|
DUTASTERIDE 0.5 MG CAPSULE
|
Facility
|
OP
|
$365.90
|
|
|
Service Code
|
NDC 31722013190
|
| Hospital Charge Code |
34089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.38 |
| Max. Negotiated Rate |
$329.31 |
| Rate for Payer: Aetna American Axle |
$237.84
|
| Rate for Payer: Aetna Commercial |
$311.02
|
| Rate for Payer: Aetna Medicare |
$182.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.84
|
| Rate for Payer: BCBS Complete |
$146.36
|
| Rate for Payer: Cash Price |
$292.72
|
| Rate for Payer: Cofinity Commercial |
$256.13
|
| Rate for Payer: Cofinity Commercial |
$314.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.72
|
| Rate for Payer: Healthscope Commercial |
$329.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.02
|
| Rate for Payer: PHP Commercial |
$311.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.84
|
| Rate for Payer: Priority Health SBD |
$230.52
|
| Rate for Payer: UMR Bronson Commercial |
$135.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.42
|
|
|
DUTASTERIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$57.57
|
|
|
Service Code
|
NDC 31722013130
|
| Hospital Charge Code |
34089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna American Axle |
$37.42
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.42
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$40.30
|
| Rate for Payer: Cofinity Commercial |
$49.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$51.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.42
|
| Rate for Payer: Priority Health SBD |
$36.27
|
| Rate for Payer: UMR Bronson Commercial |
$25.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
DUTASTERIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$2,582.75
|
|
|
Service Code
|
NDC 00173071204
|
| Hospital Charge Code |
34089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,136.41 |
| Max. Negotiated Rate |
$2,324.48 |
| Rate for Payer: Aetna American Axle |
$1,678.79
|
| Rate for Payer: Aetna Commercial |
$2,195.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,678.79
|
| Rate for Payer: Cash Price |
$2,066.20
|
| Rate for Payer: Cofinity Commercial |
$1,807.92
|
| Rate for Payer: Cofinity Commercial |
$2,221.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,807.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,066.20
|
| Rate for Payer: Healthscope Commercial |
$2,324.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,807.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,937.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,195.34
|
| Rate for Payer: PHP Commercial |
$2,195.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,678.79
|
| Rate for Payer: Priority Health SBD |
$1,627.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,136.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,937.06
|
|
|
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL-TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT
|
Facility
|
OP
|
$1,688.45
|
|
|
Service Code
|
CPT 93312
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$218.25 |
| Max. Negotiated Rate |
$1,688.45 |
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$556.75
|
| Rate for Payer: BCN Commercial |
$556.75
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$218.25
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$537.21
|
|
|
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL-TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT
|
Facility
|
OP
|
$1,688.45
|
|
|
Service Code
|
CPT 93312
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$218.25 |
| Max. Negotiated Rate |
$1,688.45 |
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$556.75
|
| Rate for Payer: BCN Commercial |
$556.75
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$218.25
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: VA VA |
$537.21
|
|
|
ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,959.78
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
81696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.15 |
| Max. Negotiated Rate |
$15,263.80 |
| Rate for Payer: Aetna American Axle |
$11,023.86
|
| Rate for Payer: Aetna Commercial |
$14,415.81
|
| Rate for Payer: Aetna Medicare |
$233.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,023.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$280.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$280.20
|
| Rate for Payer: BCBS Complete |
$126.16
|
| Rate for Payer: BCBS MAPPO |
$224.16
|
| Rate for Payer: BCBS Trust/PPO |
$605.68
|
| Rate for Payer: BCN Commercial |
$605.68
|
| Rate for Payer: BCN Medicare Advantage |
$224.16
|
| Rate for Payer: Cash Price |
$13,567.82
|
| Rate for Payer: Cash Price |
$13,567.82
|
| Rate for Payer: Cofinity Commercial |
$14,585.41
|
| Rate for Payer: Cofinity Commercial |
$11,871.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,871.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,567.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.16
|
| Rate for Payer: Healthscope Commercial |
$15,263.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,871.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,719.84
|
| Rate for Payer: Mclaren Medicaid |
$120.15
|
| Rate for Payer: Mclaren Medicare |
$224.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.37
|
| Rate for Payer: Meridian Medicaid |
$126.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,415.81
|
| Rate for Payer: Nomi Health Commercial |
$672.48
|
| Rate for Payer: PACE Medicare |
$212.95
|
| Rate for Payer: PACE SWMI |
$224.16
|
| Rate for Payer: PHP Commercial |
$14,415.81
|
| Rate for Payer: PHP Medicare Advantage |
$224.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,023.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$224.16
|
| Rate for Payer: Priority Health Narrow Network |
$517.20
|
| Rate for Payer: Priority Health SBD |
$10,684.66
|
| Rate for Payer: Railroad Medicare Medicare |
$224.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$630.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.16
|
| Rate for Payer: UHC Exchange |
$428.39
|
| Rate for Payer: UHC Medicare Advantage |
$224.16
|
| Rate for Payer: UHCCP Medicaid |
$120.15
|
| Rate for Payer: UMR Bronson Commercial |
$6,275.12
|
| Rate for Payer: VA VA |
$224.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,719.84
|
|
|
ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16,959.78
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
81696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,462.30 |
| Max. Negotiated Rate |
$15,263.80 |
| Rate for Payer: Aetna American Axle |
$11,023.86
|
| Rate for Payer: Aetna Commercial |
$14,415.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,023.86
|
| Rate for Payer: Cash Price |
$13,567.82
|
| Rate for Payer: Cofinity Commercial |
$11,871.85
|
| Rate for Payer: Cofinity Commercial |
$14,585.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,871.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,567.82
|
| Rate for Payer: Healthscope Commercial |
$15,263.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,871.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,719.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,415.81
|
| Rate for Payer: PHP Commercial |
$14,415.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,023.86
|
| Rate for Payer: Priority Health SBD |
$10,684.66
|
| Rate for Payer: UMR Bronson Commercial |
$7,462.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,719.84
|
|
|
EDARAVONE 30 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,737.60
|
|
|
Service Code
|
HCPCS J1301
|
| Hospital Charge Code |
183348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$1,563.84 |
| Rate for Payer: Aetna American Axle |
$1,129.44
|
| Rate for Payer: Aetna Commercial |
$1,476.96
|
| Rate for Payer: Aetna Medicare |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.10
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: BCBS MAPPO |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$59.68
|
| Rate for Payer: BCN Commercial |
$59.68
|
| Rate for Payer: BCN Medicare Advantage |
$21.68
|
| Rate for Payer: Cash Price |
$1,390.08
|
| Rate for Payer: Cash Price |
$1,390.08
|
| Rate for Payer: Cofinity Commercial |
$1,494.34
|
| Rate for Payer: Cofinity Commercial |
$1,216.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,216.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$1,563.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,216.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,303.20
|
| Rate for Payer: Mclaren Medicaid |
$11.62
|
| Rate for Payer: Mclaren Medicare |
$21.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.76
|
| Rate for Payer: Meridian Medicaid |
$12.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.96
|
| Rate for Payer: Nomi Health Commercial |
$65.04
|
| Rate for Payer: PACE Medicare |
$20.60
|
| Rate for Payer: PACE SWMI |
$21.68
|
| Rate for Payer: PHP Commercial |
$1,476.96
|
| Rate for Payer: PHP Medicare Advantage |
$21.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.72
|
| Rate for Payer: Priority Health Medicare |
$21.68
|
| Rate for Payer: Priority Health Narrow Network |
$50.98
|
| Rate for Payer: Priority Health SBD |
$1,094.69
|
| Rate for Payer: Railroad Medicare Medicare |
$21.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.68
|
| Rate for Payer: UHC Exchange |
$41.43
|
| Rate for Payer: UHC Medicare Advantage |
$21.68
|
| Rate for Payer: UHCCP Medicaid |
$11.62
|
| Rate for Payer: UMR Bronson Commercial |
$642.91
|
| Rate for Payer: VA VA |
$21.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,303.20
|
|
|
EDARAVONE 30 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,737.60
|
|
|
Service Code
|
HCPCS J1301
|
| Hospital Charge Code |
183348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$764.54 |
| Max. Negotiated Rate |
$1,563.84 |
| Rate for Payer: Aetna American Axle |
$1,129.44
|
| Rate for Payer: Aetna Commercial |
$1,476.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.44
|
| Rate for Payer: Cash Price |
$1,390.08
|
| Rate for Payer: Cofinity Commercial |
$1,216.32
|
| Rate for Payer: Cofinity Commercial |
$1,494.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,216.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.08
|
| Rate for Payer: Healthscope Commercial |
$1,563.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,216.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,303.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.96
|
| Rate for Payer: PHP Commercial |
$1,476.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.44
|
| Rate for Payer: Priority Health SBD |
$1,094.69
|
| Rate for Payer: UMR Bronson Commercial |
$764.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,303.20
|
|
|
EFGARTIGIMOD ALFA 1008 MG-HYALURON-QVFC 11,200 UNIT/5.6 ML SUBCUT SOLN
|
Facility
|
IP
|
$41,830.00
|
|
|
Service Code
|
HCPCS J9334
|
| Hospital Charge Code |
204386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18,405.20 |
| Max. Negotiated Rate |
$37,647.00 |
| Rate for Payer: Aetna American Axle |
$27,189.50
|
| Rate for Payer: Aetna Commercial |
$35,555.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,189.50
|
| Rate for Payer: Cash Price |
$33,464.00
|
| Rate for Payer: Cofinity Commercial |
$29,281.00
|
| Rate for Payer: Cofinity Commercial |
$35,973.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$29,281.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,464.00
|
| Rate for Payer: Healthscope Commercial |
$37,647.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,281.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,372.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,555.50
|
| Rate for Payer: PHP Commercial |
$35,555.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27,189.50
|
| Rate for Payer: Priority Health SBD |
$26,352.90
|
| Rate for Payer: UMR Bronson Commercial |
$18,405.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,372.50
|
|
|
EFGARTIGIMOD ALFA 1008 MG-HYALURON-QVFC 11,200 UNIT/5.6 ML SUBCUT SOLN
|
Facility
|
OP
|
$41,830.00
|
|
|
Service Code
|
HCPCS J9334
|
| Hospital Charge Code |
204386
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$37,647.00 |
| Rate for Payer: UHC Exchange |
$63.26
|
| Rate for Payer: UHC Medicare Advantage |
$33.10
|
| Rate for Payer: UHCCP Medicaid |
$17.74
|
| Rate for Payer: UMR Bronson Commercial |
$15,477.10
|
| Rate for Payer: VA VA |
$33.10
|
| Rate for Payer: Aetna American Axle |
$27,189.50
|
| Rate for Payer: Aetna Commercial |
$35,555.50
|
| Rate for Payer: Aetna Medicare |
$34.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,189.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.38
|
| Rate for Payer: BCBS Complete |
$18.63
|
| Rate for Payer: BCBS MAPPO |
$33.10
|
| Rate for Payer: BCBS Trust/PPO |
$89.32
|
| Rate for Payer: BCN Commercial |
$89.32
|
| Rate for Payer: BCN Medicare Advantage |
$33.10
|
| Rate for Payer: Cash Price |
$33,464.00
|
| Rate for Payer: Cash Price |
$33,464.00
|
| Rate for Payer: Cofinity Commercial |
$35,973.80
|
| Rate for Payer: Cofinity Commercial |
$29,281.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$29,281.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,464.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.10
|
| Rate for Payer: Healthscope Commercial |
$37,647.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,281.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,372.50
|
| Rate for Payer: Mclaren Medicaid |
$17.74
|
| Rate for Payer: Mclaren Medicare |
$33.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.76
|
| Rate for Payer: Meridian Medicaid |
$18.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,555.50
|
| Rate for Payer: Nomi Health Commercial |
$99.30
|
| Rate for Payer: PACE Medicare |
$31.44
|
| Rate for Payer: PACE SWMI |
$33.10
|
| Rate for Payer: PHP Commercial |
$35,555.50
|
| Rate for Payer: PHP Medicare Advantage |
$33.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27,189.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.34
|
| Rate for Payer: Priority Health Medicare |
$33.10
|
| Rate for Payer: Priority Health Narrow Network |
$76.27
|
| Rate for Payer: Priority Health SBD |
$26,352.90
|
| Rate for Payer: Railroad Medicare Medicare |
$33.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,372.50
|
|
|
EFGARTIGIMOD ALFA-FCAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16,094.99
|
|
|
Service Code
|
HCPCS J9332
|
| Hospital Charge Code |
198972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,081.80 |
| Max. Negotiated Rate |
$14,485.49 |
| Rate for Payer: Aetna American Axle |
$10,461.74
|
| Rate for Payer: Aetna Commercial |
$13,680.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,461.74
|
| Rate for Payer: Cash Price |
$12,875.99
|
| Rate for Payer: Cofinity Commercial |
$11,266.49
|
| Rate for Payer: Cofinity Commercial |
$13,841.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,266.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,875.99
|
| Rate for Payer: Healthscope Commercial |
$14,485.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,071.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,680.74
|
| Rate for Payer: PHP Commercial |
$13,680.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,461.74
|
| Rate for Payer: Priority Health SBD |
$10,139.84
|
| Rate for Payer: UMR Bronson Commercial |
$7,081.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,071.24
|
|
|
EFGARTIGIMOD ALFA-FCAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,094.99
|
|
|
Service Code
|
HCPCS J9332
|
| Hospital Charge Code |
198972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$14,485.49 |
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: Priority Health SBD |
$10,139.84
|
| Rate for Payer: Railroad Medicare Medicare |
$32.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.45
|
| Rate for Payer: UHC Exchange |
$62.02
|
| Rate for Payer: UHC Medicare Advantage |
$32.45
|
| Rate for Payer: UHCCP Medicaid |
$17.39
|
| Rate for Payer: UMR Bronson Commercial |
$5,955.15
|
| Rate for Payer: VA VA |
$32.45
|
| Rate for Payer: Aetna American Axle |
$10,461.74
|
| Rate for Payer: Aetna Commercial |
$13,680.74
|
| Rate for Payer: Aetna Medicare |
$33.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,461.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.56
|
| Rate for Payer: BCBS Complete |
$18.26
|
| Rate for Payer: BCBS MAPPO |
$32.45
|
| Rate for Payer: BCBS Trust/PPO |
$87.81
|
| Rate for Payer: BCN Commercial |
$87.81
|
| Rate for Payer: BCN Medicare Advantage |
$32.45
|
| Rate for Payer: Cash Price |
$12,875.99
|
| Rate for Payer: Cash Price |
$12,875.99
|
| Rate for Payer: Cofinity Commercial |
$13,841.69
|
| Rate for Payer: Cofinity Commercial |
$11,266.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,266.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,875.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.45
|
| Rate for Payer: Healthscope Commercial |
$14,485.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,071.24
|
| Rate for Payer: Mclaren Medicaid |
$17.39
|
| Rate for Payer: Mclaren Medicare |
$32.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.07
|
| Rate for Payer: Meridian Medicaid |
$18.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,680.74
|
| Rate for Payer: Nomi Health Commercial |
$97.35
|
| Rate for Payer: PACE Medicare |
$30.83
|
| Rate for Payer: PACE SWMI |
$32.45
|
| Rate for Payer: PHP Commercial |
$13,680.74
|
| Rate for Payer: PHP Medicare Advantage |
$32.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,461.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.75
|
| Rate for Payer: Priority Health Medicare |
$32.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,071.24
|
|
|
ELECARE INFANT UNFLAVORED INFANT CONTINUOUS FEED
|
Facility
|
IP
|
$109.52
|
|
|
Service Code
|
NDC 70074053511
|
| Hospital Charge Code |
168951
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.19 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Commercial |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UMR Bronson Commercial |
$48.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE INFANT UNFLAVORED INFANT CONTINUOUS FEED
|
Facility
|
OP
|
$109.52
|
|
|
Service Code
|
NDC 70074053511
|
| Hospital Charge Code |
168951
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: BCBS Complete |
$43.81
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Commercial |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UMR Bronson Commercial |
$40.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE INFANT UNFLAVORED ORAL POWDER CUSTOM
|
Facility
|
OP
|
$109.52
|
|
|
Service Code
|
NDC 70074053511
|
| Hospital Charge Code |
150852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: BCBS Complete |
$43.81
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Commercial |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UMR Bronson Commercial |
$40.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE INFANT UNFLAVORED ORAL POWDER CUSTOM
|
Facility
|
IP
|
$109.52
|
|
|
Service Code
|
NDC 70074053511
|
| Hospital Charge Code |
150852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.19 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Commercial |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UMR Bronson Commercial |
$48.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE JR (VANILLA) ORAL POWDER CUSTOM
|
Facility
|
IP
|
$109.52
|
|
|
Service Code
|
NDC 70074056586
|
| Hospital Charge Code |
163630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.19 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Commercial |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UMR Bronson Commercial |
$48.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE JR (VANILLA) ORAL POWDER CUSTOM
|
Facility
|
OP
|
$109.52
|
|
|
Service Code
|
NDC 70074056586
|
| Hospital Charge Code |
163630
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: BCBS Complete |
$43.81
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Commercial |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UMR Bronson Commercial |
$40.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE JUNIOR VANILLA CONTINUOUS FEED
|
Facility
|
IP
|
$113.96
|
|
|
Service Code
|
NDC 09900000581
|
| Hospital Charge Code |
168952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$102.56 |
| Rate for Payer: Aetna American Axle |
$74.07
|
| Rate for Payer: Aetna Commercial |
$96.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.07
|
| Rate for Payer: Cash Price |
$91.17
|
| Rate for Payer: Cofinity Commercial |
$79.77
|
| Rate for Payer: Cofinity Commercial |
$98.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.17
|
| Rate for Payer: Healthscope Commercial |
$102.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.87
|
| Rate for Payer: PHP Commercial |
$96.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.07
|
| Rate for Payer: Priority Health SBD |
$71.79
|
| Rate for Payer: UMR Bronson Commercial |
$50.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.47
|
|
|
ELECARE JUNIOR VANILLA CONTINUOUS FEED
|
Facility
|
OP
|
$109.52
|
|
|
Service Code
|
NDC 70074056586
|
| Hospital Charge Code |
168952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna Medicare |
$54.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: BCBS Complete |
$43.81
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Commercial |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UMR Bronson Commercial |
$40.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE JUNIOR VANILLA CONTINUOUS FEED
|
Facility
|
IP
|
$109.52
|
|
|
Service Code
|
NDC 70074056586
|
| Hospital Charge Code |
168952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.19 |
| Max. Negotiated Rate |
$98.57 |
| Rate for Payer: Aetna American Axle |
$71.19
|
| Rate for Payer: Aetna Commercial |
$93.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: Cash Price |
$87.62
|
| Rate for Payer: Cofinity Commercial |
$76.66
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.62
|
| Rate for Payer: Healthscope Commercial |
$98.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.09
|
| Rate for Payer: PHP Commercial |
$93.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.19
|
| Rate for Payer: Priority Health SBD |
$69.00
|
| Rate for Payer: UMR Bronson Commercial |
$48.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.14
|
|
|
ELECARE JUNIOR VANILLA CONTINUOUS FEED
|
Facility
|
OP
|
$113.96
|
|
|
Service Code
|
NDC 09900000581
|
| Hospital Charge Code |
168952
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$102.56 |
| Rate for Payer: Aetna American Axle |
$74.07
|
| Rate for Payer: Aetna Commercial |
$96.87
|
| Rate for Payer: Aetna Medicare |
$56.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.07
|
| Rate for Payer: BCBS Complete |
$45.58
|
| Rate for Payer: Cash Price |
$91.17
|
| Rate for Payer: Cofinity Commercial |
$79.77
|
| Rate for Payer: Cofinity Commercial |
$98.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.17
|
| Rate for Payer: Healthscope Commercial |
$102.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.87
|
| Rate for Payer: PHP Commercial |
$96.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.07
|
| Rate for Payer: Priority Health SBD |
$71.79
|
| Rate for Payer: UMR Bronson Commercial |
$42.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.47
|
|
|
ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT
|
Facility
|
OP
|
$182.90
|
|
|
Service Code
|
CPT 93005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$182.90 |
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$20.01
|
| Rate for Payer: BCN Commercial |
$20.01
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$5.75
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
ELECTROLYTE-A INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
28113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.10
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
