|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,565.30
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,088.73 |
| Max. Negotiated Rate |
$10,408.77 |
| Rate for Payer: Aetna American Axle |
$7,517.44
|
| Rate for Payer: Aetna Commercial |
$9,830.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,517.44
|
| Rate for Payer: Cash Price |
$9,252.24
|
| Rate for Payer: Cofinity Commercial |
$8,095.71
|
| Rate for Payer: Cofinity Commercial |
$9,946.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,095.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,252.24
|
| Rate for Payer: Healthscope Commercial |
$10,408.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,095.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,673.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,830.50
|
| Rate for Payer: PHP Commercial |
$9,830.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,517.44
|
| Rate for Payer: Priority Health SBD |
$7,286.14
|
| Rate for Payer: UMR Bronson Commercial |
$5,088.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,673.98
|
|
|
DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,565.30
|
|
|
Service Code
|
HCPCS J1162
|
| Hospital Charge Code |
31432
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,770.17 |
| Max. Negotiated Rate |
$14,548.05 |
| Rate for Payer: Aetna American Axle |
$7,517.44
|
| Rate for Payer: Aetna Commercial |
$9,830.50
|
| Rate for Payer: Aetna Medicare |
$5,374.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,517.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,460.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,460.29
|
| Rate for Payer: BCBS Complete |
$2,908.68
|
| Rate for Payer: BCBS MAPPO |
$5,168.23
|
| Rate for Payer: BCN Medicare Advantage |
$5,168.23
|
| Rate for Payer: Cash Price |
$9,252.24
|
| Rate for Payer: Cash Price |
$9,252.24
|
| Rate for Payer: Cofinity Commercial |
$9,946.16
|
| Rate for Payer: Cofinity Commercial |
$8,095.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,095.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,252.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,168.23
|
| Rate for Payer: Healthscope Commercial |
$10,408.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,095.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,673.98
|
| Rate for Payer: Mclaren Medicaid |
$2,770.17
|
| Rate for Payer: Mclaren Medicare |
$5,168.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,426.64
|
| Rate for Payer: Meridian Medicaid |
$2,908.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,943.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,830.50
|
| Rate for Payer: PACE Medicare |
$4,909.82
|
| Rate for Payer: PACE SWMI |
$5,168.23
|
| Rate for Payer: PHP Commercial |
$9,830.50
|
| Rate for Payer: PHP Medicare Advantage |
$5,168.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,770.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,517.44
|
| Rate for Payer: Priority Health Medicare |
$5,168.23
|
| Rate for Payer: Priority Health SBD |
$7,286.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5,168.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,548.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,168.23
|
| Rate for Payer: UHC Exchange |
$9,877.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,168.23
|
| Rate for Payer: UHCCP Medicaid |
$2,770.17
|
| Rate for Payer: UMR Bronson Commercial |
$4,279.16
|
| Rate for Payer: VA VA |
$5,168.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,673.98
|
|
|
DIGOXIN IV NEONATE 10 MCG/ML INJECTION
|
Facility
|
IP
|
$323.12
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
163536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.17 |
| Max. Negotiated Rate |
$290.81 |
| Rate for Payer: Aetna American Axle |
$210.03
|
| Rate for Payer: Aetna Commercial |
$274.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.03
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cofinity Commercial |
$226.18
|
| Rate for Payer: Cofinity Commercial |
$277.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.50
|
| Rate for Payer: Healthscope Commercial |
$290.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.65
|
| Rate for Payer: PHP Commercial |
$274.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.03
|
| Rate for Payer: Priority Health SBD |
$203.57
|
| Rate for Payer: UMR Bronson Commercial |
$142.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.34
|
|
|
DIGOXIN IV NEONATE 10 MCG/ML INJECTION
|
Facility
|
OP
|
$323.12
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
163536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$290.81 |
| Rate for Payer: Aetna American Axle |
$210.03
|
| Rate for Payer: Aetna Commercial |
$274.65
|
| Rate for Payer: Aetna Medicare |
$161.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.03
|
| Rate for Payer: BCBS Complete |
$129.25
|
| Rate for Payer: Cash Price |
$258.50
|
| Rate for Payer: Cofinity Commercial |
$226.18
|
| Rate for Payer: Cofinity Commercial |
$277.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.50
|
| Rate for Payer: Healthscope Commercial |
$290.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.65
|
| Rate for Payer: PHP Commercial |
$274.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.03
|
| Rate for Payer: Priority Health SBD |
$203.57
|
| Rate for Payer: UMR Bronson Commercial |
$119.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.34
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$200.73
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.27 |
| Max. Negotiated Rate |
$180.66 |
| Rate for Payer: Aetna American Axle |
$130.47
|
| Rate for Payer: Aetna American Axle |
$269.34
|
| Rate for Payer: Aetna American Axle |
$283.51
|
| Rate for Payer: Aetna American Axle |
$118.09
|
| Rate for Payer: Aetna American Axle |
$182.41
|
| Rate for Payer: Aetna Commercial |
$154.43
|
| Rate for Payer: Aetna Commercial |
$370.74
|
| Rate for Payer: Aetna Commercial |
$238.54
|
| Rate for Payer: Aetna Commercial |
$352.21
|
| Rate for Payer: Aetna Commercial |
$170.62
|
| Rate for Payer: Aetna Medicare |
$207.19
|
| Rate for Payer: Aetna Medicare |
$100.36
|
| Rate for Payer: Aetna Medicare |
$218.09
|
| Rate for Payer: Aetna Medicare |
$140.31
|
| Rate for Payer: Aetna Medicare |
$90.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.34
|
| Rate for Payer: BCBS Complete |
$174.47
|
| Rate for Payer: BCBS Complete |
$72.67
|
| Rate for Payer: BCBS Complete |
$165.75
|
| Rate for Payer: BCBS Complete |
$112.25
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: Cash Price |
$348.94
|
| Rate for Payer: Cash Price |
$145.34
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cofinity Commercial |
$305.32
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$356.36
|
| Rate for Payer: Cofinity Commercial |
$127.18
|
| Rate for Payer: Cofinity Commercial |
$241.34
|
| Rate for Payer: Cofinity Commercial |
$196.44
|
| Rate for Payer: Cofinity Commercial |
$290.06
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$140.51
|
| Rate for Payer: Cofinity Commercial |
$375.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.50
|
| Rate for Payer: Healthscope Commercial |
$163.51
|
| Rate for Payer: Healthscope Commercial |
$252.57
|
| Rate for Payer: Healthscope Commercial |
$392.55
|
| Rate for Payer: Healthscope Commercial |
$372.93
|
| Rate for Payer: Healthscope Commercial |
$180.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.74
|
| Rate for Payer: PHP Commercial |
$352.21
|
| Rate for Payer: PHP Commercial |
$238.54
|
| Rate for Payer: PHP Commercial |
$154.43
|
| Rate for Payer: PHP Commercial |
$170.62
|
| Rate for Payer: PHP Commercial |
$370.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.47
|
| Rate for Payer: Priority Health SBD |
$126.46
|
| Rate for Payer: Priority Health SBD |
$114.46
|
| Rate for Payer: Priority Health SBD |
$176.80
|
| Rate for Payer: Priority Health SBD |
$261.05
|
| Rate for Payer: Priority Health SBD |
$274.79
|
| Rate for Payer: UMR Bronson Commercial |
$161.38
|
| Rate for Payer: UMR Bronson Commercial |
$153.32
|
| Rate for Payer: UMR Bronson Commercial |
$74.27
|
| Rate for Payer: UMR Bronson Commercial |
$67.22
|
| Rate for Payer: UMR Bronson Commercial |
$103.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.47
|
|
|
DIHYDROERGOTAMINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$280.63
|
|
|
Service Code
|
HCPCS J1110
|
| Hospital Charge Code |
9859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$252.57 |
| Rate for Payer: Aetna American Axle |
$182.41
|
| Rate for Payer: Aetna American Axle |
$130.47
|
| Rate for Payer: Aetna American Axle |
$118.09
|
| Rate for Payer: Aetna American Axle |
$269.34
|
| Rate for Payer: Aetna Commercial |
$238.54
|
| Rate for Payer: Aetna Commercial |
$352.21
|
| Rate for Payer: Aetna Commercial |
$170.62
|
| Rate for Payer: Aetna Commercial |
$154.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.41
|
| Rate for Payer: Cash Price |
$160.58
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cash Price |
$145.34
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cofinity Commercial |
$127.18
|
| Rate for Payer: Cofinity Commercial |
$356.36
|
| Rate for Payer: Cofinity Commercial |
$290.06
|
| Rate for Payer: Cofinity Commercial |
$196.44
|
| Rate for Payer: Cofinity Commercial |
$140.51
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$241.34
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.58
|
| Rate for Payer: Healthscope Commercial |
$252.57
|
| Rate for Payer: Healthscope Commercial |
$163.51
|
| Rate for Payer: Healthscope Commercial |
$180.66
|
| Rate for Payer: Healthscope Commercial |
$372.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.54
|
| Rate for Payer: PHP Commercial |
$238.54
|
| Rate for Payer: PHP Commercial |
$352.21
|
| Rate for Payer: PHP Commercial |
$154.43
|
| Rate for Payer: PHP Commercial |
$170.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.09
|
| Rate for Payer: Priority Health SBD |
$261.05
|
| Rate for Payer: Priority Health SBD |
$114.46
|
| Rate for Payer: Priority Health SBD |
$126.46
|
| Rate for Payer: Priority Health SBD |
$176.80
|
| Rate for Payer: UMR Bronson Commercial |
$123.48
|
| Rate for Payer: UMR Bronson Commercial |
$182.32
|
| Rate for Payer: UMR Bronson Commercial |
$88.32
|
| Rate for Payer: UMR Bronson Commercial |
$79.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.47
|
|
|
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 58120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$5,926.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
DILATION OF EXISTING TRACT, PERCUTANEOUS, FOR AN ENDOUROLOGIC PROCEDURE INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, WITH POSTPROCEDURE TUBE PLACEMENT, WHEN PERFORMED;
|
Facility
|
OP
|
$9,468.51
|
|
|
Service Code
|
CPT 50436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$6,428.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
DILATION OF EXISTING TRACT, PERCUTANEOUS, FOR AN ENDOUROLOGIC PROCEDURE INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, WITH POSTPROCEDURE TUBE PLACEMENT, WHEN PERFORMED; INCLUDING NEW ACCESS INTO THE RENAL COLLECTING SYSTEM
|
Facility
|
OP
|
$9,468.51
|
|
|
Service Code
|
CPT 50437
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$6,428.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
DILATION OF RECTAL STRICTURE (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL
|
Facility
|
OP
|
$3,236.94
|
|
|
Service Code
|
CPT 45910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
DILATION SALIVARY DUCT
|
Facility
|
OP
|
$4,066.57
|
|
|
Service Code
|
CPT 42650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$774.34 |
| Max. Negotiated Rate |
$4,066.57 |
| Rate for Payer: Aetna Medicare |
$1,502.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,805.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,805.83
|
| Rate for Payer: BCBS Complete |
$813.05
|
| Rate for Payer: BCBS MAPPO |
$1,444.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,444.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,444.66
|
| Rate for Payer: Mclaren Medicaid |
$774.34
|
| Rate for Payer: Mclaren Medicare |
$1,444.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.89
|
| Rate for Payer: Meridian Medicaid |
$813.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,661.36
|
| Rate for Payer: PACE Medicare |
$1,372.43
|
| Rate for Payer: PACE SWMI |
$1,444.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,444.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.34
|
| Rate for Payer: Priority Health Medicare |
$1,444.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,444.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,066.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,444.66
|
| Rate for Payer: UHC Exchange |
$2,760.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,444.66
|
| Rate for Payer: UHCCP Medicaid |
$774.34
|
| Rate for Payer: VA VA |
$1,444.66
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$82.05
|
|
|
Service Code
|
NDC 00409435003
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$73.84 |
| Rate for Payer: Aetna American Axle |
$53.33
|
| Rate for Payer: Aetna Commercial |
$69.74
|
| Rate for Payer: Aetna Medicare |
$41.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.33
|
| Rate for Payer: BCBS Complete |
$32.82
|
| Rate for Payer: Cash Price |
$65.64
|
| Rate for Payer: Cofinity Commercial |
$57.44
|
| Rate for Payer: Cofinity Commercial |
$70.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.64
|
| Rate for Payer: Healthscope Commercial |
$73.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.74
|
| Rate for Payer: PHP Commercial |
$69.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.33
|
| Rate for Payer: Priority Health SBD |
$51.69
|
| Rate for Payer: UMR Bronson Commercial |
$30.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.54
|
|
|
DILTIAZEM 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$82.05
|
|
|
Service Code
|
NDC 00409435003
|
| Hospital Charge Code |
22156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.10 |
| Max. Negotiated Rate |
$73.84 |
| Rate for Payer: Aetna American Axle |
$53.33
|
| Rate for Payer: Aetna Commercial |
$69.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.33
|
| Rate for Payer: Cash Price |
$65.64
|
| Rate for Payer: Cofinity Commercial |
$57.44
|
| Rate for Payer: Cofinity Commercial |
$70.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.64
|
| Rate for Payer: Healthscope Commercial |
$73.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.74
|
| Rate for Payer: PHP Commercial |
$69.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.33
|
| Rate for Payer: Priority Health SBD |
$51.69
|
| Rate for Payer: UMR Bronson Commercial |
$36.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.54
|
|
|
DILTIAZEM 1MG/1 ML INFUSION 125 ML (IV PREMIX)
|
Facility
|
OP
|
$156.25
|
|
|
Service Code
|
NDC 09900000302
|
| Hospital Charge Code |
155072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.81 |
| Max. Negotiated Rate |
$140.62 |
| Rate for Payer: Aetna American Axle |
$101.56
|
| Rate for Payer: Aetna Commercial |
$132.81
|
| Rate for Payer: Aetna Medicare |
$78.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.56
|
| Rate for Payer: BCBS Complete |
$62.50
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cofinity Commercial |
$109.38
|
| Rate for Payer: Cofinity Commercial |
$134.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.00
|
| Rate for Payer: Healthscope Commercial |
$140.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.81
|
| Rate for Payer: PHP Commercial |
$132.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.56
|
| Rate for Payer: Priority Health SBD |
$98.44
|
| Rate for Payer: UMR Bronson Commercial |
$57.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.19
|
|
|
DILTIAZEM 1MG/1 ML INFUSION 125 ML (IV PREMIX)
|
Facility
|
IP
|
$156.25
|
|
|
Service Code
|
NDC 09900000302
|
| Hospital Charge Code |
155072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$68.75 |
| Max. Negotiated Rate |
$140.62 |
| Rate for Payer: Aetna American Axle |
$101.56
|
| Rate for Payer: Aetna Commercial |
$132.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.56
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cofinity Commercial |
$109.38
|
| Rate for Payer: Cofinity Commercial |
$134.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.00
|
| Rate for Payer: Healthscope Commercial |
$140.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.81
|
| Rate for Payer: PHP Commercial |
$132.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.56
|
| Rate for Payer: Priority Health SBD |
$98.44
|
| Rate for Payer: UMR Bronson Commercial |
$68.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.19
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 51079074520
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.41 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.87
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UMR Bronson Commercial |
$164.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 50228048101
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$4.09
|
|
|
Service Code
|
NDC 60687056211
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna American Axle |
$2.66
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.66
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 00093031801
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.73 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UMR Bronson Commercial |
$143.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 00378002301
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.73 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UMR Bronson Commercial |
$143.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 00093031801
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.86 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UMR Bronson Commercial |
$120.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 51079074501
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna American Axle |
$2.43
|
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna Medicare |
$1.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.43
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 50228048101
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.54
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
IP
|
$4.09
|
|
|
Service Code
|
NDC 60687056211
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna American Axle |
$2.66
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.66
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
DILTIAZEM 30 MG TABLET
|
Facility
|
OP
|
$373.65
|
|
|
Service Code
|
NDC 51079074520
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$336.29 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna Medicare |
$186.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: BCBS Complete |
$149.46
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.87
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UMR Bronson Commercial |
$138.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
