|
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
|
$13,144.63
|
|
|
Service Code
|
APR-DRG 3143
|
| Min. Negotiated Rate |
$12,518.70 |
| Max. Negotiated Rate |
$13,144.63 |
| Rate for Payer: BCBS Complete |
$13,144.63
|
| Rate for Payer: Mclaren Medicaid |
$12,518.70
|
| Rate for Payer: Meridian Medicaid |
$13,144.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,518.70
|
| Rate for Payer: UHC Medicaid |
$12,518.70
|
| Rate for Payer: UHCCP Medicaid |
$12,518.70
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$38,244.73
|
|
|
Service Code
|
MSDRG 504
|
| Min. Negotiated Rate |
$15,413.29 |
| Max. Negotiated Rate |
$38,244.73 |
| Rate for Payer: Aetna Medicare |
$16,873.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,280.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,280.65
|
| Rate for Payer: BCBS MAPPO |
$16,224.52
|
| Rate for Payer: BCBS Trust/PPO |
$38,244.73
|
| Rate for Payer: BCN Commercial |
$38,244.73
|
| Rate for Payer: BCN Medicare Advantage |
$16,224.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,224.52
|
| Rate for Payer: Mclaren Medicare |
$16,224.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,035.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,658.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,846.97
|
| Rate for Payer: Nomi Health Commercial |
$24,112.68
|
| Rate for Payer: PACE Medicare |
$15,413.29
|
| Rate for Payer: PACE SWMI |
$16,224.52
|
| Rate for Payer: PHP Medicare Advantage |
$16,224.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,135.50
|
| Rate for Payer: Priority Health Medicare |
$16,224.52
|
| Rate for Payer: Priority Health Tiered Network |
$24,108.40
|
| Rate for Payer: Railroad Medicare Medicare |
$16,224.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,467.96
|
| Rate for Payer: UHC Core |
$25,490.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,224.52
|
| Rate for Payer: UHC Exchange |
$20,817.28
|
| Rate for Payer: VA VA |
$16,224.52
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$54,547.88
|
|
|
Service Code
|
MSDRG 503
|
| Min. Negotiated Rate |
$22,737.39 |
| Max. Negotiated Rate |
$54,547.88 |
| Rate for Payer: Aetna Medicare |
$24,891.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,917.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,917.61
|
| Rate for Payer: BCBS MAPPO |
$23,934.09
|
| Rate for Payer: BCBS Trust/PPO |
$54,547.88
|
| Rate for Payer: BCN Commercial |
$54,547.88
|
| Rate for Payer: BCN Medicare Advantage |
$23,934.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,934.09
|
| Rate for Payer: Mclaren Medicare |
$23,934.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,130.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,524.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$26,327.50
|
| Rate for Payer: Nomi Health Commercial |
$36,005.19
|
| Rate for Payer: PACE Medicare |
$22,737.39
|
| Rate for Payer: PACE SWMI |
$23,934.09
|
| Rate for Payer: PHP Medicare Advantage |
$23,934.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44,998.50
|
| Rate for Payer: Priority Health Medicare |
$23,934.09
|
| Rate for Payer: Priority Health Tiered Network |
$35,998.80
|
| Rate for Payer: Railroad Medicare Medicare |
$23,934.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,494.93
|
| Rate for Payer: UHC Core |
$38,062.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,934.09
|
| Rate for Payer: UHC Exchange |
$31,084.48
|
| Rate for Payer: VA VA |
$23,934.09
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,558.45
|
|
|
Service Code
|
MSDRG 505
|
| Min. Negotiated Rate |
$14,806.33 |
| Max. Negotiated Rate |
$30,558.45 |
| Rate for Payer: Aetna Medicare |
$16,209.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,482.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,482.01
|
| Rate for Payer: BCBS MAPPO |
$15,585.61
|
| Rate for Payer: BCBS Trust/PPO |
$30,558.45
|
| Rate for Payer: BCN Commercial |
$30,558.45
|
| Rate for Payer: BCN Medicare Advantage |
$15,585.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,585.61
|
| Rate for Payer: Mclaren Medicare |
$15,585.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,364.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,923.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,144.17
|
| Rate for Payer: Nomi Health Commercial |
$23,127.12
|
| Rate for Payer: PACE Medicare |
$14,806.33
|
| Rate for Payer: PACE SWMI |
$15,585.61
|
| Rate for Payer: PHP Medicare Advantage |
$15,585.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,903.77
|
| Rate for Payer: Priority Health Medicare |
$15,585.61
|
| Rate for Payer: Priority Health Tiered Network |
$23,123.01
|
| Rate for Payer: Railroad Medicare Medicare |
$15,585.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,222.64
|
| Rate for Payer: UHC Core |
$24,448.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,585.61
|
| Rate for Payer: UHC Exchange |
$19,966.41
|
| Rate for Payer: VA VA |
$15,585.61
|
|
|
FOREHEAD FLAP WITH PRESERVATION OF VASCULAR PEDICLE (EG, AXIAL PATTERN FLAP, PARAMEDIAN FOREHEAD FLAP)
|
Facility
|
OP
|
$11,418.88
|
|
|
Service Code
|
CPT 15731
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,846.70 |
| Max. Negotiated Rate |
$11,418.88 |
| Rate for Payer: Aetna Medicare |
$3,672.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,971.24
|
| Rate for Payer: BCN Commercial |
$2,971.24
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$3,707.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Nomi Health Commercial |
$10,592.94
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,418.88
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health Tiered Network |
$9,135.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING
|
Facility
|
OP
|
$805.08
|
|
|
Service Code
|
CPT 54450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$219.66
|
| Rate for Payer: BCN Commercial |
$219.66
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; EYELIDS, NOSE, EARS, LIPS, OR INTRAORAL
|
Facility
|
OP
|
$6,648.46
|
|
|
Service Code
|
CPT 15576
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,210.95
|
| Rate for Payer: BCN Commercial |
$2,210.95
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$17.83
|
|
|
Service Code
|
HCPCS J7606
|
| Hospital Charge Code |
88225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$16.05 |
| Rate for Payer: Aetna American Axle |
$11.59
|
| Rate for Payer: Aetna American Axle |
$35.93
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$46.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.93
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cofinity Advantage |
$38.70
|
| Rate for Payer: Cofinity Advantage |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.22
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$49.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.46
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$46.99
|
| Rate for Payer: Priority Health SBD |
$34.83
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.85
|
| Rate for Payer: UMR Bronson Commercial |
$24.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.46
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$55.28
|
|
|
Service Code
|
HCPCS J7606
|
| Hospital Charge Code |
88225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna American Axle |
$35.93
|
| Rate for Payer: Aetna American Axle |
$11.59
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$46.99
|
| Rate for Payer: Aetna Medicare |
$27.64
|
| Rate for Payer: Aetna Medicare |
$8.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.93
|
| Rate for Payer: BCBS Complete |
$7.13
|
| Rate for Payer: BCBS Complete |
$22.11
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cash Price |
$44.22
|
| Rate for Payer: Cofinity Advantage |
$12.48
|
| Rate for Payer: Cofinity Advantage |
$38.70
|
| Rate for Payer: Cofinity Commercial |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$49.75
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.46
|
| Rate for Payer: PHP Commercial |
$46.99
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.20
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: Priority Health SBD |
$34.83
|
| Rate for Payer: Priority Health Tiered Network |
$1.76
|
| Rate for Payer: Priority Health Tiered Network |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.93
|
| Rate for Payer: UHC Core |
$28.80
|
| Rate for Payer: UHC Core |
$9.29
|
| Rate for Payer: UHC Exchange |
$7.01
|
| Rate for Payer: UHC Exchange |
$21.73
|
| Rate for Payer: UMR Bronson Commercial |
$20.45
|
| Rate for Payer: UMR Bronson Commercial |
$6.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.46
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$1,478.01
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$650.32 |
| Max. Negotiated Rate |
$1,330.21 |
| Rate for Payer: Aetna American Axle |
$960.71
|
| Rate for Payer: Aetna American Axle |
$137.40
|
| Rate for Payer: Aetna American Axle |
$139.83
|
| Rate for Payer: Aetna American Axle |
$278.76
|
| Rate for Payer: Aetna American Axle |
$190.55
|
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna American Axle |
$137.31
|
| Rate for Payer: Aetna Commercial |
$182.86
|
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: Aetna Commercial |
$1,256.31
|
| Rate for Payer: Aetna Commercial |
$179.67
|
| Rate for Payer: Aetna Commercial |
$364.53
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$249.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.76
|
| Rate for Payer: Cash Price |
$1,182.41
|
| Rate for Payer: Cash Price |
$172.10
|
| Rate for Payer: Cash Price |
$169.10
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cofinity Advantage |
$205.21
|
| Rate for Payer: Cofinity Advantage |
$1,034.61
|
| Rate for Payer: Cofinity Advantage |
$147.88
|
| Rate for Payer: Cofinity Advantage |
$150.59
|
| Rate for Payer: Cofinity Advantage |
$147.97
|
| Rate for Payer: Cofinity Advantage |
$187.17
|
| Rate for Payer: Cofinity Advantage |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$181.79
|
| Rate for Payer: Cofinity Commercial |
$368.82
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Cofinity Commercial |
$1,271.09
|
| Rate for Payer: Cofinity Commercial |
$181.68
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$185.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Healthscope Commercial |
$385.97
|
| Rate for Payer: Healthscope Commercial |
$1,330.21
|
| Rate for Payer: Healthscope Commercial |
$263.83
|
| Rate for Payer: Healthscope Commercial |
$193.62
|
| Rate for Payer: Healthscope Commercial |
$190.12
|
| Rate for Payer: Healthscope Commercial |
$190.24
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.44
|
| Rate for Payer: PHP Commercial |
$179.56
|
| Rate for Payer: PHP Commercial |
$249.18
|
| Rate for Payer: PHP Commercial |
$182.86
|
| Rate for Payer: PHP Commercial |
$364.53
|
| Rate for Payer: PHP Commercial |
$179.67
|
| Rate for Payer: PHP Commercial |
$1,256.31
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: Priority Health SBD |
$931.15
|
| Rate for Payer: Priority Health SBD |
$135.53
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$184.68
|
| Rate for Payer: Priority Health SBD |
$270.18
|
| Rate for Payer: Priority Health SBD |
$133.09
|
| Rate for Payer: Priority Health SBD |
$133.17
|
| Rate for Payer: UMR Bronson Commercial |
$188.70
|
| Rate for Payer: UMR Bronson Commercial |
$650.32
|
| Rate for Payer: UMR Bronson Commercial |
$94.66
|
| Rate for Payer: UMR Bronson Commercial |
$92.95
|
| Rate for Payer: UMR Bronson Commercial |
$117.65
|
| Rate for Payer: UMR Bronson Commercial |
$128.99
|
| Rate for Payer: UMR Bronson Commercial |
$93.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.64
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$1,344.40
|
|
|
Service Code
|
HCPCS J1456
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$1,209.96 |
| Rate for Payer: Aetna American Axle |
$873.86
|
| Rate for Payer: Aetna Commercial |
$1,142.74
|
| Rate for Payer: Aetna Medicare |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.02
|
| Rate for Payer: BCBS MAPPO |
$0.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: BCN Medicare Advantage |
$0.04
|
| Rate for Payer: Cash Price |
$1,075.52
|
| Rate for Payer: Cash Price |
$1,075.52
|
| Rate for Payer: Cofinity Advantage |
$941.08
|
| Rate for Payer: Cofinity Commercial |
$1,156.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.04
|
| Rate for Payer: Healthscope Commercial |
$1,209.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$941.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.30
|
| Rate for Payer: Mclaren Medicaid |
$0.04
|
| Rate for Payer: Mclaren Medicare |
$0.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.04
|
| Rate for Payer: Meridian Medicaid |
$0.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,142.74
|
| Rate for Payer: Nomi Health Commercial |
$0.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,008.30
|
| Rate for Payer: PACE Medicare |
$0.04
|
| Rate for Payer: PACE SWMI |
$0.04
|
| Rate for Payer: PHP Commercial |
$1,142.74
|
| Rate for Payer: PHP Medicare Advantage |
$0.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$0.04
|
| Rate for Payer: Priority Health SBD |
$846.97
|
| Rate for Payer: Priority Health Tiered Network |
$2.61
|
| Rate for Payer: Railroad Medicare Medicare |
$0.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.06
|
| Rate for Payer: UHC Core |
$1.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.04
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicaid |
$0.02
|
| Rate for Payer: UHCCP Medicaid |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$497.43
|
| Rate for Payer: VA VA |
$0.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.30
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$232.50
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$209.25 |
| Rate for Payer: Aetna American Axle |
$151.12
|
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna American Axle |
$126.83
|
| Rate for Payer: Aetna American Axle |
$190.55
|
| Rate for Payer: Aetna American Axle |
$278.76
|
| Rate for Payer: Aetna American Axle |
$121.96
|
| Rate for Payer: Aetna American Axle |
$180.29
|
| Rate for Payer: Aetna American Axle |
$137.40
|
| Rate for Payer: Aetna American Axle |
$137.31
|
| Rate for Payer: Aetna American Axle |
$323.60
|
| Rate for Payer: Aetna American Axle |
$960.71
|
| Rate for Payer: Aetna American Axle |
$873.86
|
| Rate for Payer: Aetna American Axle |
$139.83
|
| Rate for Payer: Aetna Commercial |
$182.86
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: Aetna Commercial |
$165.86
|
| Rate for Payer: Aetna Commercial |
$159.49
|
| Rate for Payer: Aetna Commercial |
$1,256.31
|
| Rate for Payer: Aetna Commercial |
$249.18
|
| Rate for Payer: Aetna Commercial |
$179.67
|
| Rate for Payer: Aetna Commercial |
$235.76
|
| Rate for Payer: Aetna Commercial |
$1,142.74
|
| Rate for Payer: Aetna Commercial |
$364.53
|
| Rate for Payer: Aetna Commercial |
$197.62
|
| Rate for Payer: Aetna Commercial |
$423.16
|
| Rate for Payer: Aetna Medicare |
$105.62
|
| Rate for Payer: Aetna Medicare |
$146.57
|
| Rate for Payer: Aetna Medicare |
$116.25
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: Aetna Medicare |
$739.00
|
| Rate for Payer: Aetna Medicare |
$107.56
|
| Rate for Payer: Aetna Medicare |
$672.20
|
| Rate for Payer: Aetna Medicare |
$248.92
|
| Rate for Payer: Aetna Medicare |
$93.81
|
| Rate for Payer: Aetna Medicare |
$105.69
|
| Rate for Payer: Aetna Medicare |
$214.43
|
| Rate for Payer: Aetna Medicare |
$138.69
|
| Rate for Payer: Aetna Medicare |
$97.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.76
|
| Rate for Payer: BCBS Complete |
$591.20
|
| Rate for Payer: BCBS Complete |
$537.76
|
| Rate for Payer: BCBS Complete |
$93.00
|
| Rate for Payer: BCBS Complete |
$110.95
|
| Rate for Payer: BCBS Complete |
$86.05
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: BCBS Complete |
$84.50
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Complete |
$75.05
|
| Rate for Payer: BCBS Complete |
$199.14
|
| Rate for Payer: BCBS Complete |
$84.55
|
| Rate for Payer: BCBS Complete |
$78.05
|
| Rate for Payer: BCBS Complete |
$117.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: BCN Commercial |
$0.32
|
| Rate for Payer: Cash Price |
$1,075.52
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$1,075.52
|
| Rate for Payer: Cash Price |
$150.10
|
| Rate for Payer: Cash Price |
$150.10
|
| Rate for Payer: Cash Price |
$1,182.41
|
| Rate for Payer: Cash Price |
$1,182.41
|
| Rate for Payer: Cash Price |
$398.27
|
| Rate for Payer: Cash Price |
$398.27
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$234.52
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: Cash Price |
$169.10
|
| Rate for Payer: Cash Price |
$169.10
|
| Rate for Payer: Cash Price |
$221.90
|
| Rate for Payer: Cash Price |
$172.10
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$172.10
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cofinity Advantage |
$348.49
|
| Rate for Payer: Cofinity Advantage |
$194.16
|
| Rate for Payer: Cofinity Advantage |
$300.20
|
| Rate for Payer: Cofinity Advantage |
$205.21
|
| Rate for Payer: Cofinity Advantage |
$147.97
|
| Rate for Payer: Cofinity Advantage |
$131.34
|
| Rate for Payer: Cofinity Advantage |
$136.59
|
| Rate for Payer: Cofinity Advantage |
$187.17
|
| Rate for Payer: Cofinity Advantage |
$147.88
|
| Rate for Payer: Cofinity Advantage |
$1,034.61
|
| Rate for Payer: Cofinity Advantage |
$162.75
|
| Rate for Payer: Cofinity Advantage |
$941.08
|
| Rate for Payer: Cofinity Advantage |
$150.59
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Cofinity Commercial |
$1,271.09
|
| Rate for Payer: Cofinity Commercial |
$1,156.18
|
| Rate for Payer: Cofinity Commercial |
$181.68
|
| Rate for Payer: Cofinity Commercial |
$167.81
|
| Rate for Payer: Cofinity Commercial |
$368.82
|
| Rate for Payer: Cofinity Commercial |
$181.79
|
| Rate for Payer: Cofinity Commercial |
$238.54
|
| Rate for Payer: Cofinity Commercial |
$199.95
|
| Rate for Payer: Cofinity Commercial |
$428.14
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$161.36
|
| Rate for Payer: Cofinity Commercial |
$185.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.10
|
| Rate for Payer: Healthscope Commercial |
$190.24
|
| Rate for Payer: Healthscope Commercial |
$249.63
|
| Rate for Payer: Healthscope Commercial |
$193.62
|
| Rate for Payer: Healthscope Commercial |
$190.12
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$1,209.96
|
| Rate for Payer: Healthscope Commercial |
$263.83
|
| Rate for Payer: Healthscope Commercial |
$1,330.21
|
| Rate for Payer: Healthscope Commercial |
$448.06
|
| Rate for Payer: Healthscope Commercial |
$168.87
|
| Rate for Payer: Healthscope Commercial |
$209.25
|
| Rate for Payer: Healthscope Commercial |
$385.97
|
| Rate for Payer: Healthscope Commercial |
$175.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$348.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$941.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,182.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,075.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,142.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,008.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.51
|
| Rate for Payer: PHP Commercial |
$364.53
|
| Rate for Payer: PHP Commercial |
$197.62
|
| Rate for Payer: PHP Commercial |
$249.18
|
| Rate for Payer: PHP Commercial |
$165.86
|
| Rate for Payer: PHP Commercial |
$1,142.74
|
| Rate for Payer: PHP Commercial |
$1,256.31
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$182.86
|
| Rate for Payer: PHP Commercial |
$423.16
|
| Rate for Payer: PHP Commercial |
$179.67
|
| Rate for Payer: PHP Commercial |
$159.49
|
| Rate for Payer: PHP Commercial |
$179.56
|
| Rate for Payer: PHP Commercial |
$235.76
|
| Rate for Payer: Priority Health SBD |
$184.68
|
| Rate for Payer: Priority Health SBD |
$118.21
|
| Rate for Payer: Priority Health SBD |
$135.53
|
| Rate for Payer: Priority Health SBD |
$133.17
|
| Rate for Payer: Priority Health SBD |
$174.74
|
| Rate for Payer: Priority Health SBD |
$146.47
|
| Rate for Payer: Priority Health SBD |
$133.09
|
| Rate for Payer: Priority Health SBD |
$931.15
|
| Rate for Payer: Priority Health SBD |
$122.93
|
| Rate for Payer: Priority Health SBD |
$846.97
|
| Rate for Payer: Priority Health SBD |
$270.18
|
| Rate for Payer: Priority Health SBD |
$313.64
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UMR Bronson Commercial |
$497.43
|
| Rate for Payer: UMR Bronson Commercial |
$184.20
|
| Rate for Payer: UMR Bronson Commercial |
$78.16
|
| Rate for Payer: UMR Bronson Commercial |
$86.03
|
| Rate for Payer: UMR Bronson Commercial |
$108.47
|
| Rate for Payer: UMR Bronson Commercial |
$69.42
|
| Rate for Payer: UMR Bronson Commercial |
$158.68
|
| Rate for Payer: UMR Bronson Commercial |
$78.21
|
| Rate for Payer: UMR Bronson Commercial |
$72.20
|
| Rate for Payer: UMR Bronson Commercial |
$102.63
|
| Rate for Payer: UMR Bronson Commercial |
$79.60
|
| Rate for Payer: UMR Bronson Commercial |
$98.93
|
| Rate for Payer: UMR Bronson Commercial |
$546.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.03
|
|
|
FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,061.45
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
10093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$467.04 |
| Max. Negotiated Rate |
$955.30 |
| Rate for Payer: Aetna American Axle |
$689.94
|
| Rate for Payer: Aetna Commercial |
$902.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$689.94
|
| Rate for Payer: Cash Price |
$849.16
|
| Rate for Payer: Cofinity Advantage |
$743.01
|
| Rate for Payer: Cofinity Commercial |
$912.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$849.16
|
| Rate for Payer: Healthscope Commercial |
$955.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$743.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$796.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$902.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$796.09
|
| Rate for Payer: PHP Commercial |
$902.23
|
| Rate for Payer: Priority Health SBD |
$668.71
|
| Rate for Payer: UMR Bronson Commercial |
$467.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$796.09
|
|
|
FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,061.45
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
10093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$955.30 |
| Rate for Payer: Aetna American Axle |
$689.94
|
| Rate for Payer: Aetna Commercial |
$902.23
|
| Rate for Payer: Aetna Medicare |
$530.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$689.94
|
| Rate for Payer: BCBS Complete |
$424.58
|
| Rate for Payer: BCBS Trust/PPO |
$31.83
|
| Rate for Payer: BCN Commercial |
$31.83
|
| Rate for Payer: Cash Price |
$849.16
|
| Rate for Payer: Cash Price |
$849.16
|
| Rate for Payer: Cofinity Advantage |
$743.01
|
| Rate for Payer: Cofinity Commercial |
$912.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$849.16
|
| Rate for Payer: Healthscope Commercial |
$955.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$743.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$796.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$849.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$902.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$796.09
|
| Rate for Payer: PHP Commercial |
$902.23
|
| Rate for Payer: Priority Health SBD |
$668.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.07
|
| Rate for Payer: UHC Core |
$11.07
|
| Rate for Payer: UHC Exchange |
$11.07
|
| Rate for Payer: UMR Bronson Commercial |
$392.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$796.09
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$194.25
|
|
|
Service Code
|
NDC 70700026894
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna American Axle |
$126.26
|
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.26
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Advantage |
$135.97
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health SBD |
$122.38
|
| Rate for Payer: UMR Bronson Commercial |
$85.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.69
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 82036427408
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Advantage |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$194.25
|
|
|
Service Code
|
NDC 70700026894
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna American Axle |
$126.26
|
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna Medicare |
$97.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.26
|
| Rate for Payer: BCBS Complete |
$77.70
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Advantage |
$135.97
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health SBD |
$122.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.26
|
| Rate for Payer: UHC Core |
$101.20
|
| Rate for Payer: UHC Exchange |
$76.34
|
| Rate for Payer: UMR Bronson Commercial |
$71.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.69
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$206.46
|
|
|
Service Code
|
NDC 82036427408
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.39 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna Medicare |
$103.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: BCBS Complete |
$82.58
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Advantage |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.20
|
| Rate for Payer: UHC Core |
$107.57
|
| Rate for Payer: UHC Exchange |
$81.14
|
| Rate for Payer: UMR Bronson Commercial |
$76.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$194.25
|
|
|
Service Code
|
NDC 70700026899
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna American Axle |
$126.26
|
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.26
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Advantage |
$135.97
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health SBD |
$122.38
|
| Rate for Payer: UMR Bronson Commercial |
$85.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.69
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$206.46
|
|
|
Service Code
|
NDC 82036427401
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.39 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna Medicare |
$103.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: BCBS Complete |
$82.58
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Advantage |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.20
|
| Rate for Payer: UHC Core |
$107.57
|
| Rate for Payer: UHC Exchange |
$81.14
|
| Rate for Payer: UMR Bronson Commercial |
$76.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$194.25
|
|
|
Service Code
|
NDC 70700026899
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna American Axle |
$126.26
|
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna Medicare |
$97.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.26
|
| Rate for Payer: BCBS Complete |
$77.70
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Advantage |
$135.97
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.69
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health SBD |
$122.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.26
|
| Rate for Payer: UHC Core |
$101.20
|
| Rate for Payer: UHC Exchange |
$76.34
|
| Rate for Payer: UMR Bronson Commercial |
$71.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.69
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 82036427401
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Advantage |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.84
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOSINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$308.79
|
|
|
Service Code
|
NDC 69097085705
|
| Hospital Charge Code |
10095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.87 |
| Max. Negotiated Rate |
$277.91 |
| Rate for Payer: Aetna American Axle |
$200.71
|
| Rate for Payer: Aetna Commercial |
$262.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.71
|
| Rate for Payer: Cash Price |
$247.03
|
| Rate for Payer: Cofinity Advantage |
$216.15
|
| Rate for Payer: Cofinity Commercial |
$265.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.03
|
| Rate for Payer: Healthscope Commercial |
$277.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.59
|
| Rate for Payer: PHP Commercial |
$262.47
|
| Rate for Payer: Priority Health SBD |
$194.54
|
| Rate for Payer: UMR Bronson Commercial |
$135.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.59
|
|
|
FOSINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$308.79
|
|
|
Service Code
|
NDC 69097085705
|
| Hospital Charge Code |
10095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.25 |
| Max. Negotiated Rate |
$277.91 |
| Rate for Payer: Aetna American Axle |
$200.71
|
| Rate for Payer: Aetna Commercial |
$262.47
|
| Rate for Payer: Aetna Medicare |
$154.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.71
|
| Rate for Payer: BCBS Complete |
$123.52
|
| Rate for Payer: Cash Price |
$247.03
|
| Rate for Payer: Cofinity Advantage |
$216.15
|
| Rate for Payer: Cofinity Commercial |
$265.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.03
|
| Rate for Payer: Healthscope Commercial |
$277.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.59
|
| Rate for Payer: PHP Commercial |
$262.47
|
| Rate for Payer: Priority Health SBD |
$194.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.71
|
| Rate for Payer: UHC Core |
$160.88
|
| Rate for Payer: UHC Exchange |
$121.35
|
| Rate for Payer: UMR Bronson Commercial |
$114.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.59
|
|
