|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,149.96
|
|
|
Service Code
|
NDC 00074382611
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.49 |
| Max. Negotiated Rate |
$1,034.96 |
| Rate for Payer: Aetna American Axle |
$747.47
|
| Rate for Payer: Aetna Commercial |
$977.47
|
| Rate for Payer: Aetna Medicare |
$574.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.47
|
| Rate for Payer: BCBS Complete |
$459.98
|
| Rate for Payer: Cash Price |
$919.97
|
| Rate for Payer: Cofinity Commercial |
$804.97
|
| Rate for Payer: Cofinity Commercial |
$988.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$804.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.97
|
| Rate for Payer: Healthscope Commercial |
$1,034.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$804.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.47
|
| Rate for Payer: PHP Commercial |
$977.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.47
|
| Rate for Payer: Priority Health SBD |
$724.47
|
| Rate for Payer: UMR Bronson Commercial |
$425.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.47
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,146.26
|
|
|
Service Code
|
NDC 00074382613
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$424.12 |
| Max. Negotiated Rate |
$1,031.63 |
| Rate for Payer: Aetna American Axle |
$745.07
|
| Rate for Payer: Aetna Commercial |
$974.32
|
| Rate for Payer: Aetna Medicare |
$573.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.07
|
| Rate for Payer: BCBS Complete |
$458.50
|
| Rate for Payer: Cash Price |
$917.01
|
| Rate for Payer: Cofinity Commercial |
$802.38
|
| Rate for Payer: Cofinity Commercial |
$985.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$802.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$917.01
|
| Rate for Payer: Healthscope Commercial |
$1,031.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$802.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$859.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$974.32
|
| Rate for Payer: PHP Commercial |
$974.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.07
|
| Rate for Payer: Priority Health SBD |
$722.14
|
| Rate for Payer: UMR Bronson Commercial |
$424.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$859.70
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$228.95
|
|
|
Service Code
|
NDC 65162075510
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.71 |
| Max. Negotiated Rate |
$206.06 |
| Rate for Payer: Aetna American Axle |
$148.82
|
| Rate for Payer: Aetna Commercial |
$194.61
|
| Rate for Payer: Aetna Medicare |
$114.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.82
|
| Rate for Payer: BCBS Complete |
$91.58
|
| Rate for Payer: Cash Price |
$183.16
|
| Rate for Payer: Cofinity Commercial |
$160.26
|
| Rate for Payer: Cofinity Commercial |
$196.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.16
|
| Rate for Payer: Healthscope Commercial |
$206.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.61
|
| Rate for Payer: PHP Commercial |
$194.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.82
|
| Rate for Payer: Priority Health SBD |
$144.24
|
| Rate for Payer: UMR Bronson Commercial |
$84.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.71
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$270.25
|
|
|
Service Code
|
NDC 65862059401
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.91 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna American Axle |
$175.66
|
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| Rate for Payer: UMR Bronson Commercial |
$118.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,146.26
|
|
|
Service Code
|
NDC 00074382613
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$504.35 |
| Max. Negotiated Rate |
$1,031.63 |
| Rate for Payer: Aetna American Axle |
$745.07
|
| Rate for Payer: Aetna Commercial |
$974.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.07
|
| Rate for Payer: Cash Price |
$917.01
|
| Rate for Payer: Cofinity Commercial |
$802.38
|
| Rate for Payer: Cofinity Commercial |
$985.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$802.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$917.01
|
| Rate for Payer: Healthscope Commercial |
$1,031.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$802.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$859.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$974.32
|
| Rate for Payer: PHP Commercial |
$974.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.07
|
| Rate for Payer: Priority Health SBD |
$722.14
|
| Rate for Payer: UMR Bronson Commercial |
$504.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$859.70
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
NDC 00904636361
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.70 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna American Axle |
$257.71
|
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna Medicare |
$198.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| Rate for Payer: BCBS Complete |
$158.59
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.71
|
| Rate for Payer: Priority Health SBD |
$249.78
|
| Rate for Payer: UMR Bronson Commercial |
$146.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.36
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$228.95
|
|
|
Service Code
|
NDC 65162075510
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$206.06 |
| Rate for Payer: Aetna American Axle |
$148.82
|
| Rate for Payer: Aetna Commercial |
$194.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.82
|
| Rate for Payer: Cash Price |
$183.16
|
| Rate for Payer: Cofinity Commercial |
$160.26
|
| Rate for Payer: Cofinity Commercial |
$196.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.16
|
| Rate for Payer: Healthscope Commercial |
$206.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.61
|
| Rate for Payer: PHP Commercial |
$194.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.82
|
| Rate for Payer: Priority Health SBD |
$144.24
|
| Rate for Payer: UMR Bronson Commercial |
$100.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.71
|
|
|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$270.25
|
|
|
Service Code
|
NDC 65862059401
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.99 |
| Max. Negotiated Rate |
$243.22 |
| Rate for Payer: Aetna American Axle |
$175.66
|
| Rate for Payer: Aetna Commercial |
$229.71
|
| Rate for Payer: Aetna Medicare |
$135.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.66
|
| Rate for Payer: BCBS Complete |
$108.10
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cofinity Commercial |
$189.18
|
| Rate for Payer: Cofinity Commercial |
$232.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.20
|
| Rate for Payer: Healthscope Commercial |
$243.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.71
|
| Rate for Payer: PHP Commercial |
$229.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.66
|
| Rate for Payer: Priority Health SBD |
$170.26
|
| Rate for Payer: UMR Bronson Commercial |
$99.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.69
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$611.52
|
|
|
Service Code
|
NDC 00904718261
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.07 |
| Max. Negotiated Rate |
$550.37 |
| Rate for Payer: Aetna American Axle |
$397.49
|
| Rate for Payer: Aetna Commercial |
$519.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.49
|
| Rate for Payer: Cash Price |
$489.22
|
| Rate for Payer: Cofinity Commercial |
$428.06
|
| Rate for Payer: Cofinity Commercial |
$525.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.22
|
| Rate for Payer: Healthscope Commercial |
$550.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.79
|
| Rate for Payer: PHP Commercial |
$519.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.49
|
| Rate for Payer: Priority Health SBD |
$385.26
|
| Rate for Payer: UMR Bronson Commercial |
$269.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.64
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$596.15
|
|
|
Service Code
|
NDC 00904636445
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.31 |
| Max. Negotiated Rate |
$536.54 |
| Rate for Payer: Aetna American Axle |
$387.50
|
| Rate for Payer: Aetna Commercial |
$506.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.50
|
| Rate for Payer: Cash Price |
$476.92
|
| Rate for Payer: Cofinity Commercial |
$417.30
|
| Rate for Payer: Cofinity Commercial |
$512.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$417.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.92
|
| Rate for Payer: Healthscope Commercial |
$536.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.73
|
| Rate for Payer: PHP Commercial |
$506.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.50
|
| Rate for Payer: Priority Health SBD |
$375.57
|
| Rate for Payer: UMR Bronson Commercial |
$262.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.11
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$622.08
|
|
|
Service Code
|
NDC 00904718245
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.72 |
| Max. Negotiated Rate |
$559.87 |
| Rate for Payer: Aetna American Axle |
$404.35
|
| Rate for Payer: Aetna Commercial |
$528.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.35
|
| Rate for Payer: Cash Price |
$497.66
|
| Rate for Payer: Cofinity Commercial |
$435.46
|
| Rate for Payer: Cofinity Commercial |
$534.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.66
|
| Rate for Payer: Healthscope Commercial |
$559.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.77
|
| Rate for Payer: PHP Commercial |
$528.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.35
|
| Rate for Payer: Priority Health SBD |
$391.91
|
| Rate for Payer: UMR Bronson Commercial |
$273.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.56
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$622.08
|
|
|
Service Code
|
NDC 00904718245
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.17 |
| Max. Negotiated Rate |
$559.87 |
| Rate for Payer: Aetna American Axle |
$404.35
|
| Rate for Payer: Aetna Commercial |
$528.77
|
| Rate for Payer: Aetna Medicare |
$311.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.35
|
| Rate for Payer: BCBS Complete |
$248.83
|
| Rate for Payer: Cash Price |
$497.66
|
| Rate for Payer: Cofinity Commercial |
$435.46
|
| Rate for Payer: Cofinity Commercial |
$534.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.66
|
| Rate for Payer: Healthscope Commercial |
$559.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.77
|
| Rate for Payer: PHP Commercial |
$528.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.35
|
| Rate for Payer: Priority Health SBD |
$391.91
|
| Rate for Payer: UMR Bronson Commercial |
$230.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.56
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$688.50
|
|
|
Service Code
|
NDC 51079076708
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$302.94 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Aetna American Axle |
$447.52
|
| Rate for Payer: Aetna Commercial |
$585.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.52
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Commercial |
$481.95
|
| Rate for Payer: Cofinity Commercial |
$592.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Healthscope Commercial |
$619.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.22
|
| Rate for Payer: PHP Commercial |
$585.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.52
|
| Rate for Payer: Priority Health SBD |
$433.76
|
| Rate for Payer: UMR Bronson Commercial |
$302.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.38
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$611.52
|
|
|
Service Code
|
NDC 00904718261
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.26 |
| Max. Negotiated Rate |
$550.37 |
| Rate for Payer: Aetna American Axle |
$397.49
|
| Rate for Payer: Aetna Commercial |
$519.79
|
| Rate for Payer: Aetna Medicare |
$305.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.49
|
| Rate for Payer: BCBS Complete |
$244.61
|
| Rate for Payer: Cash Price |
$489.22
|
| Rate for Payer: Cofinity Commercial |
$428.06
|
| Rate for Payer: Cofinity Commercial |
$525.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.22
|
| Rate for Payer: Healthscope Commercial |
$550.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.79
|
| Rate for Payer: PHP Commercial |
$519.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.49
|
| Rate for Payer: Priority Health SBD |
$385.26
|
| Rate for Payer: UMR Bronson Commercial |
$226.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.64
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
NDC 51079076701
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna American Axle |
$5.60
|
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Aetna Medicare |
$4.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.60
|
| Rate for Payer: BCBS Complete |
$3.44
|
| Rate for Payer: Cash Price |
$6.89
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$7.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.32
|
| Rate for Payer: PHP Commercial |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health SBD |
$5.42
|
| Rate for Payer: UMR Bronson Commercial |
$3.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.46
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
NDC 51079076701
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna American Axle |
$5.60
|
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.60
|
| Rate for Payer: Cash Price |
$6.89
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$7.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.32
|
| Rate for Payer: PHP Commercial |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health SBD |
$5.42
|
| Rate for Payer: UMR Bronson Commercial |
$3.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.46
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$596.15
|
|
|
Service Code
|
NDC 00904636445
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$536.54 |
| Rate for Payer: Aetna American Axle |
$387.50
|
| Rate for Payer: Aetna Commercial |
$506.73
|
| Rate for Payer: Aetna Medicare |
$298.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.50
|
| Rate for Payer: BCBS Complete |
$238.46
|
| Rate for Payer: Cash Price |
$476.92
|
| Rate for Payer: Cofinity Commercial |
$417.30
|
| Rate for Payer: Cofinity Commercial |
$512.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$417.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.92
|
| Rate for Payer: Healthscope Commercial |
$536.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.73
|
| Rate for Payer: PHP Commercial |
$506.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.50
|
| Rate for Payer: Priority Health SBD |
$375.57
|
| Rate for Payer: UMR Bronson Commercial |
$220.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.11
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$688.50
|
|
|
Service Code
|
NDC 51079076708
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.74 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Aetna American Axle |
$447.52
|
| Rate for Payer: Aetna Commercial |
$585.22
|
| Rate for Payer: Aetna Medicare |
$344.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.52
|
| Rate for Payer: BCBS Complete |
$275.40
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Commercial |
$481.95
|
| Rate for Payer: Cofinity Commercial |
$592.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Healthscope Commercial |
$619.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.22
|
| Rate for Payer: PHP Commercial |
$585.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.52
|
| Rate for Payer: Priority Health SBD |
$433.76
|
| Rate for Payer: UMR Bronson Commercial |
$254.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.38
|
|
|
DIVISION OF PLANTAR FASCIA AND MUSCLE (EG, STEINDLER STRIPPING) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$397.66 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$437.43
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$397.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
9892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna American Axle |
$17.59
|
| Rate for Payer: Aetna American Axle |
$20.36
|
| Rate for Payer: Aetna Commercial |
$23.00
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$26.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.59
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cash Price |
$21.65
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$23.27
|
| Rate for Payer: Cofinity Commercial |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$26.94
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.65
|
| Rate for Payer: Healthscope Commercial |
$24.35
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$28.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.00
|
| Rate for Payer: PHP Commercial |
$26.63
|
| Rate for Payer: PHP Commercial |
$23.00
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$19.74
|
| Rate for Payer: Priority Health SBD |
$17.05
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UMR Bronson Commercial |
$9.51
|
| Rate for Payer: UMR Bronson Commercial |
$13.79
|
| Rate for Payer: UMR Bronson Commercial |
$11.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.30
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.33
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
9892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$28.20 |
| Rate for Payer: Aetna American Axle |
$20.36
|
| Rate for Payer: Aetna American Axle |
$17.59
|
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna Commercial |
$26.63
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$23.00
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna Medicare |
$15.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.59
|
| Rate for Payer: BCBS Complete |
$10.82
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS Trust/PPO |
$21.36
|
| Rate for Payer: BCBS Trust/PPO |
$21.36
|
| Rate for Payer: BCBS Trust/PPO |
$21.36
|
| Rate for Payer: BCN Commercial |
$21.36
|
| Rate for Payer: BCN Commercial |
$21.36
|
| Rate for Payer: BCN Commercial |
$21.36
|
| Rate for Payer: Cash Price |
$21.65
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$21.65
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cofinity Commercial |
$23.27
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$26.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$28.20
|
| Rate for Payer: Healthscope Commercial |
$24.35
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.63
|
| Rate for Payer: PHP Commercial |
$26.63
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.36
|
| Rate for Payer: Priority Health SBD |
$17.05
|
| Rate for Payer: Priority Health SBD |
$19.74
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UMR Bronson Commercial |
$11.59
|
| Rate for Payer: UMR Bronson Commercial |
$8.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.50
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$66.56
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.29 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: Aetna American Axle |
$43.26
|
| Rate for Payer: Aetna American Axle |
$57.02
|
| Rate for Payer: Aetna Commercial |
$56.58
|
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Cofinity Commercial |
$57.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$59.90
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.58
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$56.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health SBD |
$41.93
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: UMR Bronson Commercial |
$29.29
|
| Rate for Payer: UMR Bronson Commercial |
$38.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$66.56
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: Aetna American Axle |
$43.26
|
| Rate for Payer: Aetna American Axle |
$57.02
|
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna Commercial |
$56.58
|
| Rate for Payer: Aetna Medicare |
$33.28
|
| Rate for Payer: Aetna Medicare |
$43.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS Trust/PPO |
$21.36
|
| Rate for Payer: BCBS Trust/PPO |
$21.36
|
| Rate for Payer: BCN Commercial |
$21.36
|
| Rate for Payer: BCN Commercial |
$21.36
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Cofinity Commercial |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$57.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.25
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$59.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$56.58
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: Priority Health SBD |
$41.93
|
| Rate for Payer: UMR Bronson Commercial |
$24.63
|
| Rate for Payer: UMR Bronson Commercial |
$32.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.92
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
OP
|
$80.33
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna American Axle |
$52.21
|
| Rate for Payer: Aetna American Axle |
$62.65
|
| Rate for Payer: Aetna Commercial |
$81.93
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.65
|
| Rate for Payer: BCBS Complete |
$38.56
|
| Rate for Payer: BCBS Complete |
$32.13
|
| Rate for Payer: BCBS Trust/PPO |
$21.36
|
| Rate for Payer: BCBS Trust/PPO |
$21.36
|
| Rate for Payer: BCN Commercial |
$21.36
|
| Rate for Payer: BCN Commercial |
$21.36
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.93
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: PHP Commercial |
$81.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.65
|
| Rate for Payer: Priority Health SBD |
$60.73
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: UMR Bronson Commercial |
$29.72
|
| Rate for Payer: UMR Bronson Commercial |
$35.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
IP
|
$80.33
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna American Axle |
$52.21
|
| Rate for Payer: Aetna American Axle |
$62.65
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Commercial |
$81.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.65
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: PHP Commercial |
$81.93
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.65
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: Priority Health SBD |
$60.73
|
| Rate for Payer: UMR Bronson Commercial |
$35.35
|
| Rate for Payer: UMR Bronson Commercial |
$42.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.29
|
|
