|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$16,329.25
|
|
|
Service Code
|
APR-DRG 0824
|
| Min. Negotiated Rate |
$15,551.66 |
| Max. Negotiated Rate |
$16,329.25 |
| Rate for Payer: BCBS Complete |
$16,329.25
|
| Rate for Payer: Mclaren Medicaid |
$15,551.66
|
| Rate for Payer: Meridian Medicaid |
$16,329.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,551.66
|
| Rate for Payer: UHC Medicaid |
$15,551.66
|
| Rate for Payer: UHCCP Medicaid |
$15,551.66
|
|
|
EYELASH TINTING
|
Professional
|
Both
|
$32.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 00781569092
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$115.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Advantage |
$161.59
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.14
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.05
|
| Rate for Payer: UHC Core |
$120.27
|
| Rate for Payer: UHC Exchange |
$90.72
|
| Rate for Payer: UMR Bronson Commercial |
$85.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 00781569092
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Advantage |
$161.59
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.14
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UMR Bronson Commercial |
$101.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$331.78
|
|
|
Service Code
|
NDC 60505294509
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.76 |
| Max. Negotiated Rate |
$298.60 |
| Rate for Payer: Aetna American Axle |
$215.66
|
| Rate for Payer: Aetna Commercial |
$282.01
|
| Rate for Payer: Aetna Medicare |
$165.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.66
|
| Rate for Payer: BCBS Complete |
$132.71
|
| Rate for Payer: Cash Price |
$265.42
|
| Rate for Payer: Cofinity Advantage |
$232.25
|
| Rate for Payer: Cofinity Commercial |
$285.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.42
|
| Rate for Payer: Healthscope Commercial |
$298.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.84
|
| Rate for Payer: PHP Commercial |
$282.01
|
| Rate for Payer: Priority Health SBD |
$209.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.66
|
| Rate for Payer: UHC Core |
$172.86
|
| Rate for Payer: UHC Exchange |
$130.39
|
| Rate for Payer: UMR Bronson Commercial |
$122.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.84
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$14.99
|
|
|
Service Code
|
NDC 50268029811
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna American Axle |
$9.74
|
| Rate for Payer: Aetna Commercial |
$12.74
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.74
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Cofinity Advantage |
$10.49
|
| Rate for Payer: Cofinity Commercial |
$12.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.99
|
| Rate for Payer: Healthscope Commercial |
$13.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.24
|
| Rate for Payer: PHP Commercial |
$12.74
|
| Rate for Payer: Priority Health SBD |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.74
|
| Rate for Payer: UHC Core |
$7.81
|
| Rate for Payer: UHC Exchange |
$5.89
|
| Rate for Payer: UMR Bronson Commercial |
$5.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.24
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$299.63
|
|
|
Service Code
|
NDC 50268029812
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.86 |
| Max. Negotiated Rate |
$269.67 |
| Rate for Payer: Aetna American Axle |
$194.76
|
| Rate for Payer: Aetna Commercial |
$254.69
|
| Rate for Payer: Aetna Medicare |
$149.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.76
|
| Rate for Payer: BCBS Complete |
$119.85
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cofinity Advantage |
$209.74
|
| Rate for Payer: Cofinity Commercial |
$257.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.70
|
| Rate for Payer: Healthscope Commercial |
$269.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.72
|
| Rate for Payer: PHP Commercial |
$254.69
|
| Rate for Payer: Priority Health SBD |
$188.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.76
|
| Rate for Payer: UHC Core |
$156.11
|
| Rate for Payer: UHC Exchange |
$117.75
|
| Rate for Payer: UMR Bronson Commercial |
$110.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.72
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$233.42
|
|
|
Service Code
|
NDC 67877049090
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$210.08 |
| Rate for Payer: Aetna American Axle |
$151.72
|
| Rate for Payer: Aetna Commercial |
$198.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.72
|
| Rate for Payer: Cash Price |
$186.74
|
| Rate for Payer: Cofinity Advantage |
$163.39
|
| Rate for Payer: Cofinity Commercial |
$200.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.74
|
| Rate for Payer: Healthscope Commercial |
$210.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.06
|
| Rate for Payer: PHP Commercial |
$198.41
|
| Rate for Payer: Priority Health SBD |
$147.05
|
| Rate for Payer: UMR Bronson Commercial |
$102.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.06
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$233.42
|
|
|
Service Code
|
NDC 67877049090
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.37 |
| Max. Negotiated Rate |
$210.08 |
| Rate for Payer: Aetna American Axle |
$151.72
|
| Rate for Payer: Aetna Commercial |
$198.41
|
| Rate for Payer: Aetna Medicare |
$116.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.72
|
| Rate for Payer: BCBS Complete |
$93.37
|
| Rate for Payer: Cash Price |
$186.74
|
| Rate for Payer: Cofinity Advantage |
$163.39
|
| Rate for Payer: Cofinity Commercial |
$200.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.74
|
| Rate for Payer: Healthscope Commercial |
$210.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$163.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.06
|
| Rate for Payer: PHP Commercial |
$198.41
|
| Rate for Payer: Priority Health SBD |
$147.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.72
|
| Rate for Payer: UHC Core |
$121.61
|
| Rate for Payer: UHC Exchange |
$91.73
|
| Rate for Payer: UMR Bronson Commercial |
$86.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.06
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$299.63
|
|
|
Service Code
|
NDC 50268029812
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.84 |
| Max. Negotiated Rate |
$269.67 |
| Rate for Payer: Aetna American Axle |
$194.76
|
| Rate for Payer: Aetna Commercial |
$254.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.76
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cofinity Advantage |
$209.74
|
| Rate for Payer: Cofinity Commercial |
$257.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.70
|
| Rate for Payer: Healthscope Commercial |
$269.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.72
|
| Rate for Payer: PHP Commercial |
$254.69
|
| Rate for Payer: Priority Health SBD |
$188.77
|
| Rate for Payer: UMR Bronson Commercial |
$131.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.72
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$331.78
|
|
|
Service Code
|
NDC 60505294509
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.98 |
| Max. Negotiated Rate |
$298.60 |
| Rate for Payer: Aetna American Axle |
$215.66
|
| Rate for Payer: Aetna Commercial |
$282.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.66
|
| Rate for Payer: Cash Price |
$265.42
|
| Rate for Payer: Cofinity Advantage |
$232.25
|
| Rate for Payer: Cofinity Commercial |
$285.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.42
|
| Rate for Payer: Healthscope Commercial |
$298.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$248.84
|
| Rate for Payer: PHP Commercial |
$282.01
|
| Rate for Payer: Priority Health SBD |
$209.02
|
| Rate for Payer: UMR Bronson Commercial |
$145.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.84
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$14.99
|
|
|
Service Code
|
NDC 50268029811
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: Aetna American Axle |
$9.74
|
| Rate for Payer: Aetna Commercial |
$12.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.74
|
| Rate for Payer: Cash Price |
$11.99
|
| Rate for Payer: Cofinity Advantage |
$10.49
|
| Rate for Payer: Cofinity Commercial |
$12.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.99
|
| Rate for Payer: Healthscope Commercial |
$13.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.24
|
| Rate for Payer: PHP Commercial |
$12.74
|
| Rate for Payer: Priority Health SBD |
$9.44
|
| Rate for Payer: UMR Bronson Commercial |
$6.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.24
|
|
|
FACIAL
|
Professional
|
Both
|
$68.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
| Rate for Payer: UMR Bronson Commercial |
$31.28
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$11,833.50
|
|
|
Service Code
|
APR-DRG 0921
|
| Min. Negotiated Rate |
$11,270.00 |
| Max. Negotiated Rate |
$11,833.50 |
| Rate for Payer: BCBS Complete |
$11,833.50
|
| Rate for Payer: Mclaren Medicaid |
$11,270.00
|
| Rate for Payer: Meridian Medicaid |
$11,833.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,270.00
|
| Rate for Payer: UHC Medicaid |
$11,270.00
|
| Rate for Payer: UHCCP Medicaid |
$11,270.00
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$37,603.39
|
|
|
Service Code
|
APR-DRG 0924
|
| Min. Negotiated Rate |
$35,812.76 |
| Max. Negotiated Rate |
$37,603.39 |
| Rate for Payer: BCBS Complete |
$37,603.39
|
| Rate for Payer: Mclaren Medicaid |
$35,812.76
|
| Rate for Payer: Meridian Medicaid |
$37,603.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$35,812.76
|
| Rate for Payer: UHC Medicaid |
$35,812.76
|
| Rate for Payer: UHCCP Medicaid |
$35,812.76
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$23,736.00
|
|
|
Service Code
|
APR-DRG 0923
|
| Min. Negotiated Rate |
$22,605.72 |
| Max. Negotiated Rate |
$23,736.00 |
| Rate for Payer: BCBS Complete |
$23,736.00
|
| Rate for Payer: Mclaren Medicaid |
$22,605.72
|
| Rate for Payer: Meridian Medicaid |
$23,736.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,605.72
|
| Rate for Payer: UHC Medicaid |
$22,605.72
|
| Rate for Payer: UHCCP Medicaid |
$22,605.72
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$13,312.31
|
|
|
Service Code
|
APR-DRG 0922
|
| Min. Negotiated Rate |
$12,678.39 |
| Max. Negotiated Rate |
$13,312.31 |
| Rate for Payer: BCBS Complete |
$13,312.31
|
| Rate for Payer: Mclaren Medicaid |
$12,678.39
|
| Rate for Payer: Meridian Medicaid |
$13,312.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,678.39
|
| Rate for Payer: UHC Medicaid |
$12,678.39
|
| Rate for Payer: UHCCP Medicaid |
$12,678.39
|
|
|
FACILITY SERVICES FOR DENTAL REHABILITATION PROCEDURE(S) PERFORMED ON A PATIENT WHO REQUIRES MONITORED ANESTHESIA (E.G., GENERAL, INTRAVENOUS SEDATION (MONITORED ANESTHESIA CARE) AND USE OF AN OPERATING ROOM
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT G0330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
FACTOR IX HUMAN (RECOMBINANT THR 148) 1,500 UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3.24
|
|
|
Service Code
|
HCPCS J7213
|
| Hospital Charge Code |
168781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna Medicare |
$2.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.46
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS MAPPO |
$1.97
|
| Rate for Payer: BCBS Trust/PPO |
$6.68
|
| Rate for Payer: BCN Commercial |
$6.68
|
| Rate for Payer: BCN Medicare Advantage |
$1.97
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Advantage |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Mclaren Medicaid |
$1.97
|
| Rate for Payer: Mclaren Medicare |
$1.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.07
|
| Rate for Payer: Meridian Medicaid |
$2.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Nomi Health Commercial |
$5.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.43
|
| Rate for Payer: PACE Medicare |
$1.87
|
| Rate for Payer: PACE SWMI |
$1.97
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: PHP Medicare Advantage |
$1.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.03
|
| Rate for Payer: Priority Health Medicare |
$1.97
|
| Rate for Payer: Priority Health SBD |
$2.04
|
| Rate for Payer: Priority Health Tiered Network |
$4.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.42
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.97
|
| Rate for Payer: UHC Exchange |
$3.42
|
| Rate for Payer: UHC Medicaid |
$1.03
|
| Rate for Payer: UHCCP Medicaid |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: VA VA |
$1.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
FACTOR IX HUMAN (RECOMBINANT THR 148) 1,500 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
HCPCS J7213
|
| Hospital Charge Code |
168781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Advantage |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.43
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health SBD |
$2.04
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$90.50
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$81.45 |
| Rate for Payer: Aetna American Axle |
$58.83
|
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna American Axle |
$24.31
|
| Rate for Payer: Aetna American Axle |
$356.69
|
| Rate for Payer: Aetna Commercial |
$76.92
|
| Rate for Payer: Aetna Commercial |
$466.44
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: Aetna Medicare |
$274.38
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna Medicare |
$45.25
|
| Rate for Payer: Aetna Medicare |
$142.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.69
|
| Rate for Payer: BCBS Complete |
$114.00
|
| Rate for Payer: BCBS Complete |
$14.96
|
| Rate for Payer: BCBS Complete |
$219.50
|
| Rate for Payer: BCBS Complete |
$36.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Advantage |
$63.35
|
| Rate for Payer: Cofinity Advantage |
$384.12
|
| Rate for Payer: Cofinity Advantage |
$26.18
|
| Rate for Payer: Cofinity Advantage |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Cofinity Commercial |
$471.93
|
| Rate for Payer: Cofinity Commercial |
$77.83
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$493.88
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Healthscope Commercial |
$81.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.88
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: PHP Commercial |
$466.44
|
| Rate for Payer: PHP Commercial |
$76.92
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: Priority Health SBD |
$345.71
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: Priority Health SBD |
$23.56
|
| Rate for Payer: Priority Health SBD |
$57.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$33.48
|
| Rate for Payer: UMR Bronson Commercial |
$105.45
|
| Rate for Payer: UMR Bronson Commercial |
$13.84
|
| Rate for Payer: UMR Bronson Commercial |
$203.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.88
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna American Axle |
$356.69
|
| Rate for Payer: Aetna American Axle |
$24.31
|
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Commercial |
$466.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.31
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cofinity Advantage |
$384.12
|
| Rate for Payer: Cofinity Advantage |
$199.50
|
| Rate for Payer: Cofinity Advantage |
$26.18
|
| Rate for Payer: Cofinity Commercial |
$471.93
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.00
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Healthscope Commercial |
$493.88
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.56
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: PHP Commercial |
$466.44
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: Priority Health SBD |
$23.56
|
| Rate for Payer: Priority Health SBD |
$345.71
|
| Rate for Payer: UMR Bronson Commercial |
$125.40
|
| Rate for Payer: UMR Bronson Commercial |
$241.45
|
| Rate for Payer: UMR Bronson Commercial |
$16.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.56
|
|
|
FAMOTIDINE 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$39.10
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
163732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$35.19 |
| Rate for Payer: Aetna American Axle |
$25.41
|
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna American Axle |
$356.69
|
| Rate for Payer: Aetna Commercial |
$33.23
|
| Rate for Payer: Aetna Commercial |
$466.44
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Medicare |
$19.55
|
| Rate for Payer: Aetna Medicare |
$142.50
|
| Rate for Payer: Aetna Medicare |
$274.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.69
|
| Rate for Payer: BCBS Complete |
$114.00
|
| Rate for Payer: BCBS Complete |
$15.64
|
| Rate for Payer: BCBS Complete |
$219.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cash Price |
$31.28
|
| Rate for Payer: Cash Price |
$31.28
|
| Rate for Payer: Cofinity Advantage |
$384.12
|
| Rate for Payer: Cofinity Advantage |
$27.37
|
| Rate for Payer: Cofinity Advantage |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$471.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.28
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Healthscope Commercial |
$35.19
|
| Rate for Payer: Healthscope Commercial |
$493.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.56
|
| Rate for Payer: PHP Commercial |
$33.23
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: PHP Commercial |
$466.44
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: Priority Health SBD |
$345.71
|
| Rate for Payer: Priority Health SBD |
$24.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$203.04
|
| Rate for Payer: UMR Bronson Commercial |
$105.45
|
| Rate for Payer: UMR Bronson Commercial |
$14.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.56
|
|
|
FAMOTIDINE 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
163732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna American Axle |
$356.69
|
| Rate for Payer: Aetna American Axle |
$25.41
|
| Rate for Payer: Aetna Commercial |
$33.23
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Commercial |
$466.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.41
|
| Rate for Payer: Cash Price |
$31.28
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cofinity Advantage |
$384.12
|
| Rate for Payer: Cofinity Advantage |
$199.50
|
| Rate for Payer: Cofinity Advantage |
$27.37
|
| Rate for Payer: Cofinity Commercial |
$471.93
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$33.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.00
|
| Rate for Payer: Healthscope Commercial |
$35.19
|
| Rate for Payer: Healthscope Commercial |
$493.88
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$466.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.56
|
| Rate for Payer: PHP Commercial |
$33.23
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: PHP Commercial |
$466.44
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: Priority Health SBD |
$24.63
|
| Rate for Payer: Priority Health SBD |
$345.71
|
| Rate for Payer: UMR Bronson Commercial |
$125.40
|
| Rate for Payer: UMR Bronson Commercial |
$241.45
|
| Rate for Payer: UMR Bronson Commercial |
$17.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.56
|
|
|
FAMOTIDINE 10 MG TABLET
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
NDC 09900000880
|
| Hospital Charge Code |
15065
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna American Axle |
$1.04
|
| Rate for Payer: Aetna Commercial |
$1.36
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.04
|
| Rate for Payer: BCBS Complete |
$0.64
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cofinity Advantage |
$1.12
|
| Rate for Payer: Cofinity Commercial |
$1.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.20
|
| Rate for Payer: PHP Commercial |
$1.36
|
| Rate for Payer: Priority Health SBD |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.04
|
| Rate for Payer: UHC Core |
$0.83
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UMR Bronson Commercial |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.20
|
|
