|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$42.30
|
|
|
Service Code
|
NDC 58980-410-12
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna American Axle |
$27.50
|
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.50
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Commercial |
$29.61
|
| Rate for Payer: Cofinity Commercial |
$36.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.96
|
| Rate for Payer: PHP Commercial |
$35.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.61
|
| Rate for Payer: Priority Health SBD |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.72
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
NDC 132007924
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna American Axle |
$36.66
|
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.66
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.94
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.48
|
| Rate for Payer: Priority Health SBD |
$35.53
|
| Rate for Payer: UMR Bronson Commercial |
$24.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
GLYCERIN (ADULT) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$33.28
|
|
|
Service Code
|
NDC 0132-0079-12
|
| Hospital Charge Code |
15053
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$29.95 |
| Rate for Payer: Aetna American Axle |
$21.63
|
| Rate for Payer: Aetna Commercial |
$28.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.63
|
| Rate for Payer: Cash Price |
$26.62
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$28.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.62
|
| Rate for Payer: Healthscope Commercial |
$29.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.29
|
| Rate for Payer: PHP Commercial |
$28.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.30
|
| Rate for Payer: Priority Health SBD |
$20.97
|
| Rate for Payer: UMR Bronson Commercial |
$14.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.96
|
|
|
GLYCERIN (BULK) 100 % LIQUID
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 5155200944
|
| Hospital Charge Code |
28815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.82
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.82
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.92
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.35
|
| Rate for Payer: Priority Health SBD |
$44.42
|
| Rate for Payer: UMR Bronson Commercial |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
GLYCERIN (BULK) 100 % LIQUID
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
NDC 9900-0019-67
|
| Hospital Charge Code |
28815
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna American Axle |
$143.00
|
| Rate for Payer: Aetna Commercial |
$187.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$154.00
|
| Rate for Payer: Cofinity Commercial |
$189.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$198.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.00
|
| Rate for Payer: PHP Commercial |
$187.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health SBD |
$138.60
|
| Rate for Payer: UMR Bronson Commercial |
$96.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.00
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$37.51
|
|
|
Service Code
|
NDC 0132-0081-12
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$33.76 |
| Rate for Payer: Aetna American Axle |
$24.38
|
| Rate for Payer: Aetna Commercial |
$31.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.38
|
| Rate for Payer: Cash Price |
$30.01
|
| Rate for Payer: Cofinity Commercial |
$26.26
|
| Rate for Payer: Cofinity Commercial |
$32.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.01
|
| Rate for Payer: Healthscope Commercial |
$33.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.88
|
| Rate for Payer: PHP Commercial |
$31.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.26
|
| Rate for Payer: Priority Health SBD |
$23.63
|
| Rate for Payer: UMR Bronson Commercial |
$16.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.13
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 70000-0429-1
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$35.96 |
| Rate for Payer: Aetna American Axle |
$25.97
|
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.96
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: UMR Bronson Commercial |
$17.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.96
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 9900-0010-43
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.09
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
GLYCERIN (CHILD) RECTAL SUPPOSITORY
|
Facility
|
IP
|
$76.48
|
|
|
Service Code
|
NDC 58980-409-25
|
| Hospital Charge Code |
3492
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$68.83 |
| Rate for Payer: Aetna American Axle |
$49.71
|
| Rate for Payer: Aetna Commercial |
$65.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.71
|
| Rate for Payer: Cash Price |
$61.18
|
| Rate for Payer: Cofinity Commercial |
$53.54
|
| Rate for Payer: Cofinity Commercial |
$65.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.18
|
| Rate for Payer: Healthscope Commercial |
$68.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.01
|
| Rate for Payer: PHP Commercial |
$65.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.54
|
| Rate for Payer: Priority Health SBD |
$48.18
|
| Rate for Payer: UMR Bronson Commercial |
$33.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.36
|
|
|
GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS
|
Facility
|
IP
|
$12.78
|
|
|
Service Code
|
NDC 50289-8250-5
|
| Hospital Charge Code |
116088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$11.50 |
| Rate for Payer: Aetna American Axle |
$8.31
|
| Rate for Payer: Aetna Commercial |
$10.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.31
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Cofinity Commercial |
$10.99
|
| Rate for Payer: Cofinity Commercial |
$8.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.22
|
| Rate for Payer: Healthscope Commercial |
$11.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.86
|
| Rate for Payer: PHP Commercial |
$10.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.95
|
| Rate for Payer: Priority Health SBD |
$8.05
|
| Rate for Payer: UMR Bronson Commercial |
$5.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.58
|
|
|
GLYCERIN-WITCH HAZEL 12.5 %-50 % TOPICAL PADS
|
Facility
|
IP
|
$11.34
|
|
|
Service Code
|
NDC 50289-3250-1
|
| Hospital Charge Code |
116088
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Aetna American Axle |
$7.37
|
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.37
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Cofinity Commercial |
$7.94
|
| Rate for Payer: Cofinity Commercial |
$9.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.07
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.64
|
| Rate for Payer: PHP Commercial |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.94
|
| Rate for Payer: Priority Health SBD |
$7.14
|
| Rate for Payer: UMR Bronson Commercial |
$4.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.50
|
|
|
GLYCOPYRROLATE 0.2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.25
|
|
|
Service Code
|
HCPCS J1596
|
| Hospital Charge Code |
3497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna American Axle |
$11.21
|
| Rate for Payer: Aetna American Axle |
$89.09
|
| Rate for Payer: Aetna American Axle |
$15.03
|
| Rate for Payer: Aetna American Axle |
$31.99
|
| Rate for Payer: Aetna American Axle |
$15.30
|
| Rate for Payer: Aetna American Axle |
$14.53
|
| Rate for Payer: Aetna American Axle |
$14.10
|
| Rate for Payer: Aetna American Axle |
$31.82
|
| Rate for Payer: Aetna American Axle |
$108.24
|
| Rate for Payer: Aetna American Axle |
$12.97
|
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna American Axle |
$11.85
|
| Rate for Payer: Aetna Commercial |
$18.44
|
| Rate for Payer: Aetna Commercial |
$41.61
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Commercial |
$116.50
|
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Commercial |
$141.54
|
| Rate for Payer: Aetna Commercial |
$41.84
|
| Rate for Payer: Aetna Commercial |
$20.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Cash Price |
$133.22
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cash Price |
$39.16
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cash Price |
$109.65
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cash Price |
$17.36
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$143.21
|
| Rate for Payer: Cofinity Commercial |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Cofinity Commercial |
$116.56
|
| Rate for Payer: Cofinity Commercial |
$42.33
|
| Rate for Payer: Cofinity Commercial |
$12.08
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$34.45
|
| Rate for Payer: Cofinity Commercial |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$18.66
|
| Rate for Payer: Cofinity Commercial |
$15.64
|
| Rate for Payer: Cofinity Commercial |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$95.94
|
| Rate for Payer: Cofinity Commercial |
$117.87
|
| Rate for Payer: Cofinity Commercial |
$16.18
|
| Rate for Payer: Cofinity Commercial |
$19.88
|
| Rate for Payer: Cofinity Commercial |
$42.10
|
| Rate for Payer: Cofinity Commercial |
$34.26
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.65
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Healthscope Commercial |
$123.35
|
| Rate for Payer: Healthscope Commercial |
$20.12
|
| Rate for Payer: Healthscope Commercial |
$19.53
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$44.30
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Healthscope Commercial |
$21.19
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$149.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.40
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$14.66
|
| Rate for Payer: PHP Commercial |
$116.50
|
| Rate for Payer: PHP Commercial |
$19.65
|
| Rate for Payer: PHP Commercial |
$41.61
|
| Rate for Payer: PHP Commercial |
$18.44
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: PHP Commercial |
$41.84
|
| Rate for Payer: PHP Commercial |
$20.01
|
| Rate for Payer: PHP Commercial |
$141.54
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.26
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$86.35
|
| Rate for Payer: Priority Health SBD |
$104.91
|
| Rate for Payer: Priority Health SBD |
$10.87
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: Priority Health SBD |
$13.67
|
| Rate for Payer: Priority Health SBD |
$14.08
|
| Rate for Payer: Priority Health SBD |
$14.57
|
| Rate for Payer: Priority Health SBD |
$14.83
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Priority Health SBD |
$31.01
|
| Rate for Payer: UMR Bronson Commercial |
$8.78
|
| Rate for Payer: UMR Bronson Commercial |
$21.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.02
|
| Rate for Payer: UMR Bronson Commercial |
$10.17
|
| Rate for Payer: UMR Bronson Commercial |
$7.59
|
| Rate for Payer: UMR Bronson Commercial |
$21.66
|
| Rate for Payer: UMR Bronson Commercial |
$73.27
|
| Rate for Payer: UMR Bronson Commercial |
$9.83
|
| Rate for Payer: UMR Bronson Commercial |
$60.31
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.55
|
| Rate for Payer: UMR Bronson Commercial |
$12.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
GLYCOPYRROLATE 1 MG/5 ML (0.2 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$1,214.67
|
|
|
Service Code
|
NDC 51672-5316-9
|
| Hospital Charge Code |
107829
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$534.45 |
| Max. Negotiated Rate |
$1,093.20 |
| Rate for Payer: Aetna American Axle |
$789.54
|
| Rate for Payer: Aetna Commercial |
$1,032.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.54
|
| Rate for Payer: Cash Price |
$971.74
|
| Rate for Payer: Cofinity Commercial |
$1,044.62
|
| Rate for Payer: Cofinity Commercial |
$850.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.74
|
| Rate for Payer: Healthscope Commercial |
$1,093.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$850.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$911.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,032.47
|
| Rate for Payer: PHP Commercial |
$1,032.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.27
|
| Rate for Payer: Priority Health SBD |
$765.24
|
| Rate for Payer: UMR Bronson Commercial |
$534.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$911.00
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$407.04
|
|
|
Service Code
|
NDC 55111-648-01
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.10 |
| Max. Negotiated Rate |
$366.34 |
| Rate for Payer: Aetna American Axle |
$264.58
|
| Rate for Payer: Aetna Commercial |
$345.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.58
|
| Rate for Payer: Cash Price |
$325.63
|
| Rate for Payer: Cofinity Commercial |
$284.93
|
| Rate for Payer: Cofinity Commercial |
$350.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.63
|
| Rate for Payer: Healthscope Commercial |
$366.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.98
|
| Rate for Payer: PHP Commercial |
$345.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.93
|
| Rate for Payer: Priority Health SBD |
$256.44
|
| Rate for Payer: UMR Bronson Commercial |
$179.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.28
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$385.70
|
|
|
Service Code
|
NDC 69076-475-01
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.71 |
| Max. Negotiated Rate |
$347.13 |
| Rate for Payer: Aetna American Axle |
$250.70
|
| Rate for Payer: Aetna Commercial |
$327.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.70
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Cofinity Commercial |
$269.99
|
| Rate for Payer: Cofinity Commercial |
$331.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.56
|
| Rate for Payer: Healthscope Commercial |
$347.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$327.84
|
| Rate for Payer: PHP Commercial |
$327.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.99
|
| Rate for Payer: Priority Health SBD |
$242.99
|
| Rate for Payer: UMR Bronson Commercial |
$169.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.28
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 49884-065-01
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.45 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna American Axle |
$248.85
|
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.42
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.00
|
| Rate for Payer: Priority Health SBD |
$241.20
|
| Rate for Payer: UMR Bronson Commercial |
$168.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 23155-606-01
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.86
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.74
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.08
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UMR Bronson Commercial |
$107.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,234.37
|
|
|
Service Code
|
HCPCS J1602
|
| Hospital Charge Code |
167346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$5,610.93 |
| Rate for Payer: Aetna American Axle |
$4,052.34
|
| Rate for Payer: Aetna Commercial |
$5,299.21
|
| Rate for Payer: Aetna Medicare |
$12.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,052.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.43
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.34
|
| Rate for Payer: BCBS Trust/PPO |
$39.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.34
|
| Rate for Payer: Cash Price |
$4,987.50
|
| Rate for Payer: Cash Price |
$4,987.50
|
| Rate for Payer: Cofinity Commercial |
$5,361.56
|
| Rate for Payer: Cofinity Commercial |
$4,364.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,987.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.34
|
| Rate for Payer: Healthscope Commercial |
$5,610.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,364.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,675.78
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.34
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,299.21
|
| Rate for Payer: PACE Medicare |
$11.72
|
| Rate for Payer: PACE SWMI |
$12.34
|
| Rate for Payer: PHP Commercial |
$5,299.21
|
| Rate for Payer: PHP Medicare Advantage |
$12.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,364.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.98
|
| Rate for Payer: Priority Health Medicare |
$12.34
|
| Rate for Payer: Priority Health Narrow Network |
$30.38
|
| Rate for Payer: Priority Health SBD |
$3,927.65
|
| Rate for Payer: Railroad Medicare Medicare |
$12.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.34
|
| Rate for Payer: UHC Medicare Advantage |
$12.71
|
| Rate for Payer: UMR Bronson Commercial |
$2,306.72
|
| Rate for Payer: VA VA |
$12.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,675.78
|
|
|
GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,234.37
|
|
|
Service Code
|
HCPCS J1602
|
| Hospital Charge Code |
167346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,743.12 |
| Max. Negotiated Rate |
$5,610.93 |
| Rate for Payer: Aetna American Axle |
$4,052.34
|
| Rate for Payer: Aetna Commercial |
$5,299.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,052.34
|
| Rate for Payer: Cash Price |
$4,987.50
|
| Rate for Payer: Cofinity Commercial |
$4,364.06
|
| Rate for Payer: Cofinity Commercial |
$5,361.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,987.50
|
| Rate for Payer: Healthscope Commercial |
$5,610.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,364.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,675.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,299.21
|
| Rate for Payer: PHP Commercial |
$5,299.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,364.06
|
| Rate for Payer: Priority Health SBD |
$3,927.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,743.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,675.78
|
|
|
GONIOTOMY
|
Facility
|
OP
|
$11,377.15
|
|
|
Service Code
|
CPT 65820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$803.54 |
| Max. Negotiated Rate |
$11,377.15 |
| Rate for Payer: Aetna Medicare |
$3,758.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,517.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,517.55
|
| Rate for Payer: BCBS Complete |
$2,075.90
|
| Rate for Payer: BCBS MAPPO |
$3,614.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,218.75
|
| Rate for Payer: BCN Medicare Advantage |
$3,614.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,614.04
|
| Rate for Payer: Mclaren Medicaid |
$1,976.88
|
| Rate for Payer: Mclaren Medicare |
$3,614.04
|
| Rate for Payer: Meridian Medicaid |
$2,075.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,794.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,156.15
|
| Rate for Payer: PACE Medicare |
$3,433.34
|
| Rate for Payer: PACE SWMI |
$3,614.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,614.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,976.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,377.15
|
| Rate for Payer: Priority Health Medicare |
$3,614.04
|
| Rate for Payer: Priority Health Narrow Network |
$9,101.72
|
| Rate for Payer: Railroad Medicare Medicare |
$3,614.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$883.89
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,614.04
|
| Rate for Payer: UHC Exchange |
$803.54
|
| Rate for Payer: UHC Medicare Advantage |
$3,722.46
|
| Rate for Payer: VA VA |
$3,614.04
|
|
|
GOSERELIN 10.8 MG SUBCUTANEOUS IMPLANT
|
Facility
|
OP
|
$9,818.32
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
16254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$333.13 |
| Max. Negotiated Rate |
$8,836.49 |
| Rate for Payer: Aetna American Axle |
$6,381.91
|
| Rate for Payer: Aetna Commercial |
$8,345.57
|
| Rate for Payer: Aetna Medicare |
$633.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,381.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$761.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$761.26
|
| Rate for Payer: BCBS Complete |
$349.81
|
| Rate for Payer: BCBS MAPPO |
$609.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,968.01
|
| Rate for Payer: BCN Medicare Advantage |
$609.01
|
| Rate for Payer: Cash Price |
$7,854.66
|
| Rate for Payer: Cash Price |
$7,854.66
|
| Rate for Payer: Cofinity Commercial |
$6,872.82
|
| Rate for Payer: Cofinity Commercial |
$8,443.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,854.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$609.01
|
| Rate for Payer: Healthscope Commercial |
$8,836.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,872.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,363.74
|
| Rate for Payer: Mclaren Medicaid |
$333.13
|
| Rate for Payer: Mclaren Medicare |
$609.01
|
| Rate for Payer: Meridian Medicaid |
$349.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$639.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$700.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,345.57
|
| Rate for Payer: PACE Medicare |
$578.56
|
| Rate for Payer: PACE SWMI |
$609.01
|
| Rate for Payer: PHP Commercial |
$8,345.57
|
| Rate for Payer: PHP Medicare Advantage |
$609.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,872.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,795.43
|
| Rate for Payer: Priority Health Medicare |
$609.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,436.34
|
| Rate for Payer: Priority Health SBD |
$6,185.54
|
| Rate for Payer: Railroad Medicare Medicare |
$609.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$609.01
|
| Rate for Payer: UHC Medicare Advantage |
$627.28
|
| Rate for Payer: UMR Bronson Commercial |
$3,632.78
|
| Rate for Payer: VA VA |
$609.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,363.74
|
|
|
GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT
|
Facility
|
OP
|
$3,028.61
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
10137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$333.13 |
| Max. Negotiated Rate |
$2,725.75 |
| Rate for Payer: Aetna American Axle |
$1,968.60
|
| Rate for Payer: Aetna Commercial |
$2,574.32
|
| Rate for Payer: Aetna Medicare |
$633.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,968.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$761.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$761.26
|
| Rate for Payer: BCBS Complete |
$349.81
|
| Rate for Payer: BCBS MAPPO |
$609.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,968.01
|
| Rate for Payer: BCN Medicare Advantage |
$609.01
|
| Rate for Payer: Cash Price |
$2,422.89
|
| Rate for Payer: Cash Price |
$2,422.89
|
| Rate for Payer: Cofinity Commercial |
$2,120.03
|
| Rate for Payer: Cofinity Commercial |
$2,604.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,422.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$609.01
|
| Rate for Payer: Healthscope Commercial |
$2,725.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,120.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,271.46
|
| Rate for Payer: Mclaren Medicaid |
$333.13
|
| Rate for Payer: Mclaren Medicare |
$609.01
|
| Rate for Payer: Meridian Medicaid |
$349.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$639.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$700.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,574.32
|
| Rate for Payer: PACE Medicare |
$578.56
|
| Rate for Payer: PACE SWMI |
$609.01
|
| Rate for Payer: PHP Commercial |
$2,574.32
|
| Rate for Payer: PHP Medicare Advantage |
$609.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,120.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,795.43
|
| Rate for Payer: Priority Health Medicare |
$609.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,436.34
|
| Rate for Payer: Priority Health SBD |
$1,908.02
|
| Rate for Payer: Railroad Medicare Medicare |
$609.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$609.01
|
| Rate for Payer: UHC Medicare Advantage |
$627.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,120.59
|
| Rate for Payer: VA VA |
$609.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,271.46
|
|
|
GRAFT, BONE; MANDIBLE (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 21215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$773.75 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,713.14
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$851.12
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$773.75
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
GRAFT, BONE; NASAL, MAXILLARY OR MALAR AREAS (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 21210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$744.60 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,713.14
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$819.06
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$744.60
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 21235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.51 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$5,208.62
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.96
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$564.51
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
