|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 00527058601
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.12
|
| Rate for Payer: UHC Core |
$227.73
|
| Rate for Payer: UHC Exchange |
$171.78
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$417.05
|
|
|
Service Code
|
NDC 00904698761
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna American Axle |
$271.08
|
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: Aetna Medicare |
$208.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.08
|
| Rate for Payer: BCBS Complete |
$166.82
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Advantage |
$291.94
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$375.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: Priority Health SBD |
$262.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.08
|
| Rate for Payer: UHC Core |
$217.28
|
| Rate for Payer: UHC Exchange |
$163.90
|
| Rate for Payer: UMR Bronson Commercial |
$154.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 60687036911
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$458.85
|
|
|
Service Code
|
NDC 60687036901
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.89 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna American Axle |
$298.25
|
| Rate for Payer: Aetna Commercial |
$390.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.25
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Advantage |
$321.19
|
| Rate for Payer: Cofinity Commercial |
$394.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Healthscope Commercial |
$412.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.14
|
| Rate for Payer: PHP Commercial |
$390.02
|
| Rate for Payer: Priority Health SBD |
$289.08
|
| Rate for Payer: UMR Bronson Commercial |
$201.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.14
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 51079011801
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna American Axle |
$2.48
|
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Advantage |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: UMR Bronson Commercial |
$1.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 00143312601
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 00591079401
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.12
|
| Rate for Payer: UHC Core |
$227.73
|
| Rate for Payer: UHC Exchange |
$171.78
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$458.85
|
|
|
Service Code
|
NDC 60687036901
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.77 |
| Max. Negotiated Rate |
$412.96 |
| Rate for Payer: Aetna American Axle |
$298.25
|
| Rate for Payer: Aetna Commercial |
$390.02
|
| Rate for Payer: Aetna Medicare |
$229.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.25
|
| Rate for Payer: BCBS Complete |
$183.54
|
| Rate for Payer: Cash Price |
$367.08
|
| Rate for Payer: Cofinity Advantage |
$321.19
|
| Rate for Payer: Cofinity Commercial |
$394.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.08
|
| Rate for Payer: Healthscope Commercial |
$412.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.14
|
| Rate for Payer: PHP Commercial |
$390.02
|
| Rate for Payer: Priority Health SBD |
$289.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.25
|
| Rate for Payer: UHC Core |
$239.06
|
| Rate for Payer: UHC Exchange |
$180.33
|
| Rate for Payer: UMR Bronson Commercial |
$169.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.14
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 51079011801
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna American Axle |
$2.48
|
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Advantage |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.48
|
| Rate for Payer: UHC Core |
$1.99
|
| Rate for Payer: UHC Exchange |
$1.50
|
| Rate for Payer: UMR Bronson Commercial |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 00591079401
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 00143312601
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.12
|
| Rate for Payer: UHC Core |
$227.73
|
| Rate for Payer: UHC Exchange |
$171.78
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 60687036911
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Advantage |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: UHC Exchange |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$417.05
|
|
|
Service Code
|
NDC 00904698761
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.50 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna American Axle |
$271.08
|
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.08
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Advantage |
$291.94
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$375.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.79
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: Priority Health SBD |
$262.74
|
| Rate for Payer: UMR Bronson Commercial |
$183.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 00378161001
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna American Axle |
$116.09
|
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Advantage |
$125.02
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.95
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health SBD |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$78.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
DICYCLOMINE 10 MG CAPSULE
|
Facility
|
IP
|
$381.90
|
|
|
Service Code
|
NDC 51079011820
|
| Hospital Charge Code |
2418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.04 |
| Max. Negotiated Rate |
$343.71 |
| Rate for Payer: Aetna American Axle |
$248.24
|
| Rate for Payer: Aetna Commercial |
$324.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.24
|
| Rate for Payer: Cash Price |
$305.52
|
| Rate for Payer: Cofinity Advantage |
$267.33
|
| Rate for Payer: Cofinity Commercial |
$328.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.52
|
| Rate for Payer: Healthscope Commercial |
$343.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.43
|
| Rate for Payer: PHP Commercial |
$324.62
|
| Rate for Payer: Priority Health SBD |
$240.60
|
| Rate for Payer: UMR Bronson Commercial |
$168.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.43
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$27.52
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna American Axle |
$22.87
|
| Rate for Payer: Aetna American Axle |
$180.39
|
| Rate for Payer: Aetna Commercial |
$235.89
|
| Rate for Payer: Aetna Commercial |
$23.39
|
| Rate for Payer: Aetna Commercial |
$29.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.39
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cofinity Advantage |
$24.63
|
| Rate for Payer: Cofinity Advantage |
$19.26
|
| Rate for Payer: Cofinity Advantage |
$194.26
|
| Rate for Payer: Cofinity Commercial |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$23.67
|
| Rate for Payer: Cofinity Commercial |
$238.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.15
|
| Rate for Payer: Healthscope Commercial |
$249.77
|
| Rate for Payer: Healthscope Commercial |
$31.67
|
| Rate for Payer: Healthscope Commercial |
$24.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.39
|
| Rate for Payer: PHP Commercial |
$235.89
|
| Rate for Payer: PHP Commercial |
$23.39
|
| Rate for Payer: PHP Commercial |
$29.91
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$174.84
|
| Rate for Payer: Priority Health SBD |
$22.17
|
| Rate for Payer: UMR Bronson Commercial |
$12.11
|
| Rate for Payer: UMR Bronson Commercial |
$15.48
|
| Rate for Payer: UMR Bronson Commercial |
$122.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.39
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$277.52
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2417
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$249.77 |
| Rate for Payer: Aetna American Axle |
$180.39
|
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna American Axle |
$22.87
|
| Rate for Payer: Aetna Commercial |
$235.89
|
| Rate for Payer: Aetna Commercial |
$29.91
|
| Rate for Payer: Aetna Commercial |
$23.39
|
| Rate for Payer: Aetna Medicare |
$138.76
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Aetna Medicare |
$17.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.87
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS Complete |
$111.01
|
| Rate for Payer: BCBS Complete |
$14.08
|
| Rate for Payer: BCBS Trust/PPO |
$36.73
|
| Rate for Payer: BCBS Trust/PPO |
$36.73
|
| Rate for Payer: BCBS Trust/PPO |
$36.73
|
| Rate for Payer: BCN Commercial |
$36.73
|
| Rate for Payer: BCN Commercial |
$36.73
|
| Rate for Payer: BCN Commercial |
$36.73
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cash Price |
$222.02
|
| Rate for Payer: Cofinity Advantage |
$24.63
|
| Rate for Payer: Cofinity Advantage |
$194.26
|
| Rate for Payer: Cofinity Advantage |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$23.67
|
| Rate for Payer: Cofinity Commercial |
$238.67
|
| Rate for Payer: Cofinity Commercial |
$30.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.02
|
| Rate for Payer: Healthscope Commercial |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$249.77
|
| Rate for Payer: Healthscope Commercial |
$31.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.39
|
| Rate for Payer: PHP Commercial |
$235.89
|
| Rate for Payer: PHP Commercial |
$23.39
|
| Rate for Payer: PHP Commercial |
$29.91
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$22.17
|
| Rate for Payer: Priority Health SBD |
$174.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.69
|
| Rate for Payer: UHC Core |
$18.69
|
| Rate for Payer: UHC Core |
$18.69
|
| Rate for Payer: UHC Core |
$18.69
|
| Rate for Payer: UHC Exchange |
$18.69
|
| Rate for Payer: UHC Exchange |
$18.69
|
| Rate for Payer: UHC Exchange |
$18.69
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: UMR Bronson Commercial |
$102.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.39
|
|
|
DICYCLOMINE 20 MG TABLET
|
Facility
|
OP
|
$245.10
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$220.59 |
| Rate for Payer: Aetna American Axle |
$159.31
|
| Rate for Payer: Aetna American Axle |
$279.11
|
| Rate for Payer: Aetna American Axle |
$2,566.20
|
| Rate for Payer: Aetna American Axle |
$253.79
|
| Rate for Payer: Aetna American Axle |
$2.79
|
| Rate for Payer: Aetna Commercial |
$208.34
|
| Rate for Payer: Aetna Commercial |
$331.88
|
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Commercial |
$364.99
|
| Rate for Payer: Aetna Commercial |
$3,355.80
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: Aetna Medicare |
$195.22
|
| Rate for Payer: Aetna Medicare |
$122.55
|
| Rate for Payer: Aetna Medicare |
$1,974.00
|
| Rate for Payer: Aetna Medicare |
$214.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,566.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: BCBS Complete |
$171.76
|
| Rate for Payer: BCBS Complete |
$98.04
|
| Rate for Payer: BCBS Complete |
$156.18
|
| Rate for Payer: BCBS Complete |
$1,579.20
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$36.73
|
| Rate for Payer: BCBS Trust/PPO |
$36.73
|
| Rate for Payer: BCBS Trust/PPO |
$36.73
|
| Rate for Payer: BCBS Trust/PPO |
$36.73
|
| Rate for Payer: BCBS Trust/PPO |
$36.73
|
| Rate for Payer: BCN Commercial |
$36.73
|
| Rate for Payer: BCN Commercial |
$36.73
|
| Rate for Payer: BCN Commercial |
$36.73
|
| Rate for Payer: BCN Commercial |
$36.73
|
| Rate for Payer: BCN Commercial |
$36.73
|
| Rate for Payer: Cash Price |
$343.52
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cash Price |
$312.36
|
| Rate for Payer: Cash Price |
$196.08
|
| Rate for Payer: Cash Price |
$3,158.40
|
| Rate for Payer: Cash Price |
$196.08
|
| Rate for Payer: Cash Price |
$3,158.40
|
| Rate for Payer: Cash Price |
$343.52
|
| Rate for Payer: Cash Price |
$312.36
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Advantage |
$300.58
|
| Rate for Payer: Cofinity Advantage |
$273.31
|
| Rate for Payer: Cofinity Advantage |
$2,763.60
|
| Rate for Payer: Cofinity Advantage |
$3.01
|
| Rate for Payer: Cofinity Advantage |
$171.57
|
| Rate for Payer: Cofinity Commercial |
$369.28
|
| Rate for Payer: Cofinity Commercial |
$210.79
|
| Rate for Payer: Cofinity Commercial |
$335.79
|
| Rate for Payer: Cofinity Commercial |
$3,395.28
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,158.40
|
| Rate for Payer: Healthscope Commercial |
$3,553.20
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Healthscope Commercial |
$386.46
|
| Rate for Payer: Healthscope Commercial |
$220.59
|
| Rate for Payer: Healthscope Commercial |
$351.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,763.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,961.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,158.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,355.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,961.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.23
|
| Rate for Payer: PHP Commercial |
$331.88
|
| Rate for Payer: PHP Commercial |
$3,355.80
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: PHP Commercial |
$364.99
|
| Rate for Payer: PHP Commercial |
$208.34
|
| Rate for Payer: Priority Health SBD |
$2,487.24
|
| Rate for Payer: Priority Health SBD |
$154.41
|
| Rate for Payer: Priority Health SBD |
$270.52
|
| Rate for Payer: Priority Health SBD |
$2.71
|
| Rate for Payer: Priority Health SBD |
$245.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.69
|
| Rate for Payer: UHC Core |
$18.69
|
| Rate for Payer: UHC Core |
$18.69
|
| Rate for Payer: UHC Core |
$18.69
|
| Rate for Payer: UHC Core |
$18.69
|
| Rate for Payer: UHC Core |
$18.69
|
| Rate for Payer: UHC Exchange |
$18.69
|
| Rate for Payer: UHC Exchange |
$18.69
|
| Rate for Payer: UHC Exchange |
$18.69
|
| Rate for Payer: UHC Exchange |
$18.69
|
| Rate for Payer: UHC Exchange |
$18.69
|
| Rate for Payer: UMR Bronson Commercial |
$90.69
|
| Rate for Payer: UMR Bronson Commercial |
$158.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,460.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: UMR Bronson Commercial |
$144.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,961.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.82
|
|
|
DICYCLOMINE 20 MG TABLET
|
Facility
|
IP
|
$429.40
|
|
|
Service Code
|
HCPCS J0500
|
| Hospital Charge Code |
2420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.94 |
| Max. Negotiated Rate |
$386.46 |
| Rate for Payer: Aetna American Axle |
$279.11
|
| Rate for Payer: Aetna American Axle |
$2,566.20
|
| Rate for Payer: Aetna American Axle |
$2.79
|
| Rate for Payer: Aetna American Axle |
$253.79
|
| Rate for Payer: Aetna American Axle |
$159.31
|
| Rate for Payer: Aetna Commercial |
$208.34
|
| Rate for Payer: Aetna Commercial |
$3,355.80
|
| Rate for Payer: Aetna Commercial |
$364.99
|
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Commercial |
$331.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,566.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: Cash Price |
$3,158.40
|
| Rate for Payer: Cash Price |
$312.36
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cash Price |
$343.52
|
| Rate for Payer: Cash Price |
$196.08
|
| Rate for Payer: Cofinity Advantage |
$171.57
|
| Rate for Payer: Cofinity Advantage |
$3.01
|
| Rate for Payer: Cofinity Advantage |
$273.31
|
| Rate for Payer: Cofinity Advantage |
$300.58
|
| Rate for Payer: Cofinity Advantage |
$2,763.60
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Cofinity Commercial |
$210.79
|
| Rate for Payer: Cofinity Commercial |
$335.79
|
| Rate for Payer: Cofinity Commercial |
$3,395.28
|
| Rate for Payer: Cofinity Commercial |
$369.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,158.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$220.59
|
| Rate for Payer: Healthscope Commercial |
$351.40
|
| Rate for Payer: Healthscope Commercial |
$3,553.20
|
| Rate for Payer: Healthscope Commercial |
$386.46
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,763.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,961.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,355.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,961.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.05
|
| Rate for Payer: PHP Commercial |
$3,355.80
|
| Rate for Payer: PHP Commercial |
$208.34
|
| Rate for Payer: PHP Commercial |
$364.99
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: PHP Commercial |
$331.88
|
| Rate for Payer: Priority Health SBD |
$270.52
|
| Rate for Payer: Priority Health SBD |
$2.71
|
| Rate for Payer: Priority Health SBD |
$245.98
|
| Rate for Payer: Priority Health SBD |
$154.41
|
| Rate for Payer: Priority Health SBD |
$2,487.24
|
| Rate for Payer: UMR Bronson Commercial |
$171.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,737.12
|
| Rate for Payer: UMR Bronson Commercial |
$107.84
|
| Rate for Payer: UMR Bronson Commercial |
$188.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,961.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.84
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$13,417.63
|
|
|
Service Code
|
APR-DRG 2404
|
| Min. Negotiated Rate |
$12,778.70 |
| Max. Negotiated Rate |
$13,417.63 |
| Rate for Payer: BCBS Complete |
$13,417.63
|
| Rate for Payer: Mclaren Medicaid |
$12,778.70
|
| Rate for Payer: Meridian Medicaid |
$13,417.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,778.70
|
| Rate for Payer: UHC Medicaid |
$12,778.70
|
| Rate for Payer: UHCCP Medicaid |
$12,778.70
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$6,765.72
|
|
|
Service Code
|
APR-DRG 2402
|
| Min. Negotiated Rate |
$6,443.54 |
| Max. Negotiated Rate |
$6,765.72 |
| Rate for Payer: BCBS Complete |
$6,765.72
|
| Rate for Payer: Mclaren Medicaid |
$6,443.54
|
| Rate for Payer: Meridian Medicaid |
$6,765.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,443.54
|
| Rate for Payer: UHC Medicaid |
$6,443.54
|
| Rate for Payer: UHCCP Medicaid |
$6,443.54
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$9,708.20
|
|
|
Service Code
|
APR-DRG 2403
|
| Min. Negotiated Rate |
$9,245.91 |
| Max. Negotiated Rate |
$9,708.20 |
| Rate for Payer: BCBS Complete |
$9,708.20
|
| Rate for Payer: Mclaren Medicaid |
$9,245.91
|
| Rate for Payer: Meridian Medicaid |
$9,708.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,245.91
|
| Rate for Payer: UHC Medicaid |
$9,245.91
|
| Rate for Payer: UHCCP Medicaid |
$9,245.91
|
|
|
DIGESTIVE MALIGNANCY
|
Facility
|
IP
|
$5,556.88
|
|
|
Service Code
|
APR-DRG 2401
|
| Min. Negotiated Rate |
$5,292.27 |
| Max. Negotiated Rate |
$5,556.88 |
| Rate for Payer: BCBS Complete |
$5,556.88
|
| Rate for Payer: Mclaren Medicaid |
$5,292.27
|
| Rate for Payer: Meridian Medicaid |
$5,556.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,292.27
|
| Rate for Payer: UHC Medicaid |
$5,292.27
|
| Rate for Payer: UHCCP Medicaid |
$5,292.27
|
|
|
DIGESTIVE MALIGNANCY WITH CC
|
Facility
|
IP
|
$21,889.43
|
|
|
Service Code
|
MSDRG 375
|
| Min. Negotiated Rate |
$10,173.06 |
| Max. Negotiated Rate |
$21,889.43 |
| Rate for Payer: Aetna Medicare |
$11,136.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,385.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,385.60
|
| Rate for Payer: BCBS MAPPO |
$10,708.48
|
| Rate for Payer: BCBS Trust/PPO |
$21,889.43
|
| Rate for Payer: BCN Commercial |
$21,889.43
|
| Rate for Payer: BCN Medicare Advantage |
$10,708.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,708.48
|
| Rate for Payer: Mclaren Medicare |
$10,708.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,243.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,314.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,779.33
|
| Rate for Payer: Nomi Health Commercial |
$15,603.84
|
| Rate for Payer: PACE Medicare |
$10,173.06
|
| Rate for Payer: PACE SWMI |
$10,708.48
|
| Rate for Payer: PHP Medicare Advantage |
$10,708.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,501.34
|
| Rate for Payer: Priority Health Medicare |
$10,708.48
|
| Rate for Payer: Priority Health Tiered Network |
$15,601.07
|
| Rate for Payer: Railroad Medicare Medicare |
$10,708.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,716.48
|
| Rate for Payer: UHC Core |
$16,495.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,708.48
|
| Rate for Payer: UHC Exchange |
$13,471.32
|
| Rate for Payer: VA VA |
$10,708.48
|
|
|
DIGESTIVE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$38,121.20
|
|
|
Service Code
|
MSDRG 374
|
| Min. Negotiated Rate |
$17,554.36 |
| Max. Negotiated Rate |
$38,121.20 |
| Rate for Payer: Aetna Medicare |
$19,217.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,097.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,097.84
|
| Rate for Payer: BCBS MAPPO |
$18,478.27
|
| Rate for Payer: BCBS Trust/PPO |
$38,121.20
|
| Rate for Payer: BCN Commercial |
$38,121.20
|
| Rate for Payer: BCN Medicare Advantage |
$18,478.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,478.27
|
| Rate for Payer: Mclaren Medicare |
$18,478.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,402.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,250.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,326.10
|
| Rate for Payer: Nomi Health Commercial |
$27,589.23
|
| Rate for Payer: PACE Medicare |
$17,554.36
|
| Rate for Payer: PACE SWMI |
$18,478.27
|
| Rate for Payer: PHP Medicare Advantage |
$18,478.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,480.42
|
| Rate for Payer: Priority Health Medicare |
$18,478.27
|
| Rate for Payer: Priority Health Tiered Network |
$27,584.33
|
| Rate for Payer: Railroad Medicare Medicare |
$18,478.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,860.81
|
| Rate for Payer: UHC Core |
$29,165.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,478.27
|
| Rate for Payer: UHC Exchange |
$23,818.70
|
| Rate for Payer: VA VA |
$18,478.27
|
|
