|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 65162036110
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UMR Bronson Commercial |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
IP
|
$149.60
|
|
|
Service Code
|
NDC 00904722461
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.82 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Aetna American Axle |
$97.24
|
| Rate for Payer: Aetna Commercial |
$127.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.24
|
| Rate for Payer: Cash Price |
$119.68
|
| Rate for Payer: Cofinity Advantage |
$104.72
|
| Rate for Payer: Cofinity Commercial |
$128.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.68
|
| Rate for Payer: Healthscope Commercial |
$134.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.20
|
| Rate for Payer: PHP Commercial |
$127.16
|
| Rate for Payer: Priority Health SBD |
$94.25
|
| Rate for Payer: UMR Bronson Commercial |
$65.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.20
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
NDC 11534016501
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna American Axle |
$145.60
|
| Rate for Payer: Aetna Commercial |
$190.40
|
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.60
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Advantage |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$192.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.20
|
| Rate for Payer: Healthscope Commercial |
$201.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$179.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.00
|
| Rate for Payer: PHP Commercial |
$190.40
|
| Rate for Payer: Priority Health SBD |
$141.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.60
|
| Rate for Payer: UHC Core |
$116.70
|
| Rate for Payer: UHC Exchange |
$88.03
|
| Rate for Payer: UMR Bronson Commercial |
$82.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
NDC 69315012701
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.16 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna American Axle |
$109.20
|
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.20
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Advantage |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: Priority Health SBD |
$105.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.20
|
| Rate for Payer: UHC Core |
$87.53
|
| Rate for Payer: UHC Exchange |
$66.02
|
| Rate for Payer: UMR Bronson Commercial |
$62.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
|
FOLIC ACID 1 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 65162036110
|
| Hospital Charge Code |
3233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.20
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Exchange |
$73.88
|
| Rate for Payer: UMR Bronson Commercial |
$69.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$28.45
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$25.61 |
| Rate for Payer: Aetna American Axle |
$18.49
|
| Rate for Payer: Aetna American Axle |
$184.92
|
| Rate for Payer: Aetna American Axle |
$11.10
|
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna American Axle |
$14.79
|
| Rate for Payer: Aetna American Axle |
$7.40
|
| Rate for Payer: Aetna American Axle |
$103.03
|
| Rate for Payer: Aetna American Axle |
$3.70
|
| Rate for Payer: Aetna Commercial |
$14.51
|
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: Aetna Commercial |
$19.35
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna Commercial |
$241.82
|
| Rate for Payer: Aetna Commercial |
$24.18
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Commercial |
$134.73
|
| Rate for Payer: Aetna Medicare |
$8.54
|
| Rate for Payer: Aetna Medicare |
$79.25
|
| Rate for Payer: Aetna Medicare |
$14.22
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: Aetna Medicare |
$11.38
|
| Rate for Payer: Aetna Medicare |
$103.23
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Aetna Medicare |
$142.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.79
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: BCBS Complete |
$113.80
|
| Rate for Payer: BCBS Complete |
$82.58
|
| Rate for Payer: BCBS Complete |
$4.55
|
| Rate for Payer: BCBS Complete |
$6.83
|
| Rate for Payer: BCBS Complete |
$63.40
|
| Rate for Payer: BCBS Complete |
$11.38
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$126.81
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Cash Price |
$13.66
|
| Rate for Payer: Cash Price |
$126.81
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cash Price |
$18.21
|
| Rate for Payer: Cash Price |
$18.21
|
| Rate for Payer: Cash Price |
$227.59
|
| Rate for Payer: Cash Price |
$227.59
|
| Rate for Payer: Cash Price |
$22.76
|
| Rate for Payer: Cash Price |
$22.76
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Advantage |
$199.14
|
| Rate for Payer: Cofinity Advantage |
$3.98
|
| Rate for Payer: Cofinity Advantage |
$11.95
|
| Rate for Payer: Cofinity Advantage |
$15.93
|
| Rate for Payer: Cofinity Advantage |
$19.91
|
| Rate for Payer: Cofinity Advantage |
$144.52
|
| Rate for Payer: Cofinity Advantage |
$7.97
|
| Rate for Payer: Cofinity Advantage |
$110.96
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Commercial |
$244.66
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Cofinity Commercial |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$24.47
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.76
|
| Rate for Payer: Healthscope Commercial |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Healthscope Commercial |
$25.61
|
| Rate for Payer: Healthscope Commercial |
$256.04
|
| Rate for Payer: Healthscope Commercial |
$142.66
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.80
|
| Rate for Payer: PHP Commercial |
$9.67
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: PHP Commercial |
$241.82
|
| Rate for Payer: PHP Commercial |
$14.51
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: PHP Commercial |
$24.18
|
| Rate for Payer: PHP Commercial |
$19.35
|
| Rate for Payer: PHP Commercial |
$134.73
|
| Rate for Payer: Priority Health SBD |
$99.86
|
| Rate for Payer: Priority Health SBD |
$3.58
|
| Rate for Payer: Priority Health SBD |
$7.17
|
| Rate for Payer: Priority Health SBD |
$179.23
|
| Rate for Payer: Priority Health SBD |
$17.92
|
| Rate for Payer: Priority Health SBD |
$10.75
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: Priority Health SBD |
$14.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$10.53
|
| Rate for Payer: UMR Bronson Commercial |
$2.11
|
| Rate for Payer: UMR Bronson Commercial |
$8.42
|
| Rate for Payer: UMR Bronson Commercial |
$6.32
|
| Rate for Payer: UMR Bronson Commercial |
$105.26
|
| Rate for Payer: UMR Bronson Commercial |
$4.21
|
| Rate for Payer: UMR Bronson Commercial |
$58.65
|
| Rate for Payer: UMR Bronson Commercial |
$76.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.34
|
|
|
FOLIC ACID 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
3232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna American Axle |
$103.03
|
| Rate for Payer: Aetna American Axle |
$184.92
|
| Rate for Payer: Aetna Commercial |
$241.82
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna Commercial |
$134.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.92
|
| Rate for Payer: Cash Price |
$227.59
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cash Price |
$126.81
|
| Rate for Payer: Cofinity Advantage |
$199.14
|
| Rate for Payer: Cofinity Advantage |
$110.96
|
| Rate for Payer: Cofinity Advantage |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$244.66
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.81
|
| Rate for Payer: Healthscope Commercial |
$142.66
|
| Rate for Payer: Healthscope Commercial |
$256.04
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: PHP Commercial |
$134.73
|
| Rate for Payer: PHP Commercial |
$241.82
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: Priority Health SBD |
$99.86
|
| Rate for Payer: Priority Health SBD |
$179.23
|
| Rate for Payer: UMR Bronson Commercial |
$69.74
|
| Rate for Payer: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: UMR Bronson Commercial |
$125.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.88
|
|
|
FOLIC ACID-VIT B6-VIT B12 2.5 MG-25 MG-2 MG TABLET
|
Facility
|
OP
|
$258.03
|
|
|
Service Code
|
NDC 69367022409
|
| Hospital Charge Code |
38624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.47 |
| Max. Negotiated Rate |
$232.23 |
| Rate for Payer: Aetna American Axle |
$167.72
|
| Rate for Payer: Aetna Commercial |
$219.33
|
| Rate for Payer: Aetna Medicare |
$129.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.72
|
| Rate for Payer: BCBS Complete |
$103.21
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Advantage |
$180.62
|
| Rate for Payer: Cofinity Commercial |
$221.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Healthscope Commercial |
$232.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.52
|
| Rate for Payer: PHP Commercial |
$219.33
|
| Rate for Payer: Priority Health SBD |
$162.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.72
|
| Rate for Payer: UHC Core |
$134.43
|
| Rate for Payer: UHC Exchange |
$101.41
|
| Rate for Payer: UMR Bronson Commercial |
$95.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.52
|
|
|
FOLIC ACID-VIT B6-VIT B12 2.5 MG-25 MG-2 MG TABLET
|
Facility
|
OP
|
$309.75
|
|
|
Service Code
|
NDC 51991038490
|
| Hospital Charge Code |
38624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.61 |
| Max. Negotiated Rate |
$278.77 |
| Rate for Payer: Aetna American Axle |
$201.34
|
| Rate for Payer: Aetna Commercial |
$263.29
|
| Rate for Payer: Aetna Medicare |
$154.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.34
|
| Rate for Payer: BCBS Complete |
$123.90
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cofinity Advantage |
$216.82
|
| Rate for Payer: Cofinity Commercial |
$266.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.80
|
| Rate for Payer: Healthscope Commercial |
$278.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.31
|
| Rate for Payer: PHP Commercial |
$263.29
|
| Rate for Payer: Priority Health SBD |
$195.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.34
|
| Rate for Payer: UHC Core |
$161.38
|
| Rate for Payer: UHC Exchange |
$121.73
|
| Rate for Payer: UMR Bronson Commercial |
$114.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.31
|
|
|
FOLIC ACID-VIT B6-VIT B12 2.5 MG-25 MG-2 MG TABLET
|
Facility
|
IP
|
$258.03
|
|
|
Service Code
|
NDC 69367022409
|
| Hospital Charge Code |
38624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$232.23 |
| Rate for Payer: Aetna American Axle |
$167.72
|
| Rate for Payer: Aetna Commercial |
$219.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.72
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Advantage |
$180.62
|
| Rate for Payer: Cofinity Commercial |
$221.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Healthscope Commercial |
$232.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.52
|
| Rate for Payer: PHP Commercial |
$219.33
|
| Rate for Payer: Priority Health SBD |
$162.56
|
| Rate for Payer: UMR Bronson Commercial |
$113.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.52
|
|
|
FOLIC ACID-VIT B6-VIT B12 2.5 MG-25 MG-2 MG TABLET
|
Facility
|
IP
|
$285.56
|
|
|
Service Code
|
NDC 75834008090
|
| Hospital Charge Code |
38624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.65 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: Aetna American Axle |
$185.61
|
| Rate for Payer: Aetna Commercial |
$242.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.61
|
| Rate for Payer: Cash Price |
$228.45
|
| Rate for Payer: Cofinity Advantage |
$199.89
|
| Rate for Payer: Cofinity Commercial |
$245.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.45
|
| Rate for Payer: Healthscope Commercial |
$257.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.17
|
| Rate for Payer: PHP Commercial |
$242.73
|
| Rate for Payer: Priority Health SBD |
$179.90
|
| Rate for Payer: UMR Bronson Commercial |
$125.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.17
|
|
|
FOLIC ACID-VIT B6-VIT B12 2.5 MG-25 MG-2 MG TABLET
|
Facility
|
IP
|
$309.75
|
|
|
Service Code
|
NDC 51991038490
|
| Hospital Charge Code |
38624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$278.77 |
| Rate for Payer: Aetna American Axle |
$201.34
|
| Rate for Payer: Aetna Commercial |
$263.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.34
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cofinity Advantage |
$216.82
|
| Rate for Payer: Cofinity Commercial |
$266.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.80
|
| Rate for Payer: Healthscope Commercial |
$278.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.31
|
| Rate for Payer: PHP Commercial |
$263.29
|
| Rate for Payer: Priority Health SBD |
$195.14
|
| Rate for Payer: UMR Bronson Commercial |
$136.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.31
|
|
|
FOLIC ACID-VIT B6-VIT B12 2.5 MG-25 MG-2 MG TABLET
|
Facility
|
OP
|
$285.56
|
|
|
Service Code
|
NDC 75834008090
|
| Hospital Charge Code |
38624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.66 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: Aetna American Axle |
$185.61
|
| Rate for Payer: Aetna Commercial |
$242.73
|
| Rate for Payer: Aetna Medicare |
$142.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.61
|
| Rate for Payer: BCBS Complete |
$114.22
|
| Rate for Payer: Cash Price |
$228.45
|
| Rate for Payer: Cofinity Advantage |
$199.89
|
| Rate for Payer: Cofinity Commercial |
$245.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.45
|
| Rate for Payer: Healthscope Commercial |
$257.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.17
|
| Rate for Payer: PHP Commercial |
$242.73
|
| Rate for Payer: Priority Health SBD |
$179.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.61
|
| Rate for Payer: UHC Core |
$148.78
|
| Rate for Payer: UHC Exchange |
$112.23
|
| Rate for Payer: UMR Bronson Commercial |
$105.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.17
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,934.31
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
22185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$2,640.88 |
| Rate for Payer: Aetna American Axle |
$1,907.30
|
| Rate for Payer: Aetna American Axle |
$971.07
|
| Rate for Payer: Aetna American Axle |
$987.53
|
| Rate for Payer: Aetna Commercial |
$2,494.16
|
| Rate for Payer: Aetna Commercial |
$1,291.38
|
| Rate for Payer: Aetna Commercial |
$1,269.87
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,907.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$971.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$987.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.18
|
| Rate for Payer: BCBS Complete |
$3.59
|
| Rate for Payer: BCBS Complete |
$3.59
|
| Rate for Payer: BCBS Complete |
$3.59
|
| Rate for Payer: BCBS MAPPO |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$6.54
|
| Rate for Payer: BCBS Trust/PPO |
$32.37
|
| Rate for Payer: BCBS Trust/PPO |
$32.37
|
| Rate for Payer: BCBS Trust/PPO |
$32.37
|
| Rate for Payer: BCN Commercial |
$32.37
|
| Rate for Payer: BCN Commercial |
$32.37
|
| Rate for Payer: BCN Commercial |
$32.37
|
| Rate for Payer: BCN Medicare Advantage |
$6.54
|
| Rate for Payer: BCN Medicare Advantage |
$6.54
|
| Rate for Payer: BCN Medicare Advantage |
$6.54
|
| Rate for Payer: Cash Price |
$1,215.42
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cash Price |
$1,195.17
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cash Price |
$1,215.42
|
| Rate for Payer: Cash Price |
$1,195.17
|
| Rate for Payer: Cofinity Advantage |
$1,045.77
|
| Rate for Payer: Cofinity Advantage |
$1,063.49
|
| Rate for Payer: Cofinity Advantage |
$2,054.02
|
| Rate for Payer: Cofinity Commercial |
$1,306.57
|
| Rate for Payer: Cofinity Commercial |
$2,523.51
|
| Rate for Payer: Cofinity Commercial |
$1,284.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,195.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,215.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,347.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.54
|
| Rate for Payer: Healthscope Commercial |
$1,344.56
|
| Rate for Payer: Healthscope Commercial |
$1,367.34
|
| Rate for Payer: Healthscope Commercial |
$2,640.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,063.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,045.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,054.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,139.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,200.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,120.47
|
| Rate for Payer: Mclaren Medicaid |
$6.54
|
| Rate for Payer: Mclaren Medicaid |
$6.54
|
| Rate for Payer: Mclaren Medicaid |
$6.54
|
| Rate for Payer: Mclaren Medicare |
$6.54
|
| Rate for Payer: Mclaren Medicare |
$6.54
|
| Rate for Payer: Mclaren Medicare |
$6.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.87
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,291.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,494.16
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,120.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,139.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,200.73
|
| Rate for Payer: PACE Medicare |
$6.21
|
| Rate for Payer: PACE Medicare |
$6.21
|
| Rate for Payer: PACE Medicare |
$6.21
|
| Rate for Payer: PACE SWMI |
$6.54
|
| Rate for Payer: PACE SWMI |
$6.54
|
| Rate for Payer: PACE SWMI |
$6.54
|
| Rate for Payer: PHP Commercial |
$2,494.16
|
| Rate for Payer: PHP Commercial |
$1,269.87
|
| Rate for Payer: PHP Commercial |
$1,291.38
|
| Rate for Payer: PHP Medicare Advantage |
$6.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.81
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health SBD |
$1,848.62
|
| Rate for Payer: Priority Health SBD |
$957.14
|
| Rate for Payer: Priority Health SBD |
$941.19
|
| Rate for Payer: Priority Health Tiered Network |
$15.85
|
| Rate for Payer: Priority Health Tiered Network |
$15.85
|
| Rate for Payer: Priority Health Tiered Network |
$15.85
|
| Rate for Payer: Railroad Medicare Medicare |
$6.54
|
| Rate for Payer: Railroad Medicare Medicare |
$6.54
|
| Rate for Payer: Railroad Medicare Medicare |
$6.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.61
|
| Rate for Payer: UHC Core |
$10.61
|
| Rate for Payer: UHC Core |
$10.61
|
| Rate for Payer: UHC Core |
$10.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.54
|
| Rate for Payer: UHC Exchange |
$10.61
|
| Rate for Payer: UHC Exchange |
$10.61
|
| Rate for Payer: UHC Exchange |
$10.61
|
| Rate for Payer: UHC Medicaid |
$3.42
|
| Rate for Payer: UHC Medicaid |
$3.42
|
| Rate for Payer: UHC Medicaid |
$3.42
|
| Rate for Payer: UHCCP Medicaid |
$3.42
|
| Rate for Payer: UHCCP Medicaid |
$3.42
|
| Rate for Payer: UHCCP Medicaid |
$3.42
|
| Rate for Payer: UMR Bronson Commercial |
$562.13
|
| Rate for Payer: UMR Bronson Commercial |
$552.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,085.69
|
| Rate for Payer: VA VA |
$6.54
|
| Rate for Payer: VA VA |
$6.54
|
| Rate for Payer: VA VA |
$6.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,120.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,200.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,139.45
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,493.96
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
22185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$657.34 |
| Max. Negotiated Rate |
$1,344.56 |
| Rate for Payer: Aetna American Axle |
$971.07
|
| Rate for Payer: Aetna American Axle |
$1,907.30
|
| Rate for Payer: Aetna American Axle |
$987.53
|
| Rate for Payer: Aetna Commercial |
$1,291.38
|
| Rate for Payer: Aetna Commercial |
$1,269.87
|
| Rate for Payer: Aetna Commercial |
$2,494.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,907.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$971.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$987.53
|
| Rate for Payer: Cash Price |
$1,215.42
|
| Rate for Payer: Cash Price |
$1,195.17
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cofinity Advantage |
$2,054.02
|
| Rate for Payer: Cofinity Advantage |
$1,045.77
|
| Rate for Payer: Cofinity Advantage |
$1,063.49
|
| Rate for Payer: Cofinity Commercial |
$2,523.51
|
| Rate for Payer: Cofinity Commercial |
$1,284.81
|
| Rate for Payer: Cofinity Commercial |
$1,306.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,195.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,215.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,347.45
|
| Rate for Payer: Healthscope Commercial |
$1,367.34
|
| Rate for Payer: Healthscope Commercial |
$2,640.88
|
| Rate for Payer: Healthscope Commercial |
$1,344.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,063.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,045.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,054.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,200.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,120.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,139.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,269.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,291.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,494.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,120.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,139.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,200.73
|
| Rate for Payer: PHP Commercial |
$1,291.38
|
| Rate for Payer: PHP Commercial |
$1,269.87
|
| Rate for Payer: PHP Commercial |
$2,494.16
|
| Rate for Payer: Priority Health SBD |
$941.19
|
| Rate for Payer: Priority Health SBD |
$957.14
|
| Rate for Payer: Priority Health SBD |
$1,848.62
|
| Rate for Payer: UMR Bronson Commercial |
$657.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,291.10
|
| Rate for Payer: UMR Bronson Commercial |
$668.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,139.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,120.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,200.73
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$28.25
|
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Aetna Medicare |
$21.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.25
|
| Rate for Payer: BCBS Complete |
$17.38
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: BCBS Trust/PPO |
$2.83
|
| Rate for Payer: BCBS Trust/PPO |
$2.83
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Advantage |
$30.42
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.77
|
| Rate for Payer: Healthscope Commercial |
$39.11
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.59
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$36.94
|
| Rate for Payer: Priority Health SBD |
$27.38
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.14
|
| Rate for Payer: UHC Core |
$69.05
|
| Rate for Payer: UHC Core |
$22.64
|
| Rate for Payer: UHC Exchange |
$52.08
|
| Rate for Payer: UHC Exchange |
$17.08
|
| Rate for Payer: UMR Bronson Commercial |
$49.04
|
| Rate for Payer: UMR Bronson Commercial |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.59
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$28.25
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.25
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cofinity Advantage |
$30.42
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.77
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$39.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.59
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$36.94
|
| Rate for Payer: Priority Health SBD |
$27.38
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: UMR Bronson Commercial |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.59
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$27.18
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
32215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$24.46 |
| Rate for Payer: Aetna American Axle |
$17.67
|
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Advantage |
$29.03
|
| Rate for Payer: Cofinity Advantage |
$19.03
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$24.46
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.10
|
| Rate for Payer: PHP Commercial |
$23.10
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: Priority Health SBD |
$17.12
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$18.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$27.18
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
32215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$24.46 |
| Rate for Payer: Aetna American Axle |
$17.67
|
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Aetna Medicare |
$13.59
|
| Rate for Payer: Aetna Medicare |
$20.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: BCBS Complete |
$16.59
|
| Rate for Payer: BCBS Complete |
$10.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.83
|
| Rate for Payer: BCBS Trust/PPO |
$2.83
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cofinity Advantage |
$19.03
|
| Rate for Payer: Cofinity Advantage |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Healthscope Commercial |
$24.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.10
|
| Rate for Payer: PHP Commercial |
$23.10
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: Priority Health SBD |
$17.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.67
|
| Rate for Payer: UHC Core |
$14.16
|
| Rate for Payer: UHC Core |
$21.61
|
| Rate for Payer: UHC Exchange |
$10.68
|
| Rate for Payer: UHC Exchange |
$16.30
|
| Rate for Payer: UMR Bronson Commercial |
$10.06
|
| Rate for Payer: UMR Bronson Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
|
|
FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: BCBS Trust/PPO |
$2.83
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.14
|
| Rate for Payer: UHC Core |
$69.05
|
| Rate for Payer: UHC Exchange |
$52.08
|
| Rate for Payer: UMR Bronson Commercial |
$49.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
39803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$285.61
|
| Rate for Payer: Aetna Commercial |
$373.49
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Aetna Medicare |
$219.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.61
|
| Rate for Payer: BCBS Complete |
$175.76
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: BCBS Trust/PPO |
$2.83
|
| Rate for Payer: BCBS Trust/PPO |
$2.83
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: Cash Price |
$351.52
|
| Rate for Payer: Cash Price |
$351.52
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Advantage |
$307.58
|
| Rate for Payer: Cofinity Commercial |
$377.88
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.52
|
| Rate for Payer: Healthscope Commercial |
$395.46
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.55
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$373.49
|
| Rate for Payer: Priority Health SBD |
$276.82
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.14
|
| Rate for Payer: UHC Core |
$69.05
|
| Rate for Payer: UHC Core |
$228.93
|
| Rate for Payer: UHC Exchange |
$52.08
|
| Rate for Payer: UHC Exchange |
$172.68
|
| Rate for Payer: UMR Bronson Commercial |
$49.04
|
| Rate for Payer: UMR Bronson Commercial |
$162.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.55
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
39803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$285.61
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Commercial |
$373.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.61
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$351.52
|
| Rate for Payer: Cofinity Advantage |
$307.58
|
| Rate for Payer: Cofinity Advantage |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$377.88
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.52
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$395.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.55
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$373.49
|
| Rate for Payer: Priority Health SBD |
$276.82
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: UMR Bronson Commercial |
$193.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.55
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$17,709.39
|
|
|
Service Code
|
APR-DRG 3144
|
| Min. Negotiated Rate |
$16,866.08 |
| Max. Negotiated Rate |
$17,709.39 |
| Rate for Payer: BCBS Complete |
$17,709.39
|
| Rate for Payer: Mclaren Medicaid |
$16,866.08
|
| Rate for Payer: Meridian Medicaid |
$17,709.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,866.08
|
| Rate for Payer: UHC Medicaid |
$16,866.08
|
| Rate for Payer: UHCCP Medicaid |
$16,866.08
|
|
|
FOOT AND TOE PROCEDURES
|
Facility
|
IP
|
$9,486.65
|
|
|
Service Code
|
APR-DRG 3142
|
| Min. Negotiated Rate |
$9,034.91 |
| Max. Negotiated Rate |
$9,486.65 |
| Rate for Payer: BCBS Complete |
$9,486.65
|
| Rate for Payer: Mclaren Medicaid |
$9,034.91
|
| Rate for Payer: Meridian Medicaid |
$9,486.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,034.91
|
| Rate for Payer: UHC Medicaid |
$9,034.91
|
| Rate for Payer: UHCCP Medicaid |
$9,034.91
|
|
