|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,343.92 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Advantage |
$10,092.60
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: UMR Bronson Commercial |
$6,343.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
9003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$304.26
|
| Rate for Payer: BCN Commercial |
$304.26
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Advantage |
$10,092.60
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: UMR Bronson Commercial |
$5,334.66
|
| Rate for Payer: VA VA |
$95.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE 50 MG IV INFUSION FOR STROKE
|
Facility
|
OP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
301291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$304.26
|
| Rate for Payer: BCN Commercial |
$304.26
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Advantage |
$10,092.60
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: UMR Bronson Commercial |
$5,334.66
|
| Rate for Payer: VA VA |
$95.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE 50 MG IV INFUSION FOR STROKE
|
Facility
|
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
301291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,343.92 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Advantage |
$10,092.60
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: UMR Bronson Commercial |
$6,343.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
IP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,343.92 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Advantage |
$10,092.60
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: UMR Bronson Commercial |
$6,343.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTEPLASE INFUSION FOR CARDIAC ARREST
|
Facility
|
OP
|
$14,418.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
300766
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$12,976.20 |
| Rate for Payer: Aetna American Axle |
$9,371.70
|
| Rate for Payer: Aetna Commercial |
$12,255.30
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,371.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.86
|
| Rate for Payer: BCBS Complete |
$52.22
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$304.26
|
| Rate for Payer: BCN Commercial |
$304.26
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cash Price |
$11,534.40
|
| Rate for Payer: Cofinity Advantage |
$10,092.60
|
| Rate for Payer: Cofinity Commercial |
$12,399.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,534.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$12,976.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,092.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,813.50
|
| Rate for Payer: Mclaren Medicaid |
$95.09
|
| Rate for Payer: Mclaren Medicare |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Meridian Medicaid |
$99.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,255.30
|
| Rate for Payer: Nomi Health Commercial |
$285.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,813.50
|
| Rate for Payer: PACE Medicare |
$90.34
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$12,255.30
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$297.89
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Priority Health SBD |
$9,083.34
|
| Rate for Payer: Priority Health Tiered Network |
$238.31
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.82
|
| Rate for Payer: UHC Core |
$154.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$154.82
|
| Rate for Payer: UHC Medicaid |
$49.73
|
| Rate for Payer: UHCCP Medicaid |
$49.73
|
| Rate for Payer: UMR Bronson Commercial |
$5,334.66
|
| Rate for Payer: VA VA |
$95.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,813.50
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$12,855.89
|
|
|
Service Code
|
APR-DRG 0524
|
| Min. Negotiated Rate |
$12,243.71 |
| Max. Negotiated Rate |
$12,855.89 |
| Rate for Payer: BCBS Complete |
$12,855.89
|
| Rate for Payer: Mclaren Medicaid |
$12,243.71
|
| Rate for Payer: Meridian Medicaid |
$12,855.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,243.71
|
| Rate for Payer: UHC Medicaid |
$12,243.71
|
| Rate for Payer: UHCCP Medicaid |
$12,243.71
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$4,169.48
|
|
|
Service Code
|
APR-DRG 0521
|
| Min. Negotiated Rate |
$3,970.93 |
| Max. Negotiated Rate |
$4,169.48 |
| Rate for Payer: BCBS Complete |
$4,169.48
|
| Rate for Payer: Mclaren Medicaid |
$3,970.93
|
| Rate for Payer: Meridian Medicaid |
$4,169.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,970.93
|
| Rate for Payer: UHC Medicaid |
$3,970.93
|
| Rate for Payer: UHCCP Medicaid |
$3,970.93
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$5,638.00
|
|
|
Service Code
|
APR-DRG 0522
|
| Min. Negotiated Rate |
$5,369.52 |
| Max. Negotiated Rate |
$5,638.00 |
| Rate for Payer: BCBS Complete |
$5,638.00
|
| Rate for Payer: Mclaren Medicaid |
$5,369.52
|
| Rate for Payer: Meridian Medicaid |
$5,638.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,369.52
|
| Rate for Payer: UHC Medicaid |
$5,369.52
|
| Rate for Payer: UHCCP Medicaid |
$5,369.52
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$7,746.34
|
|
|
Service Code
|
APR-DRG 0523
|
| Min. Negotiated Rate |
$7,377.47 |
| Max. Negotiated Rate |
$7,746.34 |
| Rate for Payer: BCBS Complete |
$7,746.34
|
| Rate for Payer: Mclaren Medicaid |
$7,377.47
|
| Rate for Payer: Meridian Medicaid |
$7,746.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,377.47
|
| Rate for Payer: UHC Medicaid |
$7,377.47
|
| Rate for Payer: UHCCP Medicaid |
$7,377.47
|
|
|
ALUM, AMMONIUM (BULK) POWDER
|
Facility
|
IP
|
$143.82
|
|
|
Service Code
|
NDC 00395004996
|
| Hospital Charge Code |
345
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna American Axle |
$93.48
|
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Advantage |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.86
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health SBD |
$90.61
|
| Rate for Payer: UMR Bronson Commercial |
$63.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
|
ALUM, AMMONIUM (BULK) POWDER
|
Facility
|
OP
|
$143.82
|
|
|
Service Code
|
NDC 00395004996
|
| Hospital Charge Code |
345
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.21 |
| Max. Negotiated Rate |
$129.44 |
| Rate for Payer: Aetna American Axle |
$93.48
|
| Rate for Payer: Aetna Commercial |
$122.25
|
| Rate for Payer: Aetna Medicare |
$71.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: BCBS Complete |
$57.53
|
| Rate for Payer: Cash Price |
$115.06
|
| Rate for Payer: Cofinity Advantage |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.06
|
| Rate for Payer: Healthscope Commercial |
$129.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.86
|
| Rate for Payer: PHP Commercial |
$122.25
|
| Rate for Payer: Priority Health SBD |
$90.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.48
|
| Rate for Payer: UHC Core |
$74.93
|
| Rate for Payer: UHC Exchange |
$56.52
|
| Rate for Payer: UMR Bronson Commercial |
$53.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.86
|
|
|
ALUM, AMMONIUM (BULK) POWDER
|
Facility
|
OP
|
$455.43
|
|
|
Service Code
|
NDC 00395004912
|
| Hospital Charge Code |
345
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.51 |
| Max. Negotiated Rate |
$409.89 |
| Rate for Payer: Aetna American Axle |
$296.03
|
| Rate for Payer: Aetna Commercial |
$387.12
|
| Rate for Payer: Aetna Medicare |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.03
|
| Rate for Payer: BCBS Complete |
$182.17
|
| Rate for Payer: Cash Price |
$364.34
|
| Rate for Payer: Cofinity Advantage |
$318.80
|
| Rate for Payer: Cofinity Commercial |
$391.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.34
|
| Rate for Payer: Healthscope Commercial |
$409.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$364.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$341.57
|
| Rate for Payer: PHP Commercial |
$387.12
|
| Rate for Payer: Priority Health SBD |
$286.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.03
|
| Rate for Payer: UHC Core |
$237.28
|
| Rate for Payer: UHC Exchange |
$178.98
|
| Rate for Payer: UMR Bronson Commercial |
$168.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.57
|
|
|
ALUM, AMMONIUM (BULK) POWDER
|
Facility
|
IP
|
$455.43
|
|
|
Service Code
|
NDC 00395004912
|
| Hospital Charge Code |
345
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.39 |
| Max. Negotiated Rate |
$409.89 |
| Rate for Payer: Aetna American Axle |
$296.03
|
| Rate for Payer: Aetna Commercial |
$387.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.03
|
| Rate for Payer: Cash Price |
$364.34
|
| Rate for Payer: Cofinity Advantage |
$318.80
|
| Rate for Payer: Cofinity Commercial |
$391.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.34
|
| Rate for Payer: Healthscope Commercial |
$409.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$341.57
|
| Rate for Payer: PHP Commercial |
$387.12
|
| Rate for Payer: Priority Health SBD |
$286.92
|
| Rate for Payer: UMR Bronson Commercial |
$200.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.57
|
|
|
ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$122.79
|
|
|
Service Code
|
NDC 00536009185
|
| Hospital Charge Code |
353
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna American Axle |
$79.81
|
| Rate for Payer: Aetna Commercial |
$104.37
|
| Rate for Payer: Aetna Medicare |
$61.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.81
|
| Rate for Payer: BCBS Complete |
$49.12
|
| Rate for Payer: Cash Price |
$98.23
|
| Rate for Payer: Cofinity Advantage |
$85.95
|
| Rate for Payer: Cofinity Commercial |
$105.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.23
|
| Rate for Payer: Healthscope Commercial |
$110.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.09
|
| Rate for Payer: PHP Commercial |
$104.37
|
| Rate for Payer: Priority Health SBD |
$77.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.81
|
| Rate for Payer: UHC Core |
$63.97
|
| Rate for Payer: UHC Exchange |
$48.26
|
| Rate for Payer: UMR Bronson Commercial |
$45.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.09
|
|
|
ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$122.79
|
|
|
Service Code
|
NDC 00536009185
|
| Hospital Charge Code |
353
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$110.51 |
| Rate for Payer: Aetna American Axle |
$79.81
|
| Rate for Payer: Aetna Commercial |
$104.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.81
|
| Rate for Payer: Cash Price |
$98.23
|
| Rate for Payer: Cofinity Advantage |
$85.95
|
| Rate for Payer: Cofinity Commercial |
$105.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.23
|
| Rate for Payer: Healthscope Commercial |
$110.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.09
|
| Rate for Payer: PHP Commercial |
$104.37
|
| Rate for Payer: Priority Health SBD |
$77.36
|
| Rate for Payer: UMR Bronson Commercial |
$54.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.09
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$18.50
|
|
|
Service Code
|
NDC 00121176130
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.03
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna Medicare |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.03
|
| Rate for Payer: UHC Core |
$9.64
|
| Rate for Payer: UHC Exchange |
$7.27
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$15.98
|
|
|
Service Code
|
NDC 57896062912
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Aetna American Axle |
$10.39
|
| Rate for Payer: Aetna Commercial |
$13.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.39
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cofinity Advantage |
$11.19
|
| Rate for Payer: Cofinity Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.78
|
| Rate for Payer: Healthscope Commercial |
$14.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.58
|
| Rate for Payer: Priority Health SBD |
$10.07
|
| Rate for Payer: UMR Bronson Commercial |
$7.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.98
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$15.21
|
|
|
Service Code
|
NDC 09900000191
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna American Axle |
$9.89
|
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.89
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Advantage |
$10.65
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.41
|
| Rate for Payer: PHP Commercial |
$12.93
|
| Rate for Payer: Priority Health SBD |
$9.58
|
| Rate for Payer: UMR Bronson Commercial |
$6.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.41
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$18.50
|
|
|
Service Code
|
NDC 00121176130
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$16.65 |
| Rate for Payer: Aetna American Axle |
$12.03
|
| Rate for Payer: Aetna Commercial |
$15.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.03
|
| Rate for Payer: Cash Price |
$14.80
|
| Rate for Payer: Cofinity Advantage |
$12.95
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.80
|
| Rate for Payer: Healthscope Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.88
|
| Rate for Payer: PHP Commercial |
$15.72
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.88
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$15.21
|
|
|
Service Code
|
NDC 09900000191
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna American Axle |
$9.89
|
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna Medicare |
$7.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.89
|
| Rate for Payer: BCBS Complete |
$6.08
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Advantage |
$10.65
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.41
|
| Rate for Payer: PHP Commercial |
$12.93
|
| Rate for Payer: Priority Health SBD |
$9.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.89
|
| Rate for Payer: UHC Core |
$7.92
|
| Rate for Payer: UHC Exchange |
$5.98
|
| Rate for Payer: UMR Bronson Commercial |
$5.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.41
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 200 MG-200 MG-20 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$15.98
|
|
|
Service Code
|
NDC 57896062912
|
| Hospital Charge Code |
38285
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$14.38 |
| Rate for Payer: Aetna American Axle |
$10.39
|
| Rate for Payer: Aetna Commercial |
$13.58
|
| Rate for Payer: Aetna Medicare |
$7.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.39
|
| Rate for Payer: BCBS Complete |
$6.39
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cofinity Advantage |
$11.19
|
| Rate for Payer: Cofinity Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.78
|
| Rate for Payer: Healthscope Commercial |
$14.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.98
|
| Rate for Payer: PHP Commercial |
$13.58
|
| Rate for Payer: Priority Health SBD |
$10.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.39
|
| Rate for Payer: UHC Core |
$8.33
|
| Rate for Payer: UHC Exchange |
$6.28
|
| Rate for Payer: UMR Bronson Commercial |
$5.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.98
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 00121176230
|
| Hospital Charge Code |
9015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.57
|
| Rate for Payer: UHC Core |
$47.75
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UMR Bronson Commercial |
$33.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
ALUMINUM-MAG HYDROXIDE-SIMETHICONE 400 MG-400 MG-40 MG/5 ML ORAL SUSP
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 00121176230
|
| Hospital Charge Code |
9015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
ALVEOLOPLASTY, EACH QUADRANT (SPECIFY)
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 41874
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$419.37 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$419.37
|
| Rate for Payer: BCN Commercial |
$419.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
