|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 00143124101
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.54
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
IP
|
$43.97
|
|
|
Service Code
|
NDC 00904592261
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$39.57 |
| Rate for Payer: Aetna American Axle |
$28.58
|
| Rate for Payer: Aetna Commercial |
$37.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.58
|
| Rate for Payer: Cash Price |
$35.18
|
| Rate for Payer: Cofinity Commercial |
$30.78
|
| Rate for Payer: Cofinity Commercial |
$37.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.18
|
| Rate for Payer: Healthscope Commercial |
$39.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.37
|
| Rate for Payer: PHP Commercial |
$37.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.58
|
| Rate for Payer: Priority Health SBD |
$27.70
|
| Rate for Payer: UMR Bronson Commercial |
$19.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.98
|
|
|
DIGOXIN 250 MCG (0.25 MG) TABLET
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 00143124101
|
| Hospital Charge Code |
2445
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.54
|
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$16.88
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$42.37 |
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna American Axle |
$13.74
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Aetna Medicare |
$10.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: BCBS Complete |
$8.46
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Trust/PPO |
$42.37
|
| Rate for Payer: BCBS Trust/PPO |
$42.37
|
| Rate for Payer: BCN Commercial |
$42.37
|
| Rate for Payer: BCN Commercial |
$42.37
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.74
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: UMR Bronson Commercial |
$6.25
|
| Rate for Payer: UMR Bronson Commercial |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.66
|
|
|
DIGOXIN 250 MCG/ML (0.25 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$16.88
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
108720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$15.19 |
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna American Axle |
$13.74
|
| Rate for Payer: Aetna Commercial |
$14.35
|
| Rate for Payer: Aetna Commercial |
$17.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.74
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cofinity Commercial |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$11.82
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.35
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Commercial |
$14.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.74
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: Priority Health SBD |
$13.32
|
| Rate for Payer: UMR Bronson Commercial |
$7.43
|
| Rate for Payer: UMR Bronson Commercial |
$9.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$549.80
|
|
|
Service Code
|
NDC 00054005746
|
| Hospital Charge Code |
43556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.91 |
| Max. Negotiated Rate |
$494.82 |
| Rate for Payer: Aetna American Axle |
$357.37
|
| Rate for Payer: Aetna Commercial |
$467.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.37
|
| Rate for Payer: Cash Price |
$439.84
|
| Rate for Payer: Cofinity Commercial |
$384.86
|
| Rate for Payer: Cofinity Commercial |
$472.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$384.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.84
|
| Rate for Payer: Healthscope Commercial |
$494.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.33
|
| Rate for Payer: PHP Commercial |
$467.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.37
|
| Rate for Payer: Priority Health SBD |
$346.37
|
| Rate for Payer: UMR Bronson Commercial |
$241.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.35
|
|
|
DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$549.80
|
|
|
Service Code
|
NDC 00054005746
|
| Hospital Charge Code |
43556
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.43 |
| Max. Negotiated Rate |
$494.82 |
| Rate for Payer: Aetna American Axle |
$357.37
|
| Rate for Payer: Aetna Commercial |
$467.33
|
| Rate for Payer: Aetna Medicare |
$274.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.37
|
| Rate for Payer: BCBS Complete |
$219.92
|
| Rate for Payer: Cash Price |
$439.84
|
| Rate for Payer: Cofinity Commercial |
$384.86
|
| Rate for Payer: Cofinity Commercial |
$472.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$384.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.84
|
| Rate for Payer: Healthscope Commercial |
$494.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$412.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.33
|
| Rate for Payer: PHP Commercial |
$467.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.37
|
| Rate for Payer: Priority Health SBD |
$346.37
|
| Rate for Payer: UMR Bronson Commercial |
$203.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$412.35
|
|
|
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 |
$2,717.51 |
| Max. Negotiated Rate |
$15,209.94 |
| Rate for Payer: Aetna American Axle |
$7,517.44
|
| Rate for Payer: Aetna Commercial |
$9,830.50
|
| Rate for Payer: Aetna Medicare |
$5,272.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,517.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,337.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,337.48
|
| Rate for Payer: BCBS Complete |
$2,853.38
|
| Rate for Payer: BCBS MAPPO |
$5,069.98
|
| Rate for Payer: BCBS Trust/PPO |
$13,670.35
|
| Rate for Payer: BCN Commercial |
$13,670.35
|
| Rate for Payer: BCN Medicare Advantage |
$5,069.98
|
| 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 |
$5,069.98
|
| 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 |
$2,717.51
|
| Rate for Payer: Mclaren Medicare |
$5,069.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,323.48
|
| Rate for Payer: Meridian Medicaid |
$2,853.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,830.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,830.50
|
| Rate for Payer: Nomi Health Commercial |
$15,209.94
|
| Rate for Payer: PACE Medicare |
$4,816.48
|
| Rate for Payer: PACE SWMI |
$5,069.98
|
| Rate for Payer: PHP Commercial |
$9,830.50
|
| Rate for Payer: PHP Medicare Advantage |
$5,069.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,717.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,517.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,068.05
|
| Rate for Payer: Priority Health Medicare |
$5,069.98
|
| Rate for Payer: Priority Health Narrow Network |
$11,254.44
|
| Rate for Payer: Priority Health SBD |
$7,286.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5,069.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,271.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,069.98
|
| Rate for Payer: UHC Exchange |
$9,689.24
|
| Rate for Payer: UHC Medicare Advantage |
$5,069.98
|
| Rate for Payer: UHCCP Medicaid |
$2,717.51
|
| Rate for Payer: UMR Bronson Commercial |
$4,279.16
|
| Rate for Payer: VA VA |
$5,069.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,673.98
|
|
|
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 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 |
$42.37 |
| 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: BCBS Trust/PPO |
$42.37
|
| Rate for Payer: BCN Commercial |
$42.37
|
| Rate for Payer: Cash Price |
$258.50
|
| 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
|
|
|
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
|
|
|
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
|
|
|
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 |
$182.41
|
| Rate for Payer: Aetna American Axle |
$118.09
|
| Rate for Payer: Aetna American Axle |
$283.51
|
| Rate for Payer: Aetna Commercial |
$170.62
|
| 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 Medicare |
$140.32
|
| Rate for Payer: Aetna Medicare |
$207.18
|
| Rate for Payer: Aetna Medicare |
$100.36
|
| Rate for Payer: Aetna Medicare |
$90.84
|
| Rate for Payer: Aetna Medicare |
$218.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.34
|
| 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) |
$118.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.41
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS Complete |
$72.67
|
| Rate for Payer: BCBS Complete |
$165.75
|
| Rate for Payer: BCBS Complete |
$174.47
|
| Rate for Payer: BCBS Complete |
$112.25
|
| Rate for Payer: BCBS Trust/PPO |
$129.62
|
| Rate for Payer: BCBS Trust/PPO |
$129.62
|
| Rate for Payer: BCBS Trust/PPO |
$129.62
|
| Rate for Payer: BCBS Trust/PPO |
$129.62
|
| Rate for Payer: BCBS Trust/PPO |
$129.62
|
| Rate for Payer: BCN Commercial |
$129.62
|
| Rate for Payer: BCN Commercial |
$129.62
|
| Rate for Payer: BCN Commercial |
$129.62
|
| Rate for Payer: BCN Commercial |
$129.62
|
| Rate for Payer: BCN Commercial |
$129.62
|
| 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 |
$160.58
|
| Rate for Payer: Cash Price |
$145.34
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cash Price |
$348.94
|
| Rate for Payer: Cash Price |
$348.94
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cofinity Commercial |
$140.51
|
| Rate for Payer: Cofinity Commercial |
$375.11
|
| 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 |
$305.32
|
| Rate for Payer: Cofinity Commercial |
$356.36
|
| Rate for Payer: Cofinity Commercial |
$290.06
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$156.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.50
|
| 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 |
$145.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.50
|
| Rate for Payer: Healthscope Commercial |
$372.93
|
| Rate for Payer: Healthscope Commercial |
$163.51
|
| Rate for Payer: Healthscope Commercial |
$180.66
|
| Rate for Payer: Healthscope Commercial |
$252.57
|
| Rate for Payer: Healthscope Commercial |
$392.55
|
| 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 |
$290.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.47
|
| 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 |
$352.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.43
|
| Rate for Payer: PHP Commercial |
$370.74
|
| Rate for Payer: PHP Commercial |
$352.21
|
| Rate for Payer: PHP Commercial |
$170.62
|
| Rate for Payer: PHP Commercial |
$154.43
|
| Rate for Payer: PHP Commercial |
$238.54
|
| 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 |
$182.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.47
|
| Rate for Payer: Priority Health SBD |
$126.46
|
| Rate for Payer: Priority Health SBD |
$274.79
|
| Rate for Payer: Priority Health SBD |
$261.05
|
| Rate for Payer: Priority Health SBD |
$114.46
|
| Rate for Payer: Priority Health SBD |
$176.80
|
| Rate for Payer: UMR Bronson Commercial |
$67.22
|
| Rate for Payer: UMR Bronson Commercial |
$103.83
|
| Rate for Payer: UMR Bronson Commercial |
$74.27
|
| Rate for Payer: UMR Bronson Commercial |
$153.32
|
| Rate for Payer: UMR Bronson Commercial |
$161.38
|
| 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 |
$327.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.26
|
|
|
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 58120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$226.21 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,446.86
|
| Rate for Payer: BCN Commercial |
$2,446.86
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.83
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$226.21
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
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
|
$10,620.87
|
|
|
Service Code
|
CPT 50436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,397.51
|
| Rate for Payer: BCN Commercial |
$1,397.51
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.36
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$141.24
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
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
|
$10,620.87
|
|
|
Service Code
|
CPT 50437
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$234.43 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,434.68
|
| Rate for Payer: BCN Commercial |
$2,434.68
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.87
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$234.43
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
DILATION OF RECTAL STRICTURE (SEPARATE PROCEDURE) UNDER ANESTHESIA OTHER THAN LOCAL
|
Facility
|
OP
|
$3,630.90
|
|
|
Service Code
|
CPT 45910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$186.03 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,084.69
|
| Rate for Payer: BCN Commercial |
$1,084.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.63
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$186.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$619.21
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
DILATION SALIVARY DUCT
|
Facility
|
OP
|
$4,561.52
|
|
|
Service Code
|
CPT 42650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$56.28 |
| Max. Negotiated Rate |
$4,561.52 |
| Rate for Payer: Aetna Medicare |
$1,509.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$72.16
|
| Rate for Payer: BCN Commercial |
$72.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Nomi Health Commercial |
$3,047.79
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,561.52
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,649.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.91
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$56.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$777.91
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
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 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 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
|
$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: PHP Commercial |
$111.86
|
| 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: 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
|
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
|
$3.74
|
|
|
Service Code
|
NDC 51079074501
|
| Hospital Charge Code |
2475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna American Axle |
$2.43
|
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.43
|
| 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 |
$2.80
|
| 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 |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.80
|
|
