|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$21.72
|
|
|
Service Code
|
NDC 60687037511
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Aetna American Axle |
$14.12
|
| Rate for Payer: Aetna Commercial |
$18.46
|
| Rate for Payer: Aetna Medicare |
$10.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.12
|
| Rate for Payer: BCBS Complete |
$8.69
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cofinity Commercial |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$18.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.38
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.46
|
| Rate for Payer: PHP Commercial |
$18.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.12
|
| Rate for Payer: Priority Health SBD |
$13.68
|
| Rate for Payer: UMR Bronson Commercial |
$8.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.29
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$805.14
|
|
|
Service Code
|
NDC 42858086706
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.90 |
| Max. Negotiated Rate |
$724.63 |
| Rate for Payer: Aetna American Axle |
$523.34
|
| Rate for Payer: Aetna Commercial |
$684.37
|
| Rate for Payer: Aetna Medicare |
$402.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.34
|
| Rate for Payer: BCBS Complete |
$322.06
|
| Rate for Payer: Cash Price |
$644.11
|
| Rate for Payer: Cofinity Commercial |
$563.60
|
| Rate for Payer: Cofinity Commercial |
$692.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$563.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.11
|
| Rate for Payer: Healthscope Commercial |
$724.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$563.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$603.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.37
|
| Rate for Payer: PHP Commercial |
$684.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.34
|
| Rate for Payer: Priority Health SBD |
$507.24
|
| Rate for Payer: UMR Bronson Commercial |
$297.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$603.86
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$651.42
|
|
|
Service Code
|
NDC 60687037521
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.03 |
| Max. Negotiated Rate |
$586.28 |
| Rate for Payer: Aetna American Axle |
$423.42
|
| Rate for Payer: Aetna Commercial |
$553.71
|
| Rate for Payer: Aetna Medicare |
$325.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.42
|
| Rate for Payer: BCBS Complete |
$260.57
|
| Rate for Payer: Cash Price |
$521.14
|
| Rate for Payer: Cofinity Commercial |
$455.99
|
| Rate for Payer: Cofinity Commercial |
$560.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.14
|
| Rate for Payer: Healthscope Commercial |
$586.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.71
|
| Rate for Payer: PHP Commercial |
$553.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.42
|
| Rate for Payer: Priority Health SBD |
$410.39
|
| Rate for Payer: UMR Bronson Commercial |
$241.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.56
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$21.72
|
|
|
Service Code
|
NDC 60687037511
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Aetna American Axle |
$14.12
|
| Rate for Payer: Aetna Commercial |
$18.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.12
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cofinity Commercial |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$18.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.38
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.46
|
| Rate for Payer: PHP Commercial |
$18.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.12
|
| Rate for Payer: Priority Health SBD |
$13.68
|
| Rate for Payer: UMR Bronson Commercial |
$9.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.29
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$651.42
|
|
|
Service Code
|
NDC 60687037521
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.62 |
| Max. Negotiated Rate |
$586.28 |
| Rate for Payer: Aetna American Axle |
$423.42
|
| Rate for Payer: Aetna Commercial |
$553.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.42
|
| Rate for Payer: Cash Price |
$521.14
|
| Rate for Payer: Cofinity Commercial |
$455.99
|
| Rate for Payer: Cofinity Commercial |
$560.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.14
|
| Rate for Payer: Healthscope Commercial |
$586.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.71
|
| Rate for Payer: PHP Commercial |
$553.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.42
|
| Rate for Payer: Priority Health SBD |
$410.39
|
| Rate for Payer: UMR Bronson Commercial |
$286.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.56
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$658.56
|
|
|
Service Code
|
NDC 67877075360
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.77 |
| Max. Negotiated Rate |
$592.70 |
| Rate for Payer: Aetna American Axle |
$428.06
|
| Rate for Payer: Aetna Commercial |
$559.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.06
|
| Rate for Payer: Cash Price |
$526.85
|
| Rate for Payer: Cofinity Commercial |
$460.99
|
| Rate for Payer: Cofinity Commercial |
$566.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$460.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.85
|
| Rate for Payer: Healthscope Commercial |
$592.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.78
|
| Rate for Payer: PHP Commercial |
$559.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.06
|
| Rate for Payer: Priority Health SBD |
$414.89
|
| Rate for Payer: UMR Bronson Commercial |
$289.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.92
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$805.14
|
|
|
Service Code
|
NDC 42858086706
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$354.26 |
| Max. Negotiated Rate |
$724.63 |
| Rate for Payer: Aetna American Axle |
$523.34
|
| Rate for Payer: Aetna Commercial |
$684.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.34
|
| Rate for Payer: Cash Price |
$644.11
|
| Rate for Payer: Cofinity Commercial |
$563.60
|
| Rate for Payer: Cofinity Commercial |
$692.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$563.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.11
|
| Rate for Payer: Healthscope Commercial |
$724.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$563.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$603.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.37
|
| Rate for Payer: PHP Commercial |
$684.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.34
|
| Rate for Payer: Priority Health SBD |
$507.24
|
| Rate for Payer: UMR Bronson Commercial |
$354.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$603.86
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$658.56
|
|
|
Service Code
|
NDC 67877075360
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.67 |
| Max. Negotiated Rate |
$592.70 |
| Rate for Payer: Aetna American Axle |
$428.06
|
| Rate for Payer: Aetna Commercial |
$559.78
|
| Rate for Payer: Aetna Medicare |
$329.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.06
|
| Rate for Payer: BCBS Complete |
$263.42
|
| Rate for Payer: Cash Price |
$526.85
|
| Rate for Payer: Cofinity Commercial |
$460.99
|
| Rate for Payer: Cofinity Commercial |
$566.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$460.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.85
|
| Rate for Payer: Healthscope Commercial |
$592.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.78
|
| Rate for Payer: PHP Commercial |
$559.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.06
|
| Rate for Payer: Priority Health SBD |
$414.89
|
| Rate for Payer: UMR Bronson Commercial |
$243.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.92
|
|
|
DRONEDARONE 400 MG TABLET
|
Facility
|
OP
|
$2,731.49
|
|
|
Service Code
|
NDC 00024414260
|
| Hospital Charge Code |
98329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,010.65 |
| Max. Negotiated Rate |
$2,458.34 |
| Rate for Payer: Aetna American Axle |
$1,775.47
|
| Rate for Payer: Aetna Commercial |
$2,321.77
|
| Rate for Payer: Aetna Medicare |
$1,365.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,775.47
|
| Rate for Payer: BCBS Complete |
$1,092.60
|
| Rate for Payer: Cash Price |
$2,185.19
|
| Rate for Payer: Cofinity Commercial |
$1,912.04
|
| Rate for Payer: Cofinity Commercial |
$2,349.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,912.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,185.19
|
| Rate for Payer: Healthscope Commercial |
$2,458.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,912.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,048.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,321.77
|
| Rate for Payer: PHP Commercial |
$2,321.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.47
|
| Rate for Payer: Priority Health SBD |
$1,720.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,010.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,048.62
|
|
|
DRONEDARONE 400 MG TABLET
|
Facility
|
IP
|
$2,731.49
|
|
|
Service Code
|
NDC 00024414260
|
| Hospital Charge Code |
98329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,201.86 |
| Max. Negotiated Rate |
$2,458.34 |
| Rate for Payer: Aetna American Axle |
$1,775.47
|
| Rate for Payer: Aetna Commercial |
$2,321.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,775.47
|
| Rate for Payer: Cash Price |
$2,185.19
|
| Rate for Payer: Cofinity Commercial |
$1,912.04
|
| Rate for Payer: Cofinity Commercial |
$2,349.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,912.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,185.19
|
| Rate for Payer: Healthscope Commercial |
$2,458.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,912.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,048.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,321.77
|
| Rate for Payer: PHP Commercial |
$2,321.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.47
|
| Rate for Payer: Priority Health SBD |
$1,720.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,201.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,048.62
|
|
|
DROPERIDOL 2.5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$19.43
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
2654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$25.88 |
| Rate for Payer: Aetna American Axle |
$12.63
|
| Rate for Payer: Aetna American Axle |
$35.43
|
| Rate for Payer: Aetna Commercial |
$46.33
|
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna Medicare |
$9.72
|
| Rate for Payer: Aetna Medicare |
$27.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.43
|
| Rate for Payer: BCBS Complete |
$21.80
|
| Rate for Payer: BCBS Complete |
$7.77
|
| Rate for Payer: BCBS Trust/PPO |
$25.88
|
| Rate for Payer: BCBS Trust/PPO |
$25.88
|
| Rate for Payer: BCN Commercial |
$25.88
|
| Rate for Payer: BCN Commercial |
$25.88
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Commercial |
$16.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.54
|
| Rate for Payer: Healthscope Commercial |
$49.06
|
| Rate for Payer: Healthscope Commercial |
$17.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.33
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: PHP Commercial |
$46.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.43
|
| Rate for Payer: Priority Health SBD |
$34.34
|
| Rate for Payer: Priority Health SBD |
$12.24
|
| Rate for Payer: UMR Bronson Commercial |
$7.19
|
| Rate for Payer: UMR Bronson Commercial |
$20.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.57
|
|
|
DROPERIDOL 2.5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.43
|
|
|
Service Code
|
HCPCS J1790
|
| Hospital Charge Code |
2654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$17.49 |
| Rate for Payer: UMR Bronson Commercial |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$23.98
|
| Rate for Payer: Aetna American Axle |
$12.63
|
| Rate for Payer: Aetna American Axle |
$35.43
|
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna Commercial |
$46.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.43
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cofinity Commercial |
$46.88
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Cofinity Commercial |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$16.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.61
|
| Rate for Payer: Healthscope Commercial |
$17.49
|
| Rate for Payer: Healthscope Commercial |
$49.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: PHP Commercial |
$46.33
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.43
|
| Rate for Payer: Priority Health SBD |
$12.24
|
| Rate for Payer: Priority Health SBD |
$34.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.88
|
|
|
DRUG-INDUCED SLEEP ENDOSCOPY, WITH DYNAMIC EVALUATION OF VELUM, PHARYNX, TONGUE BASE, AND LARYNX FOR EVALUATION OF SLEEP-DISORDERED BREATHING, FLEXIBLE, DIAGNOSTIC
|
Facility
|
OP
|
$5,310.41
|
|
|
Service Code
|
CPT 42975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.38 |
| Max. Negotiated Rate |
$5,310.41 |
| Rate for Payer: Aetna Medicare |
$1,757.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,112.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,112.00
|
| Rate for Payer: BCBS Complete |
$950.91
|
| Rate for Payer: BCBS MAPPO |
$1,689.60
|
| Rate for Payer: BCBS Trust/PPO |
$102.44
|
| Rate for Payer: BCN Commercial |
$102.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.60
|
| Rate for Payer: Mclaren Medicaid |
$905.63
|
| Rate for Payer: Mclaren Medicare |
$1,689.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.08
|
| Rate for Payer: Meridian Medicaid |
$950.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,943.04
|
| Rate for Payer: Nomi Health Commercial |
$3,548.16
|
| Rate for Payer: PACE Medicare |
$1,605.12
|
| Rate for Payer: PACE SWMI |
$1,689.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$905.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,310.41
|
| Rate for Payer: Priority Health Medicare |
$1,689.60
|
| Rate for Payer: Priority Health Narrow Network |
$4,248.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,689.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.72
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.60
|
| Rate for Payer: UHC Exchange |
$93.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.60
|
| Rate for Payer: UHCCP Medicaid |
$905.63
|
| Rate for Payer: VA VA |
$1,689.60
|
|
|
DRUG TEST PRESUMPTIVE READ BY INSTR ASSISTED DIRECT OPTICAL OBS
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS G0478
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$16.78 |
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.78
|
| Rate for Payer: Priority Health Narrow Network |
$16.78
|
| Rate for Payer: Priority Health SBD |
$16.78
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
|
|
DRUG TEST PRESUMPTIVE USING IMMUNOASSAY
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS G0479
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$67.44 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.44
|
| Rate for Payer: Priority Health Narrow Network |
$67.44
|
| Rate for Payer: Priority Health SBD |
$67.44
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
|
|
DRUG TEST(S), PRESUMPTIVE READ BY DIRECT OPTICAL OBSERVATION
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS G0477
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.82
|
| Rate for Payer: Priority Health Narrow Network |
$12.82
|
| Rate for Payer: Priority Health SBD |
$12.82
|
| Rate for Payer: UMR Bronson Commercial |
$5.52
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$259.35
|
|
|
Service Code
|
NDC 60505299506
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$233.42 |
| Rate for Payer: Aetna American Axle |
$168.58
|
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.58
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UMR Bronson Commercial |
$114.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$257.07
|
|
|
Service Code
|
NDC 43547037906
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna American Axle |
$167.10
|
| Rate for Payer: Aetna Commercial |
$218.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.10
|
| Rate for Payer: Cash Price |
$205.66
|
| Rate for Payer: Cofinity Commercial |
$179.95
|
| Rate for Payer: Cofinity Commercial |
$221.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.66
|
| Rate for Payer: Healthscope Commercial |
$231.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.51
|
| Rate for Payer: PHP Commercial |
$218.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.10
|
| Rate for Payer: Priority Health SBD |
$161.95
|
| Rate for Payer: UMR Bronson Commercial |
$113.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.80
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 68180029407
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$37.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 68180029407
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$44.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$1,721.84
|
|
|
Service Code
|
NDC 00002323560
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$757.61 |
| Max. Negotiated Rate |
$1,549.66 |
| Rate for Payer: Aetna American Axle |
$1,119.20
|
| Rate for Payer: Aetna Commercial |
$1,463.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.20
|
| Rate for Payer: Cash Price |
$1,377.47
|
| Rate for Payer: Cofinity Commercial |
$1,205.29
|
| Rate for Payer: Cofinity Commercial |
$1,480.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,205.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,377.47
|
| Rate for Payer: Healthscope Commercial |
$1,549.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,205.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,291.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,463.56
|
| Rate for Payer: PHP Commercial |
$1,463.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,119.20
|
| Rate for Payer: Priority Health SBD |
$1,084.76
|
| Rate for Payer: UMR Bronson Commercial |
$757.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,291.38
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 57237001760
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.67 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$44.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$259.35
|
|
|
Service Code
|
NDC 60505299506
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.96 |
| Max. Negotiated Rate |
$233.42 |
| Rate for Payer: Aetna American Axle |
$168.58
|
| Rate for Payer: Aetna Commercial |
$220.45
|
| Rate for Payer: Aetna Medicare |
$129.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.58
|
| Rate for Payer: BCBS Complete |
$103.74
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$181.54
|
| Rate for Payer: Cofinity Commercial |
$223.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.48
|
| Rate for Payer: Healthscope Commercial |
$233.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.45
|
| Rate for Payer: PHP Commercial |
$220.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.58
|
| Rate for Payer: Priority Health SBD |
$163.39
|
| Rate for Payer: UMR Bronson Commercial |
$95.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.51
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$257.07
|
|
|
Service Code
|
NDC 43547037906
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.12 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna American Axle |
$167.10
|
| Rate for Payer: Aetna Commercial |
$218.51
|
| Rate for Payer: Aetna Medicare |
$128.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.10
|
| Rate for Payer: BCBS Complete |
$102.83
|
| Rate for Payer: Cash Price |
$205.66
|
| Rate for Payer: Cofinity Commercial |
$179.95
|
| Rate for Payer: Cofinity Commercial |
$221.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.66
|
| Rate for Payer: Healthscope Commercial |
$231.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.51
|
| Rate for Payer: PHP Commercial |
$218.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.10
|
| Rate for Payer: Priority Health SBD |
$161.95
|
| Rate for Payer: UMR Bronson Commercial |
$95.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.80
|
|
|
DULOXETINE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 57237001760
|
| Hospital Charge Code |
39275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna American Axle |
$65.99
|
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.99
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health SBD |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$37.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
