |
$580.04
|
| Rate for Payer: Priority Health SBD |
$349.18
|
| Rate for Payer: Priority Health SBD |
$224.02
|
| Rate for Payer: Priority Health SBD |
$290.78
|
| Rate for Payer: Priority Health SBD |
$545.11
|
| Rate for Payer: Priority Health SBD |
$200.12
|
| Rate for Payer: Priority Health SBD |
$234.22
|
| Rate for Payer: UMR Bronson Commercial |
$139.77
|
| Rate for Payer: UMR Bronson Commercial |
$204.31
|
| Rate for Payer: UMR Bronson Commercial |
$156.46
|
| Rate for Payer: UMR Bronson Commercial |
$115.95
|
| Rate for Payer: UMR Bronson Commercial |
$139.72
|
| Rate for Payer: UMR Bronson Commercial |
$380.71
|
| Rate for Payer: UMR Bronson Commercial |
$163.58
|
| Rate for Payer: UMR Bronson Commercial |
$405.11
|
| Rate for Payer: UMR Bronson Commercial |
$203.09
|
| Rate for Payer: UMR Bronson Commercial |
$243.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.69
|
|
|
DECITABINE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$464.35
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
76364
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$417.92 |
| Rate for Payer: Aetna American Axle |
$301.83
|
| Rate for Payer: Aetna American Axle |
$360.27
|
| Rate for Payer: Aetna American Axle |
$206.47
|
| Rate for Payer: Aetna American Axle |
$562.41
|
| Rate for Payer: Aetna American Axle |
$598.46
|
| Rate for Payer: Aetna American Axle |
$206.41
|
| Rate for Payer: Aetna American Axle |
$559.16
|
| Rate for Payer: Aetna American Axle |
$241.65
|
| Rate for Payer: Aetna American Axle |
$231.13
|
| Rate for Payer: Aetna American Axle |
$646.05
|
| Rate for Payer: Aetna American Axle |
$191.43
|
| Rate for Payer: Aetna American Axle |
$171.29
|
| Rate for Payer: Aetna American Axle |
$300.01
|
| Rate for Payer: Aetna Commercial |
$392.33
|
| Rate for Payer: Aetna Commercial |
$471.12
|
| Rate for Payer: Aetna Commercial |
$302.24
|
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Commercial |
$269.92
|
| Rate for Payer: Aetna Commercial |
$250.32
|
| Rate for Payer: Aetna Commercial |
$735.46
|
| Rate for Payer: Aetna Commercial |
$316.00
|
| Rate for Payer: Aetna Commercial |
$731.21
|
| Rate for Payer: Aetna Commercial |
$224.00
|
| Rate for Payer: Aetna Commercial |
$782.60
|
| Rate for Payer: Aetna Commercial |
$394.70
|
| Rate for Payer: Aetna Commercial |
$844.83
|
| Rate for Payer: Aetna Medicare |
$177.79
|
| Rate for Payer: Aetna Medicare |
$432.62
|
| Rate for Payer: Aetna Medicare |
$232.18
|
| Rate for Payer: Aetna Medicare |
$277.13
|
| Rate for Payer: Aetna Medicare |
$147.25
|
| Rate for Payer: Aetna Medicare |
$230.78
|
| Rate for Payer: Aetna Medicare |
$131.76
|
| Rate for Payer: Aetna Medicare |
$496.96
|
| Rate for Payer: Aetna Medicare |
$158.78
|
| Rate for Payer: Aetna Medicare |
$185.88
|
| Rate for Payer: Aetna Medicare |
$460.35
|
| Rate for Payer: Aetna Medicare |
$430.12
|
| Rate for Payer: Aetna Medicare |
$158.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.46
|
| Rate for Payer: BCBS Complete |
$117.80
|
| Rate for Payer: BCBS Complete |
$105.41
|
| Rate for Payer: BCBS Complete |
$185.74
|
| Rate for Payer: BCBS Complete |
$344.10
|
| Rate for Payer: BCBS Complete |
$184.62
|
| Rate for Payer: BCBS Complete |
$368.28
|
| Rate for Payer: BCBS Complete |
$142.23
|
| Rate for Payer: BCBS Complete |
$221.70
|
| Rate for Payer: BCBS Complete |
$127.02
|
| Rate for Payer: BCBS Complete |
$397.57
|
| Rate for Payer: BCBS Complete |
$148.71
|
| Rate for Payer: BCBS Complete |
$127.06
|
| Rate for Payer: BCBS Complete |
$346.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cash Price |
$371.48
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cash Price |
$254.04
|
| Rate for Payer: Cash Price |
$254.04
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cash Price |
$795.14
|
| Rate for Payer: Cash Price |
$795.14
|
| Rate for Payer: Cash Price |
$736.56
|
| Rate for Payer: Cash Price |
$736.56
|
| Rate for Payer: Cash Price |
$254.12
|
| Rate for Payer: Cash Price |
$254.12
|
| Rate for Payer: Cash Price |
$692.20
|
| Rate for Payer: Cash Price |
$692.20
|
| Rate for Payer: Cash Price |
$284.46
|
| Rate for Payer: Cash Price |
$284.46
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cash Price |
$297.42
|
| Rate for Payer: Cash Price |
$297.42
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cash Price |
$369.25
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$369.25
|
| Rate for Payer: Cash Price |
$443.41
|
| Rate for Payer: Cash Price |
$371.48
|
| Rate for Payer: Cofinity Advantage |
$695.74
|
| Rate for Payer: Cofinity Advantage |
$602.17
|
| Rate for Payer: Cofinity Advantage |
$644.49
|
| Rate for Payer: Cofinity Advantage |
$605.67
|
| Rate for Payer: Cofinity Advantage |
$260.24
|
| Rate for Payer: Cofinity Advantage |
$222.28
|
| Rate for Payer: Cofinity Advantage |
$222.35
|
| Rate for Payer: Cofinity Advantage |
$387.98
|
| Rate for Payer: Cofinity Advantage |
$248.91
|
| Rate for Payer: Cofinity Advantage |
$206.15
|
| Rate for Payer: Cofinity Advantage |
$325.05
|
| Rate for Payer: Cofinity Advantage |
$184.47
|
| Rate for Payer: Cofinity Advantage |
$323.09
|
| Rate for Payer: Cofinity Commercial |
$744.12
|
| Rate for Payer: Cofinity Commercial |
$253.27
|
| Rate for Payer: Cofinity Commercial |
$226.64
|
| Rate for Payer: Cofinity Commercial |
$305.80
|
| Rate for Payer: Cofinity Commercial |
$273.18
|
| Rate for Payer: Cofinity Commercial |
$791.80
|
| Rate for Payer: Cofinity Commercial |
$319.72
|
| Rate for Payer: Cofinity Commercial |
$739.82
|
| Rate for Payer: Cofinity Commercial |
$399.34
|
| Rate for Payer: Cofinity Commercial |
$854.77
|
| Rate for Payer: Cofinity Commercial |
$476.66
|
| Rate for Payer: Cofinity Commercial |
$273.09
|
| Rate for Payer: Cofinity Commercial |
$396.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$443.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.04
|
| Rate for Payer: Healthscope Commercial |
$334.59
|
| Rate for Payer: Healthscope Commercial |
$774.23
|
| Rate for Payer: Healthscope Commercial |
$415.40
|
| Rate for Payer: Healthscope Commercial |
$320.02
|
| Rate for Payer: Healthscope Commercial |
$498.83
|
| Rate for Payer: Healthscope Commercial |
$237.18
|
| Rate for Payer: Healthscope Commercial |
$778.73
|
| Rate for Payer: Healthscope Commercial |
$265.05
|
| Rate for Payer: Healthscope Commercial |
$894.53
|
| Rate for Payer: Healthscope Commercial |
$285.80
|
| Rate for Payer: Healthscope Commercial |
$417.92
|
| Rate for Payer: Healthscope Commercial |
$828.63
|
| Rate for Payer: Healthscope Commercial |
$285.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$644.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$387.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$695.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$369.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$795.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$692.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$736.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$688.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$371.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$443.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$745.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$415.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$690.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.88
|
| Rate for Payer: PHP Commercial |
$782.60
|
| Rate for Payer: PHP Commercial |
$394.70
|
| Rate for Payer: PHP Commercial |
$735.46
|
| Rate for Payer: PHP Commercial |
$270.00
|
| Rate for Payer: PHP Commercial |
$224.00
|
| Rate for Payer: PHP Commercial |
$250.32
|
| Rate for Payer: PHP Commercial |
$471.12
|
| Rate for Payer: PHP Commercial |
$392.33
|
| Rate for Payer: PHP Commercial |
$844.83
|
| Rate for Payer: PHP Commercial |
$316.00
|
| Rate for Payer: PHP Commercial |
$269.92
|
| Rate for Payer: PHP Commercial |
$302.24
|
| Rate for Payer: PHP Commercial |
$731.21
|
| Rate for Payer: Priority Health SBD |
$545.11
|
| Rate for Payer: Priority Health SBD |
$200.06
|
| Rate for Payer: Priority Health SBD |
$290.78
|
| Rate for Payer: Priority Health SBD |
$234.22
|
| Rate for Payer: Priority Health SBD |
$541.96
|
| Rate for Payer: Priority Health SBD |
$292.54
|
| Rate for Payer: Priority Health SBD |
$224.02
|
| Rate for Payer: Priority Health SBD |
$185.53
|
| Rate for Payer: Priority Health SBD |
$200.12
|
| Rate for Payer: Priority Health SBD |
$166.02
|
| Rate for Payer: Priority Health SBD |
$580.04
|
| Rate for Payer: Priority Health SBD |
$626.17
|
| Rate for Payer: Priority Health SBD |
$349.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Core |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UMR Bronson Commercial |
$97.51
|
| Rate for Payer: UMR Bronson Commercial |
$367.75
|
| Rate for Payer: UMR Bronson Commercial |
$131.56
|
| Rate for Payer: UMR Bronson Commercial |
$171.81
|
| Rate for Payer: UMR Bronson Commercial |
$320.14
|
| Rate for Payer: UMR Bronson Commercial |
$117.49
|
| Rate for Payer: UMR Bronson Commercial |
$340.66
|
| Rate for Payer: UMR Bronson Commercial |
$137.55
|
| Rate for Payer: UMR Bronson Commercial |
$117.53
|
| Rate for Payer: UMR Bronson Commercial |
$318.29
|
| Rate for Payer: UMR Bronson Commercial |
$170.78
|
| Rate for Payer: UMR Bronson Commercial |
$205.08
|
| Rate for Payer: UMR Bronson Commercial |
$108.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.19
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET
|
Facility
|
OP
|
$1,307.81
|
|
|
Service Code
|
NDC 43598085630
|
| Hospital Charge Code |
43416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$483.89 |
| Max. Negotiated Rate |
$1,177.03 |
| Rate for Payer: Aetna American Axle |
$850.08
|
| Rate for Payer: Aetna Commercial |
$1,111.64
|
| Rate for Payer: Aetna Medicare |
$653.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.08
|
| Rate for Payer: BCBS Complete |
$523.12
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cofinity Advantage |
$915.47
|
| Rate for Payer: Cofinity Commercial |
$1,124.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.25
|
| Rate for Payer: Healthscope Commercial |
$1,177.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,046.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$980.86
|
| Rate for Payer: PHP Commercial |
$1,111.64
|
| Rate for Payer: Priority Health SBD |
$823.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$850.08
|
| Rate for Payer: UHC Core |
$681.37
|
| Rate for Payer: UHC Exchange |
$513.97
|
| Rate for Payer: UMR Bronson Commercial |
$483.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.86
|
|
|
DEFERASIROX 250 MG DISPERSIBLE TABLET
|
Facility
|
IP
|
$1,307.81
|
|
|
Service Code
|
NDC 43598085630
|
| Hospital Charge Code |
43416
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$575.44 |
| Max. Negotiated Rate |
$1,177.03 |
| Rate for Payer: Aetna American Axle |
$850.08
|
| Rate for Payer: Aetna Commercial |
$1,111.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.08
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cofinity Advantage |
$915.47
|
| Rate for Payer: Cofinity Commercial |
$1,124.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,046.25
|
| Rate for Payer: Healthscope Commercial |
$1,177.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$915.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$980.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,111.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$980.86
|
| Rate for Payer: PHP Commercial |
$1,111.64
|
| Rate for Payer: Priority Health SBD |
$823.92
|
| Rate for Payer: UMR Bronson Commercial |
$575.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$980.86
|
|
|
DEFERASIROX 360 MG TABLET
|
Facility
|
OP
|
$564.33
|
|
|
Service Code
|
NDC 31722001330
|
| Hospital Charge Code |
163509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$507.90 |
| Rate for Payer: Aetna American Axle |
$366.81
|
| Rate for Payer: Aetna Commercial |
$479.68
|
| Rate for Payer: Aetna Medicare |
$282.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.81
|
| Rate for Payer: BCBS Complete |
$225.73
|
| Rate for Payer: Cash Price |
$451.46
|
| Rate for Payer: Cofinity Advantage |
$395.03
|
| Rate for Payer: Cofinity Commercial |
$485.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.46
|
| Rate for Payer: Healthscope Commercial |
$507.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.25
|
| Rate for Payer: PHP Commercial |
$479.68
|
| Rate for Payer: Priority Health SBD |
$355.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.81
|
| Rate for Payer: UHC Core |
$294.02
|
| Rate for Payer: UHC Exchange |
$221.78
|
| Rate for Payer: UMR Bronson Commercial |
$208.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.25
|
|
|
DEFERASIROX 360 MG TABLET
|
Facility
|
OP
|
$242.93
|
|
|
Service Code
|
NDC 43598085130
|
| Hospital Charge Code |
163509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$218.64 |
| Rate for Payer: Aetna American Axle |
$157.90
|
| Rate for Payer: Aetna Commercial |
$206.49
|
| Rate for Payer: Aetna Medicare |
$121.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.90
|
| Rate for Payer: BCBS Complete |
$97.17
|
| Rate for Payer: Cash Price |
$194.34
|
| Rate for Payer: Cofinity Advantage |
$170.05
|
| Rate for Payer: Cofinity Commercial |
$208.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.34
|
| Rate for Payer: Healthscope Commercial |
$218.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.20
|
| Rate for Payer: PHP Commercial |
$206.49
|
| Rate for Payer: Priority Health SBD |
$153.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.90
|
| Rate for Payer: UHC Core |
$126.57
|
| Rate for Payer: UHC Exchange |
$95.47
|
| Rate for Payer: UMR Bronson Commercial |
$89.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.20
|
|
|
DEFERASIROX 360 MG TABLET
|
Facility
|
IP
|
$564.33
|
|
|
Service Code
|
NDC 31722001330
|
| Hospital Charge Code |
163509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.31 |
| Max. Negotiated Rate |
$507.90 |
| Rate for Payer: Aetna American Axle |
$366.81
|
| Rate for Payer: Aetna Commercial |
$479.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.81
|
| Rate for Payer: Cash Price |
$451.46
|
| Rate for Payer: Cofinity Advantage |
$395.03
|
| Rate for Payer: Cofinity Commercial |
$485.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.46
|
| Rate for Payer: Healthscope Commercial |
$507.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.25
|
| Rate for Payer: PHP Commercial |
$479.68
|
| Rate for Payer: Priority Health SBD |
$355.53
|
| Rate for Payer: UMR Bronson Commercial |
$248.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.25
|
|
|
DEFERASIROX 360 MG TABLET
|
Facility
|
IP
|
$242.93
|
|
|
Service Code
|
NDC 43598085130
|
| Hospital Charge Code |
163509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.89 |
| Max. Negotiated Rate |
$218.64 |
| Rate for Payer: Aetna American Axle |
$157.90
|
| Rate for Payer: Aetna Commercial |
$206.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.90
|
| Rate for Payer: Cash Price |
$194.34
|
| Rate for Payer: Cofinity Advantage |
$170.05
|
| Rate for Payer: Cofinity Commercial |
$208.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.34
|
| Rate for Payer: Healthscope Commercial |
$218.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.20
|
| Rate for Payer: PHP Commercial |
$206.49
|
| Rate for Payer: Priority Health SBD |
$153.05
|
| Rate for Payer: UMR Bronson Commercial |
$106.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.20
|
|
|
DEFERASIROX 90 MG TABLET
|
Facility
|
IP
|
$6,560.77
|
|
|
Service Code
|
NDC 00078065415
|
| Hospital Charge Code |
163507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,886.74 |
| Max. Negotiated Rate |
$5,904.69 |
| Rate for Payer: Aetna American Axle |
$4,264.50
|
| Rate for Payer: Aetna Commercial |
$5,576.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,264.50
|
| Rate for Payer: Cash Price |
$5,248.62
|
| Rate for Payer: Cofinity Advantage |
$4,592.54
|
| Rate for Payer: Cofinity Commercial |
$5,642.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,248.62
|
| Rate for Payer: Healthscope Commercial |
$5,904.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,592.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,920.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,576.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,920.58
|
| Rate for Payer: PHP Commercial |
$5,576.65
|
| Rate for Payer: Priority Health SBD |
$4,133.29
|
| Rate for Payer: UMR Bronson Commercial |
$2,886.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,920.58
|
|
|
DEFERASIROX 90 MG TABLET
|
Facility
|
IP
|
$83.67
|
|
|
Service Code
|
NDC 43598085330
|
| Hospital Charge Code |
163507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$75.30 |
| Rate for Payer: Aetna American Axle |
$54.39
|
| Rate for Payer: Aetna Commercial |
$71.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.39
|
| Rate for Payer: Cash Price |
$66.94
|
| Rate for Payer: Cofinity Advantage |
$58.57
|
| Rate for Payer: Cofinity Commercial |
$71.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.94
|
| Rate for Payer: Healthscope Commercial |
$75.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.75
|
| Rate for Payer: PHP Commercial |
$71.12
|
| Rate for Payer: Priority Health SBD |
$52.71
|
| Rate for Payer: UMR Bronson Commercial |
$36.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.75
|
|
|
DEFERASIROX 90 MG TABLET
|
Facility
|
OP
|
$6,560.77
|
|
|
Service Code
|
NDC 00078065415
|
| Hospital Charge Code |
163507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,427.48 |
| Max. Negotiated Rate |
$5,904.69 |
| Rate for Payer: Aetna American Axle |
$4,264.50
|
| Rate for Payer: Aetna Commercial |
$5,576.65
|
| Rate for Payer: Aetna Medicare |
$3,280.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,264.50
|
| Rate for Payer: BCBS Complete |
$2,624.31
|
| Rate for Payer: Cash Price |
$5,248.62
|
| Rate for Payer: Cofinity Advantage |
$4,592.54
|
| Rate for Payer: Cofinity Commercial |
$5,642.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,248.62
|
| Rate for Payer: Healthscope Commercial |
$5,904.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,592.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,920.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,248.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,576.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,920.58
|
| Rate for Payer: PHP Commercial |
$5,576.65
|
| Rate for Payer: Priority Health SBD |
$4,133.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,264.50
|
| Rate for Payer: UHC Core |
$3,418.16
|
| Rate for Payer: UHC Exchange |
$2,578.38
|
| Rate for Payer: UMR Bronson Commercial |
$2,427.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,920.58
|
|
