|
DESFLURANE 100 % INHALATION LIQUID
|
Facility
|
OP
|
$1,137.72
|
|
|
Service Code
|
NDC 10019064434
|
| Hospital Charge Code |
9747
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$420.96 |
| Max. Negotiated Rate |
$1,023.95 |
| Rate for Payer: Aetna American Axle |
$739.52
|
| Rate for Payer: Aetna Commercial |
$967.06
|
| Rate for Payer: Aetna Medicare |
$568.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.52
|
| Rate for Payer: BCBS Complete |
$455.09
|
| Rate for Payer: Cash Price |
$910.18
|
| Rate for Payer: Cofinity Advantage |
$796.40
|
| Rate for Payer: Cofinity Commercial |
$978.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.18
|
| Rate for Payer: Healthscope Commercial |
$1,023.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$796.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$910.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$853.29
|
| Rate for Payer: PHP Commercial |
$967.06
|
| Rate for Payer: Priority Health SBD |
$716.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.52
|
| Rate for Payer: UHC Core |
$592.75
|
| Rate for Payer: UHC Exchange |
$447.12
|
| Rate for Payer: UMR Bronson Commercial |
$420.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.29
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
OP
|
$354.85
|
|
|
Service Code
|
NDC 50742011301
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.29 |
| Max. Negotiated Rate |
$319.37 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna Medicare |
$177.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: BCBS Complete |
$141.94
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Advantage |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$283.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.14
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.65
|
| Rate for Payer: UHC Core |
$184.88
|
| Rate for Payer: UHC Exchange |
$139.46
|
| Rate for Payer: UMR Bronson Commercial |
$131.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
NDC 23155057901
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.36 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Medicare |
$114.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Advantage |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.00
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health SBD |
$143.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.20
|
| Rate for Payer: UHC Core |
$118.79
|
| Rate for Payer: UHC Exchange |
$89.60
|
| Rate for Payer: UMR Bronson Commercial |
$84.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 23155057901
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Advantage |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.00
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health SBD |
$143.64
|
| Rate for Payer: UMR Bronson Commercial |
$100.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 62332031631
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Advantage |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$199.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
IP
|
$354.85
|
|
|
Service Code
|
NDC 50742011301
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$319.37 |
| Rate for Payer: Aetna American Axle |
$230.65
|
| Rate for Payer: Aetna Commercial |
$301.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.65
|
| Rate for Payer: Cash Price |
$283.88
|
| Rate for Payer: Cofinity Advantage |
$248.40
|
| Rate for Payer: Cofinity Commercial |
$305.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.88
|
| Rate for Payer: Healthscope Commercial |
$319.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.14
|
| Rate for Payer: PHP Commercial |
$301.62
|
| Rate for Payer: Priority Health SBD |
$223.56
|
| Rate for Payer: UMR Bronson Commercial |
$156.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.14
|
|
|
DESIPRAMINE 25 MG TABLET
|
Facility
|
OP
|
$453.55
|
|
|
Service Code
|
NDC 62332031631
|
| Hospital Charge Code |
2286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.81 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna Medicare |
$226.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: BCBS Complete |
$181.42
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Advantage |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.81
|
| Rate for Payer: UHC Core |
$236.30
|
| Rate for Payer: UHC Exchange |
$178.25
|
| Rate for Payer: UMR Bronson Commercial |
$167.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
OP
|
$1,309.43
|
|
|
Service Code
|
NDC 00591246401
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$484.49 |
| Max. Negotiated Rate |
$1,178.49 |
| Rate for Payer: Aetna American Axle |
$851.13
|
| Rate for Payer: Aetna Commercial |
$1,113.02
|
| Rate for Payer: Aetna Medicare |
$654.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.13
|
| Rate for Payer: BCBS Complete |
$523.77
|
| Rate for Payer: Cash Price |
$1,047.54
|
| Rate for Payer: Cofinity Advantage |
$916.60
|
| Rate for Payer: Cofinity Commercial |
$1,126.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.54
|
| Rate for Payer: Healthscope Commercial |
$1,178.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$916.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$982.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,047.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$982.07
|
| Rate for Payer: PHP Commercial |
$1,113.02
|
| Rate for Payer: Priority Health SBD |
$824.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$851.13
|
| Rate for Payer: UHC Core |
$682.21
|
| Rate for Payer: UHC Exchange |
$514.61
|
| Rate for Payer: UMR Bronson Commercial |
$484.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$982.07
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$430.05
|
|
|
Service Code
|
NDC 23155048901
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.22 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna American Axle |
$279.53
|
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.53
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Advantage |
$301.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$387.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.54
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: Priority Health SBD |
$270.93
|
| Rate for Payer: UMR Bronson Commercial |
$189.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
NDC 69918010101
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.92 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna American Axle |
$304.20
|
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.20
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Advantage |
$327.60
|
| Rate for Payer: Cofinity Commercial |
$402.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.40
|
| Rate for Payer: Healthscope Commercial |
$421.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.00
|
| Rate for Payer: PHP Commercial |
$397.80
|
| Rate for Payer: Priority Health SBD |
$294.84
|
| Rate for Payer: UMR Bronson Commercial |
$205.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.00
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$327.84
|
|
|
Service Code
|
NDC 68462027501
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.25 |
| Max. Negotiated Rate |
$295.06 |
| Rate for Payer: Aetna American Axle |
$213.10
|
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.10
|
| Rate for Payer: Cash Price |
$262.27
|
| Rate for Payer: Cofinity Advantage |
$229.49
|
| Rate for Payer: Cofinity Commercial |
$281.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.27
|
| Rate for Payer: Healthscope Commercial |
$295.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.88
|
| Rate for Payer: PHP Commercial |
$278.66
|
| Rate for Payer: Priority Health SBD |
$206.54
|
| Rate for Payer: UMR Bronson Commercial |
$144.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.88
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
OP
|
$327.84
|
|
|
Service Code
|
NDC 68462027501
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.30 |
| Max. Negotiated Rate |
$295.06 |
| Rate for Payer: Aetna American Axle |
$213.10
|
| Rate for Payer: Aetna Commercial |
$278.66
|
| Rate for Payer: Aetna Medicare |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.10
|
| Rate for Payer: BCBS Complete |
$131.14
|
| Rate for Payer: Cash Price |
$262.27
|
| Rate for Payer: Cofinity Advantage |
$229.49
|
| Rate for Payer: Cofinity Commercial |
$281.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.27
|
| Rate for Payer: Healthscope Commercial |
$295.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$262.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.88
|
| Rate for Payer: PHP Commercial |
$278.66
|
| Rate for Payer: Priority Health SBD |
$206.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.10
|
| Rate for Payer: UHC Core |
$170.80
|
| Rate for Payer: UHC Exchange |
$128.84
|
| Rate for Payer: UMR Bronson Commercial |
$121.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.88
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
NDC 69918010101
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.16 |
| Max. Negotiated Rate |
$421.20 |
| Rate for Payer: Aetna American Axle |
$304.20
|
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Medicare |
$234.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.20
|
| Rate for Payer: BCBS Complete |
$187.20
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Advantage |
$327.60
|
| Rate for Payer: Cofinity Commercial |
$402.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.40
|
| Rate for Payer: Healthscope Commercial |
$421.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.00
|
| Rate for Payer: PHP Commercial |
$397.80
|
| Rate for Payer: Priority Health SBD |
$294.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.20
|
| Rate for Payer: UHC Core |
$243.83
|
| Rate for Payer: UHC Exchange |
$183.92
|
| Rate for Payer: UMR Bronson Commercial |
$173.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.00
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
OP
|
$430.05
|
|
|
Service Code
|
NDC 23155048901
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna American Axle |
$279.53
|
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna Medicare |
$215.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.53
|
| Rate for Payer: BCBS Complete |
$172.02
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Advantage |
$301.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$387.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.54
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: Priority Health SBD |
$270.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.53
|
| Rate for Payer: UHC Core |
$224.06
|
| Rate for Payer: UHC Exchange |
$169.01
|
| Rate for Payer: UMR Bronson Commercial |
$159.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
DESMOPRESSIN 0.1 MG TABLET
|
Facility
|
IP
|
$1,309.43
|
|
|
Service Code
|
NDC 00591246401
|
| Hospital Charge Code |
16052
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$576.15 |
| Max. Negotiated Rate |
$1,178.49 |
| Rate for Payer: Aetna American Axle |
$851.13
|
| Rate for Payer: Aetna Commercial |
$1,113.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.13
|
| Rate for Payer: Cash Price |
$1,047.54
|
| Rate for Payer: Cofinity Advantage |
$916.60
|
| Rate for Payer: Cofinity Commercial |
$1,126.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,047.54
|
| Rate for Payer: Healthscope Commercial |
$1,178.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$916.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$982.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$982.07
|
| Rate for Payer: PHP Commercial |
$1,113.02
|
| Rate for Payer: Priority Health SBD |
$824.94
|
| Rate for Payer: UMR Bronson Commercial |
$576.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$982.07
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY
|
Facility
|
IP
|
$641.27
|
|
|
Service Code
|
NDC 24208034205
|
| Hospital Charge Code |
27770
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$282.16 |
| Max. Negotiated Rate |
$577.14 |
| Rate for Payer: Aetna American Axle |
$416.83
|
| Rate for Payer: Aetna Commercial |
$545.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.83
|
| Rate for Payer: Cash Price |
$513.02
|
| Rate for Payer: Cofinity Advantage |
$448.89
|
| Rate for Payer: Cofinity Commercial |
$551.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.02
|
| Rate for Payer: Healthscope Commercial |
$577.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$480.95
|
| Rate for Payer: PHP Commercial |
$545.08
|
| Rate for Payer: Priority Health SBD |
$404.00
|
| Rate for Payer: UMR Bronson Commercial |
$282.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.95
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY
|
Facility
|
OP
|
$641.27
|
|
|
Service Code
|
NDC 24208034205
|
| Hospital Charge Code |
27770
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.27 |
| Max. Negotiated Rate |
$577.14 |
| Rate for Payer: Aetna American Axle |
$416.83
|
| Rate for Payer: Aetna Commercial |
$545.08
|
| Rate for Payer: Aetna Medicare |
$320.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.83
|
| Rate for Payer: BCBS Complete |
$256.51
|
| Rate for Payer: Cash Price |
$513.02
|
| Rate for Payer: Cofinity Advantage |
$448.89
|
| Rate for Payer: Cofinity Commercial |
$551.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.02
|
| Rate for Payer: Healthscope Commercial |
$577.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$513.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$480.95
|
| Rate for Payer: PHP Commercial |
$545.08
|
| Rate for Payer: Priority Health SBD |
$404.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.83
|
| Rate for Payer: UHC Core |
$334.10
|
| Rate for Payer: UHC Exchange |
$252.02
|
| Rate for Payer: UMR Bronson Commercial |
$237.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.95
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)
|
Facility
|
OP
|
$175.75
|
|
|
Service Code
|
NDC 60505081500
|
| Hospital Charge Code |
21135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$158.18 |
| Rate for Payer: Aetna American Axle |
$114.24
|
| Rate for Payer: Aetna Commercial |
$149.39
|
| Rate for Payer: Aetna Medicare |
$87.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.24
|
| Rate for Payer: BCBS Complete |
$70.30
|
| Rate for Payer: Cash Price |
$140.60
|
| Rate for Payer: Cofinity Advantage |
$123.03
|
| Rate for Payer: Cofinity Commercial |
$151.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.60
|
| Rate for Payer: Healthscope Commercial |
$158.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.81
|
| Rate for Payer: PHP Commercial |
$149.39
|
| Rate for Payer: Priority Health SBD |
$110.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.24
|
| Rate for Payer: UHC Core |
$91.57
|
| Rate for Payer: UHC Exchange |
$69.07
|
| Rate for Payer: UMR Bronson Commercial |
$65.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.81
|
|
|
DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASAL SPRAY (NON-REFRIGERATED)
|
Facility
|
IP
|
$175.75
|
|
|
Service Code
|
NDC 60505081500
|
| Hospital Charge Code |
21135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.33 |
| Max. Negotiated Rate |
$158.18 |
| Rate for Payer: Aetna American Axle |
$114.24
|
| Rate for Payer: Aetna Commercial |
$149.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.24
|
| Rate for Payer: Cash Price |
$140.60
|
| Rate for Payer: Cofinity Advantage |
$123.03
|
| Rate for Payer: Cofinity Commercial |
$151.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.60
|
| Rate for Payer: Healthscope Commercial |
$158.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.81
|
| Rate for Payer: PHP Commercial |
$149.39
|
| Rate for Payer: Priority Health SBD |
$110.72
|
| Rate for Payer: UMR Bronson Commercial |
$77.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.81
|
|
|
DESMOPRESSIN 150 MCG/SPRAY (0.1 ML) NASAL SPRAY
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
NDC 73177011415
|
| Hospital Charge Code |
13506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$616.00 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna American Axle |
$910.00
|
| Rate for Payer: Aetna Commercial |
$1,190.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cofinity Advantage |
$980.00
|
| Rate for Payer: Cofinity Commercial |
$1,204.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.00
|
| Rate for Payer: Healthscope Commercial |
$1,260.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$980.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,050.00
|
| Rate for Payer: PHP Commercial |
$1,190.00
|
| Rate for Payer: Priority Health SBD |
$882.00
|
| Rate for Payer: UMR Bronson Commercial |
$616.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.00
|
|
|
DESMOPRESSIN 150 MCG/SPRAY (0.1 ML) NASAL SPRAY
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
NDC 73177011415
|
| Hospital Charge Code |
13506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$518.00 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna American Axle |
$910.00
|
| Rate for Payer: Aetna Commercial |
$1,190.00
|
| Rate for Payer: Aetna Medicare |
$700.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.00
|
| Rate for Payer: BCBS Complete |
$560.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cofinity Advantage |
$980.00
|
| Rate for Payer: Cofinity Commercial |
$1,204.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.00
|
| Rate for Payer: Healthscope Commercial |
$1,260.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$980.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,190.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,050.00
|
| Rate for Payer: PHP Commercial |
$1,190.00
|
| Rate for Payer: Priority Health SBD |
$882.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.00
|
| Rate for Payer: UHC Core |
$729.40
|
| Rate for Payer: UHC Exchange |
$550.20
|
| Rate for Payer: UMR Bronson Commercial |
$518.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.00
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$80.29
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$72.26 |
| Rate for Payer: Aetna American Axle |
$52.19
|
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna American Axle |
$38.82
|
| Rate for Payer: Aetna American Axle |
$396.54
|
| Rate for Payer: Aetna American Axle |
$125.46
|
| Rate for Payer: Aetna American Axle |
$1,277.30
|
| Rate for Payer: Aetna American Axle |
$57.79
|
| Rate for Payer: Aetna Commercial |
$227.71
|
| Rate for Payer: Aetna Commercial |
$164.06
|
| Rate for Payer: Aetna Commercial |
$518.55
|
| Rate for Payer: Aetna Commercial |
$50.76
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna Commercial |
$68.25
|
| Rate for Payer: Aetna Commercial |
$75.57
|
| Rate for Payer: Aetna Commercial |
$1,670.31
|
| Rate for Payer: Aetna Medicare |
$133.94
|
| Rate for Payer: Aetna Medicare |
$982.53
|
| Rate for Payer: Aetna Medicare |
$40.15
|
| Rate for Payer: Aetna Medicare |
$96.50
|
| Rate for Payer: Aetna Medicare |
$305.03
|
| Rate for Payer: Aetna Medicare |
$29.86
|
| Rate for Payer: Aetna Medicare |
$44.45
|
| Rate for Payer: Aetna Medicare |
$31.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,277.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.54
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: BCBS Complete |
$23.89
|
| Rate for Payer: BCBS Complete |
$77.20
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: BCBS Complete |
$786.03
|
| Rate for Payer: BCBS Complete |
$32.12
|
| Rate for Payer: BCBS Complete |
$244.02
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: Cash Price |
$1,572.06
|
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Cash Price |
$214.31
|
| Rate for Payer: Cash Price |
$214.31
|
| Rate for Payer: Cash Price |
$1,572.06
|
| Rate for Payer: Cash Price |
$47.78
|
| Rate for Payer: Cash Price |
$47.78
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cash Price |
$64.23
|
| Rate for Payer: Cash Price |
$64.23
|
| Rate for Payer: Cash Price |
$71.13
|
| Rate for Payer: Cash Price |
$71.13
|
| Rate for Payer: Cofinity Advantage |
$44.41
|
| Rate for Payer: Cofinity Advantage |
$62.24
|
| Rate for Payer: Cofinity Advantage |
$187.52
|
| Rate for Payer: Cofinity Advantage |
$427.04
|
| Rate for Payer: Cofinity Advantage |
$56.20
|
| Rate for Payer: Cofinity Advantage |
$41.80
|
| Rate for Payer: Cofinity Advantage |
$135.11
|
| Rate for Payer: Cofinity Advantage |
$1,375.55
|
| Rate for Payer: Cofinity Commercial |
$51.36
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Cofinity Commercial |
$76.46
|
| Rate for Payer: Cofinity Commercial |
$165.99
|
| Rate for Payer: Cofinity Commercial |
$1,689.96
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Commercial |
$69.05
|
| Rate for Payer: Cofinity Commercial |
$524.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,572.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.23
|
| Rate for Payer: Healthscope Commercial |
$173.71
|
| Rate for Payer: Healthscope Commercial |
$80.02
|
| Rate for Payer: Healthscope Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$72.26
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Healthscope Commercial |
$1,768.56
|
| Rate for Payer: Healthscope Commercial |
$549.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,375.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$488.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,572.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,670.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$457.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.92
|
| Rate for Payer: PHP Commercial |
$164.06
|
| Rate for Payer: PHP Commercial |
$50.76
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Commercial |
$227.71
|
| Rate for Payer: PHP Commercial |
$75.57
|
| Rate for Payer: PHP Commercial |
$68.25
|
| Rate for Payer: PHP Commercial |
$518.55
|
| Rate for Payer: PHP Commercial |
$1,670.31
|
| Rate for Payer: Priority Health SBD |
$1,237.99
|
| Rate for Payer: Priority Health SBD |
$56.01
|
| Rate for Payer: Priority Health SBD |
$121.60
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: Priority Health SBD |
$50.58
|
| Rate for Payer: Priority Health SBD |
$168.77
|
| Rate for Payer: Priority Health SBD |
$37.62
|
| Rate for Payer: Priority Health SBD |
$384.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Core |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UMR Bronson Commercial |
$29.71
|
| Rate for Payer: UMR Bronson Commercial |
$32.90
|
| Rate for Payer: UMR Bronson Commercial |
$225.72
|
| Rate for Payer: UMR Bronson Commercial |
$99.12
|
| Rate for Payer: UMR Bronson Commercial |
$23.48
|
| Rate for Payer: UMR Bronson Commercial |
$71.41
|
| Rate for Payer: UMR Bronson Commercial |
$727.08
|
| Rate for Payer: UMR Bronson Commercial |
$22.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.22
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$59.72
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Aetna American Axle |
$38.82
|
| Rate for Payer: Aetna American Axle |
$41.24
|
| Rate for Payer: Aetna American Axle |
$52.19
|
| Rate for Payer: Aetna American Axle |
$125.46
|
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna American Axle |
$1,277.30
|
| Rate for Payer: Aetna American Axle |
$57.79
|
| Rate for Payer: Aetna American Axle |
$396.54
|
| Rate for Payer: Aetna Commercial |
$75.57
|
| Rate for Payer: Aetna Commercial |
$68.25
|
| Rate for Payer: Aetna Commercial |
$50.76
|
| Rate for Payer: Aetna Commercial |
$164.06
|
| Rate for Payer: Aetna Commercial |
$1,670.31
|
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: Aetna Commercial |
$227.71
|
| Rate for Payer: Aetna Commercial |
$518.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,277.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.24
|
| Rate for Payer: Cash Price |
$1,572.06
|
| Rate for Payer: Cash Price |
$71.13
|
| Rate for Payer: Cash Price |
$47.78
|
| Rate for Payer: Cash Price |
$154.41
|
| Rate for Payer: Cash Price |
$214.31
|
| Rate for Payer: Cash Price |
$488.05
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cash Price |
$64.23
|
| Rate for Payer: Cofinity Advantage |
$62.24
|
| Rate for Payer: Cofinity Advantage |
$1,375.55
|
| Rate for Payer: Cofinity Advantage |
$41.80
|
| Rate for Payer: Cofinity Advantage |
$187.52
|
| Rate for Payer: Cofinity Advantage |
$135.11
|
| Rate for Payer: Cofinity Advantage |
$44.41
|
| Rate for Payer: Cofinity Advantage |
$56.20
|
| Rate for Payer: Cofinity Advantage |
$427.04
|
| Rate for Payer: Cofinity Commercial |
$1,689.96
|
| Rate for Payer: Cofinity Commercial |
$165.99
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Commercial |
$51.36
|
| Rate for Payer: Cofinity Commercial |
$76.46
|
| Rate for Payer: Cofinity Commercial |
$524.65
|
| Rate for Payer: Cofinity Commercial |
$69.05
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,572.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.41
|
| Rate for Payer: Healthscope Commercial |
$549.05
|
| Rate for Payer: Healthscope Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$173.71
|
| Rate for Payer: Healthscope Commercial |
$80.02
|
| Rate for Payer: Healthscope Commercial |
$72.26
|
| Rate for Payer: Healthscope Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$1,768.56
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,375.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$457.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,670.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$457.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.68
|
| Rate for Payer: PHP Commercial |
$50.76
|
| Rate for Payer: PHP Commercial |
$518.55
|
| Rate for Payer: PHP Commercial |
$75.57
|
| Rate for Payer: PHP Commercial |
$227.71
|
| Rate for Payer: PHP Commercial |
$1,670.31
|
| Rate for Payer: PHP Commercial |
$164.06
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: PHP Commercial |
$68.25
|
| Rate for Payer: Priority Health SBD |
$39.97
|
| Rate for Payer: Priority Health SBD |
$50.58
|
| Rate for Payer: Priority Health SBD |
$56.01
|
| Rate for Payer: Priority Health SBD |
$1,237.99
|
| Rate for Payer: Priority Health SBD |
$121.60
|
| Rate for Payer: Priority Health SBD |
$168.77
|
| Rate for Payer: Priority Health SBD |
$37.62
|
| Rate for Payer: Priority Health SBD |
$384.34
|
| Rate for Payer: UMR Bronson Commercial |
$84.92
|
| Rate for Payer: UMR Bronson Commercial |
$268.43
|
| Rate for Payer: UMR Bronson Commercial |
$117.87
|
| Rate for Payer: UMR Bronson Commercial |
$39.12
|
| Rate for Payer: UMR Bronson Commercial |
$35.33
|
| Rate for Payer: UMR Bronson Commercial |
$26.28
|
| Rate for Payer: UMR Bronson Commercial |
$864.63
|
| Rate for Payer: UMR Bronson Commercial |
$27.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$457.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.22
|
|
|
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; 15 OR MORE LESIONS
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 17111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$373.07
|
| Rate for Payer: BCN Commercial |
$373.07
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 17110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$126.14
|
| Rate for Payer: BCN Commercial |
$126.14
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
