|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$651.42
|
|
|
Service Code
|
NDC 60687037521
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.03 |
| Max. Negotiated Rate |
$586.28 |
| Rate for Payer: Aetna American Axle |
$423.42
|
| Rate for Payer: Aetna Commercial |
$553.71
|
| Rate for Payer: Aetna Medicare |
$325.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.42
|
| Rate for Payer: BCBS Complete |
$260.57
|
| Rate for Payer: Cash Price |
$521.14
|
| Rate for Payer: Cofinity Advantage |
$455.99
|
| Rate for Payer: Cofinity Commercial |
$560.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.14
|
| Rate for Payer: Healthscope Commercial |
$586.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$521.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$488.56
|
| Rate for Payer: PHP Commercial |
$553.71
|
| Rate for Payer: Priority Health SBD |
$410.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.42
|
| Rate for Payer: UHC Core |
$339.39
|
| Rate for Payer: UHC Exchange |
$256.01
|
| Rate for Payer: UMR Bronson Commercial |
$241.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.56
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$21.72
|
|
|
Service Code
|
NDC 60687037511
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Aetna American Axle |
$14.12
|
| Rate for Payer: Aetna Commercial |
$18.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.12
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cofinity Advantage |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$18.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.38
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.29
|
| Rate for Payer: PHP Commercial |
$18.46
|
| Rate for Payer: Priority Health SBD |
$13.68
|
| Rate for Payer: UMR Bronson Commercial |
$9.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.29
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$21.72
|
|
|
Service Code
|
NDC 60687037511
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Aetna American Axle |
$14.12
|
| Rate for Payer: Aetna Commercial |
$18.46
|
| Rate for Payer: Aetna Medicare |
$10.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.12
|
| Rate for Payer: BCBS Complete |
$8.69
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cofinity Advantage |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$18.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.38
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.29
|
| Rate for Payer: PHP Commercial |
$18.46
|
| Rate for Payer: Priority Health SBD |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.12
|
| Rate for Payer: UHC Core |
$11.32
|
| Rate for Payer: UHC Exchange |
$8.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.29
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$805.14
|
|
|
Service Code
|
NDC 42858086706
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.90 |
| Max. Negotiated Rate |
$724.63 |
| Rate for Payer: Aetna American Axle |
$523.34
|
| Rate for Payer: Aetna Commercial |
$684.37
|
| Rate for Payer: Aetna Medicare |
$402.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.34
|
| Rate for Payer: BCBS Complete |
$322.06
|
| Rate for Payer: Cash Price |
$644.11
|
| Rate for Payer: Cofinity Advantage |
$563.60
|
| Rate for Payer: Cofinity Commercial |
$692.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.11
|
| Rate for Payer: Healthscope Commercial |
$724.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$563.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$603.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$644.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$603.86
|
| Rate for Payer: PHP Commercial |
$684.37
|
| Rate for Payer: Priority Health SBD |
$507.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.34
|
| Rate for Payer: UHC Core |
$419.48
|
| Rate for Payer: UHC Exchange |
$316.42
|
| Rate for Payer: UMR Bronson Commercial |
$297.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$603.86
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$651.42
|
|
|
Service Code
|
NDC 60687037521
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.62 |
| Max. Negotiated Rate |
$586.28 |
| Rate for Payer: Aetna American Axle |
$423.42
|
| Rate for Payer: Aetna Commercial |
$553.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.42
|
| Rate for Payer: Cash Price |
$521.14
|
| Rate for Payer: Cofinity Advantage |
$455.99
|
| Rate for Payer: Cofinity Commercial |
$560.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.14
|
| Rate for Payer: Healthscope Commercial |
$586.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$488.56
|
| Rate for Payer: PHP Commercial |
$553.71
|
| Rate for Payer: Priority Health SBD |
$410.39
|
| Rate for Payer: UMR Bronson Commercial |
$286.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.56
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$805.14
|
|
|
Service Code
|
NDC 42858086706
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$354.26 |
| Max. Negotiated Rate |
$724.63 |
| Rate for Payer: Aetna American Axle |
$523.34
|
| Rate for Payer: Aetna Commercial |
$684.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.34
|
| Rate for Payer: Cash Price |
$644.11
|
| Rate for Payer: Cofinity Advantage |
$563.60
|
| Rate for Payer: Cofinity Commercial |
$692.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.11
|
| Rate for Payer: Healthscope Commercial |
$724.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$563.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$603.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$603.86
|
| Rate for Payer: PHP Commercial |
$684.37
|
| Rate for Payer: Priority Health SBD |
$507.24
|
| Rate for Payer: UMR Bronson Commercial |
$354.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$603.86
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$697.20
|
|
|
Service Code
|
NDC 67877075360
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.77 |
| Max. Negotiated Rate |
$627.48 |
| Rate for Payer: Aetna American Axle |
$453.18
|
| Rate for Payer: Aetna Commercial |
$592.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.18
|
| Rate for Payer: Cash Price |
$557.76
|
| Rate for Payer: Cofinity Advantage |
$488.04
|
| Rate for Payer: Cofinity Commercial |
$599.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.76
|
| Rate for Payer: Healthscope Commercial |
$627.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$488.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$522.90
|
| Rate for Payer: PHP Commercial |
$592.62
|
| Rate for Payer: Priority Health SBD |
$439.24
|
| Rate for Payer: UMR Bronson Commercial |
$306.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.90
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$697.20
|
|
|
Service Code
|
NDC 67877075360
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.96 |
| Max. Negotiated Rate |
$627.48 |
| Rate for Payer: Aetna American Axle |
$453.18
|
| Rate for Payer: Aetna Commercial |
$592.62
|
| Rate for Payer: Aetna Medicare |
$348.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.18
|
| Rate for Payer: BCBS Complete |
$278.88
|
| Rate for Payer: Cash Price |
$557.76
|
| Rate for Payer: Cofinity Advantage |
$488.04
|
| Rate for Payer: Cofinity Commercial |
$599.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.76
|
| Rate for Payer: Healthscope Commercial |
$627.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$488.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$557.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$522.90
|
| Rate for Payer: PHP Commercial |
$592.62
|
| Rate for Payer: Priority Health SBD |
$439.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.18
|
| Rate for Payer: UHC Core |
$363.24
|
| Rate for Payer: UHC Exchange |
$274.00
|
| Rate for Payer: UMR Bronson Commercial |
$257.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.90
|
|
|
DRONEDARONE 400 MG TABLET
|
Facility
|
OP
|
$2,786.10
|
|
|
Service Code
|
NDC 00024414260
|
| Hospital Charge Code |
98329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,030.86 |
| Max. Negotiated Rate |
$2,507.49 |
| Rate for Payer: Aetna American Axle |
$1,810.96
|
| Rate for Payer: Aetna Commercial |
$2,368.18
|
| Rate for Payer: Aetna Medicare |
$1,393.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,810.96
|
| Rate for Payer: BCBS Complete |
$1,114.44
|
| Rate for Payer: Cash Price |
$2,228.88
|
| Rate for Payer: Cofinity Advantage |
$1,950.27
|
| Rate for Payer: Cofinity Commercial |
$2,396.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,228.88
|
| Rate for Payer: Healthscope Commercial |
$2,507.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,950.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,089.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,228.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,368.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,089.57
|
| Rate for Payer: PHP Commercial |
$2,368.18
|
| Rate for Payer: Priority Health SBD |
$1,755.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,810.96
|
| Rate for Payer: UHC Core |
$1,451.56
|
| Rate for Payer: UHC Exchange |
$1,094.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,030.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,089.57
|
|
|
DRONEDARONE 400 MG TABLET
|
Facility
|
IP
|
$2,786.10
|
|
|
Service Code
|
NDC 00024414260
|
| Hospital Charge Code |
98329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,225.88 |
| Max. Negotiated Rate |
$2,507.49 |
| Rate for Payer: Aetna American Axle |
$1,810.96
|
| Rate for Payer: Aetna Commercial |
$2,368.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,810.96
|
| Rate for Payer: Cash Price |
$2,228.88
|
| Rate for Payer: Cofinity Advantage |
$1,950.27
|
| Rate for Payer: Cofinity Commercial |
$2,396.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,228.88
|
| Rate for Payer: Healthscope Commercial |
$2,507.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,950.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,089.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,368.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,089.57
|
| Rate for Payer: PHP Commercial |
$2,368.18
|
| Rate for Payer: Priority Health SBD |
$1,755.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,225.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,089.57
|
|
|
DROPERIDOL 2.5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$28.21
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
2654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna American Axle |
$18.34
|
| Rate for Payer: Aetna American Axle |
$35.43
|
| Rate for Payer: Aetna Commercial |
$23.98
|
| Rate for Payer: Aetna Commercial |
$46.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.43
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cofinity Advantage |
$38.16
|
| Rate for Payer: Cofinity Advantage |
$19.75
|
| Rate for Payer: Cofinity Commercial |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.61
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Commercial |
$49.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.88
|
| Rate for Payer: PHP Commercial |
$23.98
|
| Rate for Payer: PHP Commercial |
$46.33
|
| Rate for Payer: Priority Health SBD |
$34.34
|
| Rate for Payer: Priority Health SBD |
$17.77
|
| Rate for Payer: UMR Bronson Commercial |
$12.41
|
| Rate for Payer: UMR Bronson Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.88
|
|
|
DROPERIDOL 2.5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$28.21
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
2654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna American Axle |
$18.34
|
| Rate for Payer: Aetna American Axle |
$35.43
|
| Rate for Payer: Aetna Commercial |
$23.98
|
| Rate for Payer: Aetna Commercial |
$46.33
|
| Rate for Payer: Aetna Medicare |
$14.11
|
| Rate for Payer: Aetna Medicare |
$27.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.43
|
| Rate for Payer: BCBS Complete |
$21.80
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$22.57
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cofinity Advantage |
$19.75
|
| Rate for Payer: Cofinity Advantage |
$38.16
|
| Rate for Payer: Cofinity Commercial |
$24.26
|
| Rate for Payer: Cofinity Commercial |
$46.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.61
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Commercial |
$49.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.16
|
| Rate for Payer: PHP Commercial |
$23.98
|
| Rate for Payer: PHP Commercial |
$46.33
|
| Rate for Payer: Priority Health SBD |
$17.77
|
| Rate for Payer: Priority Health SBD |
$34.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.85
|
| Rate for Payer: UHC Core |
$11.85
|
| Rate for Payer: UHC Core |
$11.85
|
| Rate for Payer: UHC Exchange |
$11.85
|
| Rate for Payer: UHC Exchange |
$11.85
|
| Rate for Payer: UMR Bronson Commercial |
$10.44
|
| Rate for Payer: UMR Bronson Commercial |
$20.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.88
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$11,397.06
|
|
|
Service Code
|
APR-DRG 7704
|
| Min. Negotiated Rate |
$10,854.34 |
| Max. Negotiated Rate |
$11,397.06 |
| Rate for Payer: BCBS Complete |
$11,397.06
|
| Rate for Payer: Mclaren Medicaid |
$10,854.34
|
| Rate for Payer: Meridian Medicaid |
$11,397.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,854.34
|
| Rate for Payer: UHC Medicaid |
$10,854.34
|
| Rate for Payer: UHCCP Medicaid |
$10,854.34
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$1,946.12
|
|
|
Service Code
|
APR-DRG 7701
|
| Min. Negotiated Rate |
$1,853.45 |
| Max. Negotiated Rate |
$1,946.12 |
| Rate for Payer: BCBS Complete |
$1,946.12
|
| Rate for Payer: Mclaren Medicaid |
$1,853.45
|
| Rate for Payer: Meridian Medicaid |
$1,946.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.45
|
| Rate for Payer: UHC Medicaid |
$1,853.45
|
| Rate for Payer: UHCCP Medicaid |
$1,853.45
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$3,375.90
|
|
|
Service Code
|
APR-DRG 7703
|
| Min. Negotiated Rate |
$3,215.14 |
| Max. Negotiated Rate |
$3,375.90 |
| Rate for Payer: BCBS Complete |
$3,375.90
|
| Rate for Payer: Mclaren Medicaid |
$3,215.14
|
| Rate for Payer: Meridian Medicaid |
$3,375.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,215.14
|
| Rate for Payer: UHC Medicaid |
$3,215.14
|
| Rate for Payer: UHCCP Medicaid |
$3,215.14
|
|
|
DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE
|
Facility
|
IP
|
$2,490.31
|
|
|
Service Code
|
APR-DRG 7702
|
| Min. Negotiated Rate |
$2,371.72 |
| Max. Negotiated Rate |
$2,490.31 |
| Rate for Payer: BCBS Complete |
$2,490.31
|
| Rate for Payer: Mclaren Medicaid |
$2,371.72
|
| Rate for Payer: Meridian Medicaid |
$2,490.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,371.72
|
| Rate for Payer: UHC Medicaid |
$2,371.72
|
| Rate for Payer: UHCCP Medicaid |
$2,371.72
|
|
|
DRUG-INDUCED SLEEP ENDOSCOPY, WITH DYNAMIC EVALUATION OF VELUM, PHARYNX, TONGUE BASE, AND LARYNX FOR EVALUATION OF SLEEP-DISORDERED BREATHING, FLEXIBLE, DIAGNOSTIC
|
Facility
|
OP
|
$5,735.32
|
|
|
Service Code
|
CPT 42975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$5,735.32 |
| Rate for Payer: Aetna Medicare |
$1,844.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,216.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,216.88
|
| Rate for Payer: BCBS Complete |
$974.01
|
| Rate for Payer: BCBS MAPPO |
$1,773.50
|
| Rate for Payer: BCBS Trust/PPO |
$123.75
|
| Rate for Payer: BCN Commercial |
$123.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,773.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,773.50
|
| Rate for Payer: Mclaren Medicaid |
$1,773.50
|
| Rate for Payer: Mclaren Medicare |
$1,773.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,862.17
|
| Rate for Payer: Meridian Medicaid |
$1,862.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,039.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,950.85
|
| Rate for Payer: Nomi Health Commercial |
$5,320.50
|
| Rate for Payer: PACE Medicare |
$1,684.83
|
| Rate for Payer: PACE SWMI |
$1,773.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,773.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$927.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,735.32
|
| Rate for Payer: Priority Health Medicare |
$1,773.50
|
| Rate for Payer: Priority Health Tiered Network |
$4,588.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,773.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,773.50
|
| Rate for Payer: UHC Medicaid |
$927.54
|
| Rate for Payer: UHCCP Medicaid |
$927.54
|
| Rate for Payer: VA VA |
$1,773.50
|
|
|
DRUG TEST PRESUMPTIVE READ BY INSTR ASSISTED DIRECT OPTICAL OBS
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS G0478
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
|
|
DRUG TEST PRESUMPTIVE USING IMMUNOASSAY
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS G0479
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.00
|
| Rate for Payer: UMR Bronson Commercial |
$38.64
|
|
|
DRUG TEST(S), PRESUMPTIVE READ BY DIRECT OPTICAL OBSERVATION
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS G0477
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: UMR Bronson Commercial |
$5.52
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 68180029407
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.99
|
| Rate for Payer: UHC Core |
$52.89
|
| Rate for Payer: UHC Exchange |
$39.90
|
| Rate for Payer: UMR Bronson Commercial |
$37.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$257.07
|
|
|
Service Code
|
NDC 43547037906
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.12 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna American Axle |
$167.10
|
| Rate for Payer: Aetna Commercial |
$218.51
|
| Rate for Payer: Aetna Medicare |
$128.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.10
|
| Rate for Payer: BCBS Complete |
$102.83
|
| Rate for Payer: Cash Price |
$205.66
|
| Rate for Payer: Cofinity Advantage |
$179.95
|
| Rate for Payer: Cofinity Commercial |
$221.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.66
|
| Rate for Payer: Healthscope Commercial |
$231.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.80
|
| Rate for Payer: PHP Commercial |
$218.51
|
| Rate for Payer: Priority Health SBD |
$161.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.10
|
| Rate for Payer: UHC Core |
$133.93
|
| Rate for Payer: UHC Exchange |
$101.03
|
| Rate for Payer: UMR Bronson Commercial |
$95.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.80
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 57237001760
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.99
|
| Rate for Payer: UHC Core |
$52.89
|
| Rate for Payer: UHC Exchange |
$39.90
|
| Rate for Payer: UMR Bronson Commercial |
$37.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$1,721.84
|
|
|
Service Code
|
NDC 00002323560
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$637.08 |
| Max. Negotiated Rate |
$1,549.66 |
| Rate for Payer: Aetna American Axle |
$1,119.20
|
| Rate for Payer: Aetna Commercial |
$1,463.56
|
| Rate for Payer: Aetna Medicare |
$860.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.20
|
| Rate for Payer: BCBS Complete |
$688.74
|
| Rate for Payer: Cash Price |
$1,377.47
|
| Rate for Payer: Cofinity Advantage |
$1,205.29
|
| Rate for Payer: Cofinity Commercial |
$1,480.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,377.47
|
| Rate for Payer: Healthscope Commercial |
$1,549.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,205.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,291.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,377.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,463.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,291.38
|
| Rate for Payer: PHP Commercial |
$1,463.56
|
| Rate for Payer: Priority Health SBD |
$1,084.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,119.20
|
| Rate for Payer: UHC Core |
$897.08
|
| Rate for Payer: UHC Exchange |
$676.68
|
| Rate for Payer: UMR Bronson Commercial |
$637.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,291.38
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 57237001760
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Advantage |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.14
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$44.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
