|
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 |
$8.66 |
| 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: 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 |
$7.29 |
| 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: 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
|
$8,907.47
|
|
|
Service Code
|
CPT 26951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH LOCAL ADVANCEMENT FLAPS (V-Y, HOOD)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26952
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
AMPUTATION, FOOT; TRANSMETATARSAL
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAY AMPUTATION), SINGLE, WITH OR WITHOUT INTEROSSEOUS TRANSFER
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
AMPUTATION, METATARSAL, WITH TOE, SINGLE
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
AMPUTATION, TOE; INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
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
|
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
|
|
|
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
|
|
|
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
|
IP
|
$81.78
|
|
|
Service Code
|
NDC 16729003510
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna American Axle |
$53.16
|
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$57.25
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.16
|
| Rate for Payer: Priority Health SBD |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$35.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
IP
|
$129.12
|
|
|
Service Code
|
NDC 50268007515
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.81 |
| Max. Negotiated Rate |
$116.21 |
| Rate for Payer: Aetna American Axle |
$83.93
|
| Rate for Payer: Aetna Commercial |
$109.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.93
|
| Rate for Payer: Cash Price |
$103.30
|
| Rate for Payer: Cofinity Commercial |
$111.04
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.30
|
| Rate for Payer: Healthscope Commercial |
$116.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.75
|
| Rate for Payer: PHP Commercial |
$109.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.93
|
| Rate for Payer: Priority Health SBD |
$81.35
|
| Rate for Payer: UMR Bronson Commercial |
$56.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.84
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
OP
|
$70.68
|
|
|
Service Code
|
NDC 62756025083
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$63.61 |
| Rate for Payer: Aetna American Axle |
$45.94
|
| Rate for Payer: Aetna Commercial |
$60.08
|
| Rate for Payer: Aetna Medicare |
$35.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.94
|
| Rate for Payer: BCBS Complete |
$28.27
|
| Rate for Payer: Cash Price |
$56.54
|
| Rate for Payer: Cofinity Commercial |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.54
|
| Rate for Payer: Healthscope Commercial |
$63.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.08
|
| Rate for Payer: PHP Commercial |
$60.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.94
|
| Rate for Payer: Priority Health SBD |
$44.53
|
| Rate for Payer: UMR Bronson Commercial |
$26.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.01
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
OP
|
$81.78
|
|
|
Service Code
|
NDC 16729003510
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna American Axle |
$53.16
|
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna Medicare |
$40.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: BCBS Complete |
$32.71
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$57.25
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.16
|
| Rate for Payer: Priority Health SBD |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$30.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 50268007511
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna American Axle |
$1.68
|
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare |
$1.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.68
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.63
|
| Rate for Payer: UMR Bronson Commercial |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
|
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
|
$1,280.75
|
|
|
Service Code
|
NDC 16729003516
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$563.53 |
| Max. Negotiated Rate |
$1,152.67 |
| 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 |
$1,152.67
|
| 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
|
$129.12
|
|
|
Service Code
|
NDC 50268007515
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.77 |
| Max. Negotiated Rate |
$116.21 |
| Rate for Payer: Aetna American Axle |
$83.93
|
| Rate for Payer: Aetna Commercial |
$109.75
|
| Rate for Payer: Aetna Medicare |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.93
|
| Rate for Payer: BCBS Complete |
$51.65
|
| Rate for Payer: Cash Price |
$103.30
|
| Rate for Payer: Cofinity Commercial |
$111.04
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.30
|
| Rate for Payer: Healthscope Commercial |
$116.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.75
|
| Rate for Payer: PHP Commercial |
$109.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.93
|
| Rate for Payer: Priority Health SBD |
$81.35
|
| Rate for Payer: UMR Bronson Commercial |
$47.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.84
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 50268007511
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna American Axle |
$1.68
|
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.68
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: PHP Commercial |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.94
|
|
