|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 51079096620
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$74.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Advantage |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.23
|
| Rate for Payer: UHC Core |
$77.13
|
| Rate for Payer: UHC Exchange |
$58.18
|
| Rate for Payer: UMR Bronson Commercial |
$54.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 00536129801
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Advantage |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.43
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$116.33
|
|
|
Service Code
|
NDC 00904578051
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.04 |
| Max. Negotiated Rate |
$104.70 |
| Rate for Payer: Aetna American Axle |
$75.61
|
| Rate for Payer: Aetna Commercial |
$98.88
|
| Rate for Payer: Aetna Medicare |
$58.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.61
|
| Rate for Payer: BCBS Complete |
$46.53
|
| Rate for Payer: Cash Price |
$93.06
|
| Rate for Payer: Cofinity Advantage |
$81.43
|
| Rate for Payer: Cofinity Commercial |
$100.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.06
|
| Rate for Payer: Healthscope Commercial |
$104.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.25
|
| Rate for Payer: PHP Commercial |
$98.88
|
| Rate for Payer: Priority Health SBD |
$73.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.61
|
| Rate for Payer: UHC Core |
$60.61
|
| Rate for Payer: UHC Exchange |
$45.72
|
| Rate for Payer: UMR Bronson Commercial |
$43.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.25
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
NDC 51079096601
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna American Axle |
$0.97
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.97
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Advantage |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.12
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health SBD |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 00172572860
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.86
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Advantage |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.30
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UMR Bronson Commercial |
$107.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
NDC 51079096601
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna American Axle |
$0.97
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna Medicare |
$0.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.97
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Advantage |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.12
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health SBD |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.97
|
| Rate for Payer: UHC Core |
$0.78
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 61442012101
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Advantage |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$65.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 50268030315
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UMR Bronson Commercial |
$48.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$244.40
|
|
|
Service Code
|
NDC 172572860
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.43 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.86
|
| Rate for Payer: BCBS Complete |
$97.76
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Advantage |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.30
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.86
|
| Rate for Payer: UHC Core |
$127.33
|
| Rate for Payer: UHC Exchange |
$96.05
|
| Rate for Payer: UMR Bronson Commercial |
$90.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 63739064510
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna American Axle |
$116.09
|
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.09
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Advantage |
$125.02
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.95
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health SBD |
$112.52
|
| Rate for Payer: UMR Bronson Commercial |
$78.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
FAMOTIDINE 20 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 00536129801
|
| Hospital Charge Code |
10011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Advantage |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.03
|
| Rate for Payer: UHC Core |
$90.60
|
| Rate for Payer: UHC Exchange |
$68.34
|
| Rate for Payer: UMR Bronson Commercial |
$64.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.43
|
|
|
FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$226.58
|
|
|
Service Code
|
NDC 70954031610
|
| Hospital Charge Code |
10010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.83 |
| Max. Negotiated Rate |
$203.92 |
| Rate for Payer: Aetna American Axle |
$147.28
|
| Rate for Payer: Aetna Commercial |
$192.59
|
| Rate for Payer: Aetna Medicare |
$113.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.28
|
| Rate for Payer: BCBS Complete |
$90.63
|
| Rate for Payer: Cash Price |
$181.26
|
| Rate for Payer: Cofinity Advantage |
$158.61
|
| Rate for Payer: Cofinity Commercial |
$194.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.26
|
| Rate for Payer: Healthscope Commercial |
$203.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.94
|
| Rate for Payer: PHP Commercial |
$192.59
|
| Rate for Payer: Priority Health SBD |
$142.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.28
|
| Rate for Payer: UHC Core |
$118.05
|
| Rate for Payer: UHC Exchange |
$89.05
|
| Rate for Payer: UMR Bronson Commercial |
$83.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.94
|
|
|
FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$440.88
|
|
|
Service Code
|
NDC 68382044405
|
| Hospital Charge Code |
10010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.99 |
| Max. Negotiated Rate |
$396.79 |
| Rate for Payer: Aetna American Axle |
$286.57
|
| Rate for Payer: Aetna Commercial |
$374.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.57
|
| Rate for Payer: Cash Price |
$352.70
|
| Rate for Payer: Cofinity Advantage |
$308.62
|
| Rate for Payer: Cofinity Commercial |
$379.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.70
|
| Rate for Payer: Healthscope Commercial |
$396.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.66
|
| Rate for Payer: PHP Commercial |
$374.75
|
| Rate for Payer: Priority Health SBD |
$277.75
|
| Rate for Payer: UMR Bronson Commercial |
$193.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.66
|
|
|
FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$226.58
|
|
|
Service Code
|
NDC 70954031610
|
| Hospital Charge Code |
10010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.70 |
| Max. Negotiated Rate |
$203.92 |
| Rate for Payer: Aetna American Axle |
$147.28
|
| Rate for Payer: Aetna Commercial |
$192.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.28
|
| Rate for Payer: Cash Price |
$181.26
|
| Rate for Payer: Cofinity Advantage |
$158.61
|
| Rate for Payer: Cofinity Commercial |
$194.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.26
|
| Rate for Payer: Healthscope Commercial |
$203.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.94
|
| Rate for Payer: PHP Commercial |
$192.59
|
| Rate for Payer: Priority Health SBD |
$142.75
|
| Rate for Payer: UMR Bronson Commercial |
$99.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.94
|
|
|
FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$441.84
|
|
|
Service Code
|
NDC 68180015001
|
| Hospital Charge Code |
10010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.41 |
| Max. Negotiated Rate |
$397.66 |
| Rate for Payer: Aetna American Axle |
$287.20
|
| Rate for Payer: Aetna Commercial |
$375.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.20
|
| Rate for Payer: Cash Price |
$353.47
|
| Rate for Payer: Cofinity Advantage |
$309.29
|
| Rate for Payer: Cofinity Commercial |
$379.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.47
|
| Rate for Payer: Healthscope Commercial |
$397.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.38
|
| Rate for Payer: PHP Commercial |
$375.56
|
| Rate for Payer: Priority Health SBD |
$278.36
|
| Rate for Payer: UMR Bronson Commercial |
$194.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.38
|
|
|
FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$441.84
|
|
|
Service Code
|
NDC 68180015001
|
| Hospital Charge Code |
10010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.48 |
| Max. Negotiated Rate |
$397.66 |
| Rate for Payer: Aetna American Axle |
$287.20
|
| Rate for Payer: Aetna Commercial |
$375.56
|
| Rate for Payer: Aetna Medicare |
$220.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.20
|
| Rate for Payer: BCBS Complete |
$176.74
|
| Rate for Payer: Cash Price |
$353.47
|
| Rate for Payer: Cofinity Advantage |
$309.29
|
| Rate for Payer: Cofinity Commercial |
$379.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.47
|
| Rate for Payer: Healthscope Commercial |
$397.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.38
|
| Rate for Payer: PHP Commercial |
$375.56
|
| Rate for Payer: Priority Health SBD |
$278.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.20
|
| Rate for Payer: UHC Core |
$230.20
|
| Rate for Payer: UHC Exchange |
$173.64
|
| Rate for Payer: UMR Bronson Commercial |
$163.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.38
|
|
|
FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$440.88
|
|
|
Service Code
|
NDC 68382044405
|
| Hospital Charge Code |
10010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.13 |
| Max. Negotiated Rate |
$396.79 |
| Rate for Payer: Aetna American Axle |
$286.57
|
| Rate for Payer: Aetna Commercial |
$374.75
|
| Rate for Payer: Aetna Medicare |
$220.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.57
|
| Rate for Payer: BCBS Complete |
$176.35
|
| Rate for Payer: Cash Price |
$352.70
|
| Rate for Payer: Cofinity Advantage |
$308.62
|
| Rate for Payer: Cofinity Commercial |
$379.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.70
|
| Rate for Payer: Healthscope Commercial |
$396.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$352.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.66
|
| Rate for Payer: PHP Commercial |
$374.75
|
| Rate for Payer: Priority Health SBD |
$277.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.57
|
| Rate for Payer: UHC Core |
$229.70
|
| Rate for Payer: UHC Exchange |
$173.27
|
| Rate for Payer: UMR Bronson Commercial |
$163.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.66
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Aetna American Axle |
$8.42
|
| Rate for Payer: Aetna American Axle |
$10.76
|
| Rate for Payer: Aetna American Axle |
$10.43
|
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cofinity Advantage |
$11.59
|
| Rate for Payer: Cofinity Advantage |
$9.06
|
| Rate for Payer: Cofinity Advantage |
$11.23
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Cofinity Commercial |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$11.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.42
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: PHP Commercial |
$11.01
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health SBD |
$8.16
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: Priority Health SBD |
$10.43
|
| Rate for Payer: UMR Bronson Commercial |
$5.70
|
| Rate for Payer: UMR Bronson Commercial |
$7.29
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.42
|
|
|
FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12.70
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
117801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Aetna American Axle |
$8.26
|
| Rate for Payer: Aetna American Axle |
$9.95
|
| Rate for Payer: Aetna American Axle |
$10.43
|
| Rate for Payer: Aetna American Axle |
$7.83
|
| Rate for Payer: Aetna American Axle |
$10.76
|
| Rate for Payer: Aetna American Axle |
$8.42
|
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna Commercial |
$13.01
|
| Rate for Payer: Aetna Commercial |
$10.79
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Aetna Medicare |
$6.35
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Aetna Medicare |
$8.28
|
| Rate for Payer: Aetna Medicare |
$8.03
|
| Rate for Payer: Aetna Medicare |
$7.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.95
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS Complete |
$5.08
|
| Rate for Payer: BCBS Complete |
$4.82
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Complete |
$6.62
|
| 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: 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: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cash Price |
$10.36
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Cash Price |
$10.16
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Advantage |
$10.71
|
| Rate for Payer: Cofinity Advantage |
$9.06
|
| Rate for Payer: Cofinity Advantage |
$11.59
|
| Rate for Payer: Cofinity Advantage |
$8.44
|
| Rate for Payer: Cofinity Advantage |
$8.89
|
| Rate for Payer: Cofinity Advantage |
$11.23
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Cofinity Commercial |
$10.92
|
| Rate for Payer: Cofinity Commercial |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$10.85
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$11.65
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$11.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.71
|
| Rate for Payer: PHP Commercial |
$10.79
|
| Rate for Payer: PHP Commercial |
$11.01
|
| Rate for Payer: PHP Commercial |
$13.01
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: Priority Health SBD |
$7.59
|
| Rate for Payer: Priority Health SBD |
$8.00
|
| Rate for Payer: Priority Health SBD |
$10.43
|
| Rate for Payer: Priority Health SBD |
$8.16
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| 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 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 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: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$5.66
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: UMR Bronson Commercial |
$4.70
|
| Rate for Payer: UMR Bronson Commercial |
$4.46
|
| Rate for Payer: UMR Bronson Commercial |
$6.13
|
| Rate for Payer: UMR Bronson Commercial |
$4.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.53
|
|
|
FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,551.15
|
|
|
Service Code
|
HCPCS J9358
|
| Hospital Charge Code |
192405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,402.51 |
| Max. Negotiated Rate |
$13,096.03 |
| Rate for Payer: Aetna American Axle |
$9,458.25
|
| Rate for Payer: Aetna Commercial |
$12,368.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,458.25
|
| Rate for Payer: Cash Price |
$11,640.92
|
| Rate for Payer: Cofinity Advantage |
$10,185.81
|
| Rate for Payer: Cofinity Commercial |
$12,513.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,640.92
|
| Rate for Payer: Healthscope Commercial |
$13,096.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,913.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,368.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,913.36
|
| Rate for Payer: PHP Commercial |
$12,368.48
|
| Rate for Payer: Priority Health SBD |
$9,167.22
|
| Rate for Payer: UMR Bronson Commercial |
$6,402.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,913.36
|
|
|
FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,551.15
|
|
|
Service Code
|
HCPCS J9358
|
| Hospital Charge Code |
192405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$13,096.03 |
| Rate for Payer: Aetna American Axle |
$9,458.25
|
| Rate for Payer: Aetna Commercial |
$12,368.48
|
| Rate for Payer: Aetna Medicare |
$32.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,458.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.08
|
| Rate for Payer: BCBS Complete |
$17.17
|
| Rate for Payer: BCBS MAPPO |
$31.26
|
| Rate for Payer: BCBS Trust/PPO |
$101.49
|
| Rate for Payer: BCN Commercial |
$101.49
|
| Rate for Payer: BCN Medicare Advantage |
$31.26
|
| Rate for Payer: Cash Price |
$11,640.92
|
| Rate for Payer: Cash Price |
$11,640.92
|
| Rate for Payer: Cofinity Advantage |
$10,185.81
|
| Rate for Payer: Cofinity Commercial |
$12,513.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,640.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.26
|
| Rate for Payer: Healthscope Commercial |
$13,096.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,913.36
|
| Rate for Payer: Mclaren Medicaid |
$31.26
|
| Rate for Payer: Mclaren Medicare |
$31.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.82
|
| Rate for Payer: Meridian Medicaid |
$32.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,368.48
|
| Rate for Payer: Nomi Health Commercial |
$93.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,913.36
|
| Rate for Payer: PACE Medicare |
$29.70
|
| Rate for Payer: PACE SWMI |
$31.26
|
| Rate for Payer: PHP Commercial |
$12,368.48
|
| Rate for Payer: PHP Medicare Advantage |
$31.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94.54
|
| Rate for Payer: Priority Health Medicare |
$31.26
|
| Rate for Payer: Priority Health SBD |
$9,167.22
|
| Rate for Payer: Priority Health Tiered Network |
$75.63
|
| Rate for Payer: Railroad Medicare Medicare |
$31.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.65
|
| Rate for Payer: UHC Core |
$51.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.26
|
| Rate for Payer: UHC Exchange |
$51.65
|
| Rate for Payer: UHC Medicaid |
$16.35
|
| Rate for Payer: UHCCP Medicaid |
$16.35
|
| Rate for Payer: UMR Bronson Commercial |
$5,383.93
|
| Rate for Payer: VA VA |
$31.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,913.36
|
|
|
FASCIECTOMY, PALM ONLY, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 26121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL JOINT, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT);
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 26123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,929.36
|
| Rate for Payer: BCN Commercial |
$3,929.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL JOINT, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT); EACH ADDITIONAL DIGIT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,208.92
|
|
|
Service Code
|
CPT 26125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,208.92 |
| Max. Negotiated Rate |
$1,208.92 |
| Rate for Payer: BCBS Trust/PPO |
$1,208.92
|
| Rate for Payer: BCN Commercial |
$1,208.92
|
|
|
FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,921.04
|
| Rate for Payer: BCN Commercial |
$2,921.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
