|
FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 46200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,965.51
|
| Rate for Payer: BCN Commercial |
$2,965.51
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$2,765.68
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
FISTULIZATION OF SCLERA FOR GLAUCOMA; SCLERECTOMY WITH PUNCH OR SCISSORS, WITH IRIDECTOMY
|
Facility
|
OP
|
$7,436.46
|
|
|
Service Code
|
CPT 66160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,202.65 |
| Max. Negotiated Rate |
$7,436.46 |
| Rate for Payer: Aetna Medicare |
$2,391.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,874.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,874.40
|
| Rate for Payer: BCBS Complete |
$1,262.90
|
| Rate for Payer: BCBS MAPPO |
$2,299.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,452.78
|
| Rate for Payer: BCN Commercial |
$2,452.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,299.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,299.52
|
| Rate for Payer: Mclaren Medicaid |
$2,299.52
|
| Rate for Payer: Mclaren Medicare |
$2,299.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,414.50
|
| Rate for Payer: Meridian Medicaid |
$2,414.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,644.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,529.47
|
| Rate for Payer: Nomi Health Commercial |
$6,898.56
|
| Rate for Payer: PACE Medicare |
$2,184.54
|
| Rate for Payer: PACE SWMI |
$2,299.52
|
| Rate for Payer: PHP Medicare Advantage |
$2,299.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,202.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,436.46
|
| Rate for Payer: Priority Health Medicare |
$2,299.52
|
| Rate for Payer: Priority Health Tiered Network |
$5,949.17
|
| Rate for Payer: Railroad Medicare Medicare |
$2,299.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,299.52
|
| Rate for Payer: UHC Medicaid |
$1,202.65
|
| Rate for Payer: UHCCP Medicaid |
$1,202.65
|
| Rate for Payer: VA VA |
$2,299.52
|
|
|
FIXATION OF CONTRALATERAL TESTIS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$11,358.48
|
|
|
Service Code
|
CPT 54620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,836.94 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,221.94
|
| Rate for Payer: BCN Commercial |
$2,221.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: VA VA |
$3,512.31
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
OP
|
$418.56
|
|
|
Service Code
|
NDC 00054001125
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.87 |
| Max. Negotiated Rate |
$376.70 |
| Rate for Payer: Aetna American Axle |
$272.06
|
| Rate for Payer: Aetna Commercial |
$355.78
|
| Rate for Payer: Aetna Medicare |
$209.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.06
|
| Rate for Payer: BCBS Complete |
$167.42
|
| Rate for Payer: Cash Price |
$334.85
|
| Rate for Payer: Cofinity Advantage |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$359.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.85
|
| Rate for Payer: Healthscope Commercial |
$376.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$334.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.92
|
| Rate for Payer: PHP Commercial |
$355.78
|
| Rate for Payer: Priority Health SBD |
$263.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.06
|
| Rate for Payer: UHC Core |
$218.07
|
| Rate for Payer: UHC Exchange |
$164.49
|
| Rate for Payer: UMR Bronson Commercial |
$154.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.92
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
IP
|
$333.70
|
|
|
Service Code
|
NDC 53746064201
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.83 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna American Axle |
$216.91
|
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.91
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Advantage |
$233.59
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health SBD |
$210.23
|
| Rate for Payer: UMR Bronson Commercial |
$146.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
OP
|
$333.70
|
|
|
Service Code
|
NDC 53746064201
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.47 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna American Axle |
$216.91
|
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna Medicare |
$166.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.91
|
| Rate for Payer: BCBS Complete |
$133.48
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Advantage |
$233.59
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health SBD |
$210.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.91
|
| Rate for Payer: UHC Core |
$173.86
|
| Rate for Payer: UHC Exchange |
$131.14
|
| Rate for Payer: UMR Bronson Commercial |
$123.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
FLECAINIDE 100 MG TABLET
|
Facility
|
IP
|
$418.56
|
|
|
Service Code
|
NDC 00054001125
|
| Hospital Charge Code |
10041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.17 |
| Max. Negotiated Rate |
$376.70 |
| Rate for Payer: Aetna American Axle |
$272.06
|
| Rate for Payer: Aetna Commercial |
$355.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.06
|
| Rate for Payer: Cash Price |
$334.85
|
| Rate for Payer: Cofinity Advantage |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$359.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.85
|
| Rate for Payer: Healthscope Commercial |
$376.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.92
|
| Rate for Payer: PHP Commercial |
$355.78
|
| Rate for Payer: Priority Health SBD |
$263.69
|
| Rate for Payer: UMR Bronson Commercial |
$184.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.92
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$256.32
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.84 |
| Max. Negotiated Rate |
$230.69 |
| Rate for Payer: Aetna American Axle |
$166.61
|
| Rate for Payer: Aetna Commercial |
$217.87
|
| Rate for Payer: Aetna Medicare |
$128.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.61
|
| Rate for Payer: BCBS Complete |
$102.53
|
| Rate for Payer: Cash Price |
$205.06
|
| Rate for Payer: Cofinity Advantage |
$179.42
|
| Rate for Payer: Cofinity Commercial |
$220.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.06
|
| Rate for Payer: Healthscope Commercial |
$230.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.24
|
| Rate for Payer: PHP Commercial |
$217.87
|
| Rate for Payer: Priority Health SBD |
$161.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.61
|
| Rate for Payer: UHC Core |
$133.54
|
| Rate for Payer: UHC Exchange |
$100.73
|
| Rate for Payer: UMR Bronson Commercial |
$94.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.24
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
NDC 65862062101
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna American Axle |
$247.00
|
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Medicare |
$190.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.00
|
| Rate for Payer: BCBS Complete |
$152.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Advantage |
$266.00
|
| Rate for Payer: Cofinity Commercial |
$326.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.00
|
| Rate for Payer: Healthscope Commercial |
$342.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.00
|
| Rate for Payer: PHP Commercial |
$323.00
|
| Rate for Payer: Priority Health SBD |
$239.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.00
|
| Rate for Payer: UHC Core |
$197.98
|
| Rate for Payer: UHC Exchange |
$149.34
|
| Rate for Payer: UMR Bronson Commercial |
$140.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.00
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$307.85
|
|
|
Service Code
|
NDC 53746064101
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.90 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna American Axle |
$200.10
|
| Rate for Payer: Aetna Commercial |
$261.67
|
| Rate for Payer: Aetna Medicare |
$153.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.10
|
| Rate for Payer: BCBS Complete |
$123.14
|
| Rate for Payer: Cash Price |
$246.28
|
| Rate for Payer: Cofinity Advantage |
$215.50
|
| Rate for Payer: Cofinity Commercial |
$264.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.28
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.89
|
| Rate for Payer: PHP Commercial |
$261.67
|
| Rate for Payer: Priority Health SBD |
$193.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.10
|
| Rate for Payer: UHC Core |
$160.39
|
| Rate for Payer: UHC Exchange |
$120.99
|
| Rate for Payer: UMR Bronson Commercial |
$113.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.89
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$307.85
|
|
|
Service Code
|
NDC 53746064101
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna American Axle |
$200.10
|
| Rate for Payer: Aetna Commercial |
$261.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.10
|
| Rate for Payer: Cash Price |
$246.28
|
| Rate for Payer: Cofinity Advantage |
$215.50
|
| Rate for Payer: Cofinity Commercial |
$264.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.28
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.89
|
| Rate for Payer: PHP Commercial |
$261.67
|
| Rate for Payer: Priority Health SBD |
$193.95
|
| Rate for Payer: UMR Bronson Commercial |
$135.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.89
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
OP
|
$256.32
|
|
|
Service Code
|
NDC 00054001025
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.84 |
| Max. Negotiated Rate |
$230.69 |
| Rate for Payer: Aetna American Axle |
$166.61
|
| Rate for Payer: Aetna Commercial |
$217.87
|
| Rate for Payer: Aetna Medicare |
$128.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.61
|
| Rate for Payer: BCBS Complete |
$102.53
|
| Rate for Payer: Cash Price |
$205.06
|
| Rate for Payer: Cofinity Advantage |
$179.42
|
| Rate for Payer: Cofinity Commercial |
$220.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.06
|
| Rate for Payer: Healthscope Commercial |
$230.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.24
|
| Rate for Payer: PHP Commercial |
$217.87
|
| Rate for Payer: Priority Health SBD |
$161.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.61
|
| Rate for Payer: UHC Core |
$133.54
|
| Rate for Payer: UHC Exchange |
$100.73
|
| Rate for Payer: UMR Bronson Commercial |
$94.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.24
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
NDC 65862062101
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna American Axle |
$247.00
|
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Advantage |
$266.00
|
| Rate for Payer: Cofinity Commercial |
$326.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.00
|
| Rate for Payer: Healthscope Commercial |
$342.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.00
|
| Rate for Payer: PHP Commercial |
$323.00
|
| Rate for Payer: Priority Health SBD |
$239.40
|
| Rate for Payer: UMR Bronson Commercial |
$167.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.00
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$256.32
|
|
|
Service Code
|
NDC 00054001025
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.78 |
| Max. Negotiated Rate |
$230.69 |
| Rate for Payer: Aetna American Axle |
$166.61
|
| Rate for Payer: Aetna Commercial |
$217.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.61
|
| Rate for Payer: Cash Price |
$205.06
|
| Rate for Payer: Cofinity Advantage |
$179.42
|
| Rate for Payer: Cofinity Commercial |
$220.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.06
|
| Rate for Payer: Healthscope Commercial |
$230.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.24
|
| Rate for Payer: PHP Commercial |
$217.87
|
| Rate for Payer: Priority Health SBD |
$161.48
|
| Rate for Payer: UMR Bronson Commercial |
$112.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.24
|
|
|
FLECAINIDE 50 MG TABLET
|
Facility
|
IP
|
$256.32
|
|
|
Service Code
|
NDC 00054001020
|
| Hospital Charge Code |
10043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.78 |
| Max. Negotiated Rate |
$230.69 |
| Rate for Payer: Aetna American Axle |
$166.61
|
| Rate for Payer: Aetna Commercial |
$217.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.61
|
| Rate for Payer: Cash Price |
$205.06
|
| Rate for Payer: Cofinity Advantage |
$179.42
|
| Rate for Payer: Cofinity Commercial |
$220.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.06
|
| Rate for Payer: Healthscope Commercial |
$230.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.24
|
| Rate for Payer: PHP Commercial |
$217.87
|
| Rate for Payer: Priority Health SBD |
$161.48
|
| Rate for Payer: UMR Bronson Commercial |
$112.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.24
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$6.41
|
|
|
Service Code
|
NDC 68084072811
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Aetna American Axle |
$4.17
|
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: Aetna Medicare |
$3.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.17
|
| Rate for Payer: BCBS Complete |
$2.56
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Advantage |
$4.49
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Healthscope Commercial |
$5.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.81
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: Priority Health SBD |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.17
|
| Rate for Payer: UHC Core |
$3.34
|
| Rate for Payer: UHC Exchange |
$2.52
|
| Rate for Payer: UMR Bronson Commercial |
$2.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.81
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$640.32
|
|
|
Service Code
|
NDC 68084072801
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.74 |
| Max. Negotiated Rate |
$576.29 |
| Rate for Payer: Aetna American Axle |
$416.21
|
| Rate for Payer: Aetna Commercial |
$544.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.21
|
| Rate for Payer: Cash Price |
$512.26
|
| Rate for Payer: Cofinity Advantage |
$448.22
|
| Rate for Payer: Cofinity Commercial |
$550.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.26
|
| Rate for Payer: Healthscope Commercial |
$576.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$480.24
|
| Rate for Payer: PHP Commercial |
$544.27
|
| Rate for Payer: Priority Health SBD |
$403.40
|
| Rate for Payer: UMR Bronson Commercial |
$281.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.24
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$582.24
|
|
|
Service Code
|
NDC 00904650061
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.19 |
| Max. Negotiated Rate |
$524.02 |
| Rate for Payer: Aetna American Axle |
$378.46
|
| Rate for Payer: Aetna Commercial |
$494.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.46
|
| Rate for Payer: Cash Price |
$465.79
|
| Rate for Payer: Cofinity Advantage |
$407.57
|
| Rate for Payer: Cofinity Commercial |
$500.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.79
|
| Rate for Payer: Healthscope Commercial |
$524.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.68
|
| Rate for Payer: PHP Commercial |
$494.90
|
| Rate for Payer: Priority Health SBD |
$366.81
|
| Rate for Payer: UMR Bronson Commercial |
$256.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.68
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$582.24
|
|
|
Service Code
|
NDC 00904650061
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.43 |
| Max. Negotiated Rate |
$524.02 |
| Rate for Payer: Aetna American Axle |
$378.46
|
| Rate for Payer: Aetna Commercial |
$494.90
|
| Rate for Payer: Aetna Medicare |
$291.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.46
|
| Rate for Payer: BCBS Complete |
$232.90
|
| Rate for Payer: Cash Price |
$465.79
|
| Rate for Payer: Cofinity Advantage |
$407.57
|
| Rate for Payer: Cofinity Commercial |
$500.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.79
|
| Rate for Payer: Healthscope Commercial |
$524.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$436.68
|
| Rate for Payer: PHP Commercial |
$494.90
|
| Rate for Payer: Priority Health SBD |
$366.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.46
|
| Rate for Payer: UHC Core |
$303.35
|
| Rate for Payer: UHC Exchange |
$228.82
|
| Rate for Payer: UMR Bronson Commercial |
$215.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.68
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
OP
|
$640.32
|
|
|
Service Code
|
NDC 68084072801
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$576.29 |
| Rate for Payer: Aetna American Axle |
$416.21
|
| Rate for Payer: Aetna Commercial |
$544.27
|
| Rate for Payer: Aetna Medicare |
$320.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.21
|
| Rate for Payer: BCBS Complete |
$256.13
|
| Rate for Payer: Cash Price |
$512.26
|
| Rate for Payer: Cofinity Advantage |
$448.22
|
| Rate for Payer: Cofinity Commercial |
$550.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.26
|
| Rate for Payer: Healthscope Commercial |
$576.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$512.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$480.24
|
| Rate for Payer: PHP Commercial |
$544.27
|
| Rate for Payer: Priority Health SBD |
$403.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.21
|
| Rate for Payer: UHC Core |
$333.61
|
| Rate for Payer: UHC Exchange |
$251.65
|
| Rate for Payer: UMR Bronson Commercial |
$236.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.24
|
|
|
FLUCONAZOLE 100 MG TABLET
|
Facility
|
IP
|
$6.41
|
|
|
Service Code
|
NDC 68084072811
|
| Hospital Charge Code |
10044
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$5.77 |
| Rate for Payer: Aetna American Axle |
$4.17
|
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.17
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Advantage |
$4.49
|
| Rate for Payer: Cofinity Commercial |
$5.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Healthscope Commercial |
$5.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.81
|
| Rate for Payer: PHP Commercial |
$5.45
|
| Rate for Payer: Priority Health SBD |
$4.04
|
| Rate for Payer: UMR Bronson Commercial |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.81
|
|
|
FLUCONAZOLE 150 MG TABLET
|
Facility
|
IP
|
$40.44
|
|
|
Service Code
|
NDC 57237000511
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Aetna American Axle |
$26.29
|
| Rate for Payer: Aetna Commercial |
$34.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.29
|
| Rate for Payer: Cash Price |
$32.35
|
| Rate for Payer: Cofinity Advantage |
$28.31
|
| Rate for Payer: Cofinity Commercial |
$34.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.35
|
| Rate for Payer: Healthscope Commercial |
$36.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.33
|
| Rate for Payer: PHP Commercial |
$34.37
|
| Rate for Payer: Priority Health SBD |
$25.48
|
| Rate for Payer: UMR Bronson Commercial |
$17.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.33
|
|
|
FLUCONAZOLE 150 MG TABLET
|
Facility
|
IP
|
$112.56
|
|
|
Service Code
|
NDC 68462011944
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.53 |
| Max. Negotiated Rate |
$101.30 |
| Rate for Payer: Aetna American Axle |
$73.16
|
| Rate for Payer: Aetna Commercial |
$95.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.16
|
| Rate for Payer: Cash Price |
$90.05
|
| Rate for Payer: Cofinity Advantage |
$78.79
|
| Rate for Payer: Cofinity Commercial |
$96.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.05
|
| Rate for Payer: Healthscope Commercial |
$101.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.42
|
| Rate for Payer: PHP Commercial |
$95.68
|
| Rate for Payer: Priority Health SBD |
$70.91
|
| Rate for Payer: UMR Bronson Commercial |
$49.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.42
|
|
|
FLUCONAZOLE 150 MG TABLET
|
Facility
|
OP
|
$9.38
|
|
|
Service Code
|
NDC 68462011940
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$8.44 |
| Rate for Payer: Aetna American Axle |
$6.10
|
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Aetna Medicare |
$4.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.10
|
| Rate for Payer: BCBS Complete |
$3.75
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Advantage |
$6.57
|
| Rate for Payer: Cofinity Commercial |
$8.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.04
|
| Rate for Payer: PHP Commercial |
$7.97
|
| Rate for Payer: Priority Health SBD |
$5.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.10
|
| Rate for Payer: UHC Core |
$4.89
|
| Rate for Payer: UHC Exchange |
$3.69
|
| Rate for Payer: UMR Bronson Commercial |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.04
|
|
|
FLUCONAZOLE 150 MG TABLET
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
NDC 68462011940
|
| Hospital Charge Code |
13577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$8.44 |
| Rate for Payer: Aetna American Axle |
$6.10
|
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.10
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Advantage |
$6.57
|
| Rate for Payer: Cofinity Commercial |
$8.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.04
|
| Rate for Payer: PHP Commercial |
$7.97
|
| Rate for Payer: Priority Health SBD |
$5.91
|
| Rate for Payer: UMR Bronson Commercial |
$4.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.04
|
|
