|
AMPICILLIN-SULBACTAM 3 GRAM/100 ML NS (IV PREMIX)
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
180341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UMR Bronson Commercial |
$41.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM/100 ML NS (IV PREMIX)
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
180341
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna American Axle |
$60.87
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UMR Bronson Commercial |
$34.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$36.66
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$32.99 |
| Rate for Payer: Aetna American Axle |
$23.83
|
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna American Axle |
$19.02
|
| Rate for Payer: Aetna American Axle |
$23.63
|
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna American Axle |
$17.52
|
| Rate for Payer: Aetna American Axle |
$16.36
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$30.96
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Medicare |
$14.63
|
| Rate for Payer: Aetna Medicare |
$12.58
|
| Rate for Payer: Aetna Medicare |
$18.21
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Aetna Medicare |
$16.04
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: BCBS Complete |
$11.70
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS Complete |
$14.57
|
| Rate for Payer: BCBS Complete |
$12.84
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$25.45
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Cofinity Commercial |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$22.46
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Healthscope Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$28.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$30.96
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: Priority Health SBD |
$18.43
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health SBD |
$15.86
|
| Rate for Payer: Priority Health SBD |
$16.98
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Priority Health SBD |
$22.91
|
| Rate for Payer: UMR Bronson Commercial |
$13.48
|
| Rate for Payer: UMR Bronson Commercial |
$13.56
|
| Rate for Payer: UMR Bronson Commercial |
$13.45
|
| Rate for Payer: UMR Bronson Commercial |
$11.87
|
| Rate for Payer: UMR Bronson Commercial |
$10.83
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: UMR Bronson Commercial |
$8.66
|
| Rate for Payer: UMR Bronson Commercial |
$9.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$36.42
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$32.78 |
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna American Axle |
$23.63
|
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna American Axle |
$17.52
|
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna American Axle |
$16.36
|
| Rate for Payer: Aetna American Axle |
$19.02
|
| Rate for Payer: Aetna American Axle |
$23.83
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Commercial |
$30.96
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$24.87
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Cash Price |
$23.41
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cofinity Commercial |
$25.16
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.48
|
| Rate for Payer: Cofinity Commercial |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$22.46
|
| Rate for Payer: Cofinity Commercial |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$25.45
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$28.88
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$26.33
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$30.96
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$24.87
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.52
|
| Rate for Payer: Priority Health SBD |
$16.98
|
| Rate for Payer: Priority Health SBD |
$15.86
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$18.43
|
| Rate for Payer: Priority Health SBD |
$22.91
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: UMR Bronson Commercial |
$11.86
|
| Rate for Payer: UMR Bronson Commercial |
$12.87
|
| Rate for Payer: UMR Bronson Commercial |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$16.02
|
| Rate for Payer: UMR Bronson Commercial |
$11.07
|
| Rate for Payer: UMR Bronson Commercial |
$16.13
|
| Rate for Payer: UMR Bronson Commercial |
$14.12
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.07
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$23.40
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: UMR Bronson Commercial |
$8.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$23.40
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna American Axle |
$15.21
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.21
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.55
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
OP
|
$19.71
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$17.74 |
| Rate for Payer: Aetna American Axle |
$12.81
|
| Rate for Payer: Aetna Commercial |
$16.75
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.81
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS Trust/PPO |
$5.43
|
| Rate for Payer: BCN Commercial |
$5.43
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Healthscope Commercial |
$17.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: PHP Commercial |
$16.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$7.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.78
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
IP
|
$19.71
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$17.74 |
| Rate for Payer: Aetna American Axle |
$12.81
|
| Rate for Payer: Aetna Commercial |
$16.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.81
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Healthscope Commercial |
$17.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: PHP Commercial |
$16.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$8.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.78
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH DIRECT CLOSURE
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$666.26 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,638.12
|
| Rate for Payer: BCN Commercial |
$2,638.12
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$732.89
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$666.26
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH LOCAL ADVANCEMENT FLAPS (V-Y, HOOD)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26952
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$649.90 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$714.89
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$649.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
AMPUTATION, FOOT; TRANSMETATARSAL
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$682.18 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,277.38
|
| Rate for Payer: BCN Commercial |
$2,277.38
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.40
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$682.18
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAY AMPUTATION), SINGLE, WITH OR WITHOUT INTEROSSEOUS TRANSFER
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$726.31 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,372.99
|
| Rate for Payer: BCN Commercial |
$2,372.99
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$798.94
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$726.31
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
AMPUTATION, METATARSAL, WITH TOE, SINGLE
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$407.88 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.67
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$407.88
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
AMPUTATION, TOE; INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$167.59 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,545.77
|
| Rate for Payer: BCN Commercial |
$2,545.77
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.35
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$167.59
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$171.85 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,547.91
|
| Rate for Payer: BCN Commercial |
$2,547.91
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.04
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$171.85
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
NDC 00172524160
|
| Hospital Charge Code |
20446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.64 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Aetna American Axle |
$241.80
|
| Rate for Payer: Aetna Commercial |
$316.20
|
| Rate for Payer: Aetna Medicare |
$186.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.80
|
| Rate for Payer: BCBS Complete |
$148.80
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$260.40
|
| Rate for Payer: Cofinity Commercial |
$319.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.60
|
| Rate for Payer: Healthscope Commercial |
$334.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.20
|
| Rate for Payer: PHP Commercial |
$316.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.80
|
| Rate for Payer: Priority Health SBD |
$234.36
|
| Rate for Payer: UMR Bronson Commercial |
$137.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.00
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$262.56
|
|
|
Service Code
|
NDC 13668045301
|
| Hospital Charge Code |
20446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.53 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Aetna American Axle |
$170.66
|
| Rate for Payer: Aetna Commercial |
$223.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.66
|
| Rate for Payer: Cash Price |
$210.05
|
| Rate for Payer: Cofinity Commercial |
$183.79
|
| Rate for Payer: Cofinity Commercial |
$225.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.05
|
| Rate for Payer: Healthscope Commercial |
$236.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.18
|
| Rate for Payer: PHP Commercial |
$223.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.66
|
| Rate for Payer: Priority Health SBD |
$165.41
|
| Rate for Payer: UMR Bronson Commercial |
$115.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.92
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
NDC 00172524160
|
| Hospital Charge Code |
20446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Aetna American Axle |
$241.80
|
| Rate for Payer: Aetna Commercial |
$316.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.80
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$260.40
|
| Rate for Payer: Cofinity Commercial |
$319.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.60
|
| Rate for Payer: Healthscope Commercial |
$334.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.20
|
| Rate for Payer: PHP Commercial |
$316.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.80
|
| Rate for Payer: Priority Health SBD |
$234.36
|
| Rate for Payer: UMR Bronson Commercial |
$163.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.00
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
OP
|
$262.56
|
|
|
Service Code
|
NDC 13668045301
|
| Hospital Charge Code |
20446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.15 |
| Max. Negotiated Rate |
$236.30 |
| Rate for Payer: Aetna American Axle |
$170.66
|
| Rate for Payer: Aetna Commercial |
$223.18
|
| Rate for Payer: Aetna Medicare |
$131.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.66
|
| Rate for Payer: BCBS Complete |
$105.02
|
| Rate for Payer: Cash Price |
$210.05
|
| Rate for Payer: Cofinity Commercial |
$183.79
|
| Rate for Payer: Cofinity Commercial |
$225.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.05
|
| Rate for Payer: Healthscope Commercial |
$236.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.18
|
| Rate for Payer: PHP Commercial |
$223.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.66
|
| Rate for Payer: Priority Health SBD |
$165.41
|
| Rate for Payer: UMR Bronson Commercial |
$97.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.92
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
IP
|
$104.34
|
|
|
Service Code
|
NDC 00904619546
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.91 |
| Max. Negotiated Rate |
$93.91 |
| Rate for Payer: Aetna American Axle |
$67.82
|
| Rate for Payer: Aetna Commercial |
$88.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.82
|
| Rate for Payer: Cash Price |
$83.47
|
| Rate for Payer: Cofinity Commercial |
$73.04
|
| Rate for Payer: Cofinity Commercial |
$89.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.47
|
| Rate for Payer: Healthscope Commercial |
$93.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.69
|
| Rate for Payer: PHP Commercial |
$88.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.82
|
| Rate for Payer: Priority Health SBD |
$65.73
|
| Rate for Payer: UMR Bronson Commercial |
$45.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.26
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
IP
|
$132.53
|
|
|
Service Code
|
NDC 68382020906
|
| Hospital Charge Code |
16205
|
|
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 Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.77
|
| 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: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.14
|
| 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
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
IP
|
$1,280.75
|
|
|
Service Code
|
NDC 16729003516
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$563.53 |
| Max. Negotiated Rate |
$1,152.68 |
| Rate for Payer: Aetna American Axle |
$832.49
|
| Rate for Payer: Aetna Commercial |
$1,088.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$832.49
|
| Rate for Payer: Cash Price |
$1,024.60
|
| Rate for Payer: Cofinity Commercial |
$1,101.44
|
| Rate for Payer: Cofinity Commercial |
$896.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$896.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,024.60
|
| Rate for Payer: Healthscope Commercial |
$1,152.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$896.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$960.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,088.64
|
| Rate for Payer: PHP Commercial |
$1,088.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.49
|
| Rate for Payer: Priority Health SBD |
$806.87
|
| Rate for Payer: UMR Bronson Commercial |
$563.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$960.56
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
OP
|
$81.23
|
|
|
Service Code
|
NDC 51991062033
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.06 |
| Max. Negotiated Rate |
$73.11 |
| Rate for Payer: Aetna American Axle |
$52.80
|
| Rate for Payer: Aetna Commercial |
$69.05
|
| Rate for Payer: Aetna Medicare |
$40.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.80
|
| Rate for Payer: BCBS Complete |
$32.49
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cofinity Commercial |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$69.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.98
|
| Rate for Payer: Healthscope Commercial |
$73.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.05
|
| Rate for Payer: PHP Commercial |
$69.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.80
|
| Rate for Payer: Priority Health SBD |
$51.17
|
| Rate for Payer: UMR Bronson Commercial |
$30.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.92
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
IP
|
$81.23
|
|
|
Service Code
|
NDC 51991062033
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$73.11 |
| Rate for Payer: Aetna American Axle |
$52.80
|
| Rate for Payer: Aetna Commercial |
$69.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.80
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cofinity Commercial |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$69.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.98
|
| Rate for Payer: Healthscope Commercial |
$73.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.05
|
| Rate for Payer: PHP Commercial |
$69.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.80
|
| Rate for Payer: Priority Health SBD |
$51.17
|
| Rate for Payer: UMR Bronson Commercial |
$35.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.92
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
OP
|
$1,280.75
|
|
|
Service Code
|
NDC 16729003516
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$473.88 |
| Max. Negotiated Rate |
$1,152.68 |
| Rate for Payer: Aetna American Axle |
$832.49
|
| Rate for Payer: Aetna Commercial |
$1,088.64
|
| Rate for Payer: Aetna Medicare |
$640.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$832.49
|
| Rate for Payer: BCBS Complete |
$512.30
|
| Rate for Payer: Cash Price |
$1,024.60
|
| Rate for Payer: Cofinity Commercial |
$1,101.44
|
| Rate for Payer: Cofinity Commercial |
$896.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$896.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,024.60
|
| Rate for Payer: Healthscope Commercial |
$1,152.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$896.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$960.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,088.64
|
| Rate for Payer: PHP Commercial |
$1,088.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.49
|
| Rate for Payer: Priority Health SBD |
$806.87
|
| Rate for Payer: UMR Bronson Commercial |
$473.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$960.56
|
|
