|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$373.65
|
|
|
Service Code
|
NDC 00378145401
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$336.28 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna Medicare |
$186.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: BCBS Complete |
$149.46
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.87
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UMR Bronson Commercial |
$138.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 00555088602
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna American Axle |
$176.60
|
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.60
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UMR Bronson Commercial |
$119.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
NDC 00555088602
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna American Axle |
$176.60
|
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna Medicare |
$135.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: BCBS Complete |
$108.68
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.60
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UMR Bronson Commercial |
$100.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
ESTRADIOL 1 MG TABLET
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 00378145401
|
| Hospital Charge Code |
9967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.41 |
| Max. Negotiated Rate |
$336.28 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$261.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.60
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.87
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UMR Bronson Commercial |
$164.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$736.49
|
|
|
Service Code
|
HCPCS J1000
|
| Hospital Charge Code |
2929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$324.06 |
| Max. Negotiated Rate |
$662.84 |
| Rate for Payer: Aetna American Axle |
$478.72
|
| Rate for Payer: Aetna Commercial |
$626.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.72
|
| Rate for Payer: Cash Price |
$589.19
|
| Rate for Payer: Cofinity Commercial |
$515.54
|
| Rate for Payer: Cofinity Commercial |
$633.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.19
|
| Rate for Payer: Healthscope Commercial |
$662.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.02
|
| Rate for Payer: PHP Commercial |
$626.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.72
|
| Rate for Payer: Priority Health SBD |
$463.99
|
| Rate for Payer: UMR Bronson Commercial |
$324.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.37
|
|
|
ESTRADIOL CYPIONATE 5 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$736.49
|
|
|
Service Code
|
HCPCS J1000
|
| Hospital Charge Code |
2929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.22 |
| Max. Negotiated Rate |
$662.84 |
| Rate for Payer: Aetna American Axle |
$478.72
|
| Rate for Payer: Aetna Commercial |
$626.02
|
| Rate for Payer: Aetna Medicare |
$368.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.72
|
| Rate for Payer: BCBS Complete |
$294.60
|
| Rate for Payer: BCBS Trust/PPO |
$104.22
|
| Rate for Payer: BCN Commercial |
$104.22
|
| Rate for Payer: Cash Price |
$589.19
|
| Rate for Payer: Cash Price |
$589.19
|
| Rate for Payer: Cofinity Commercial |
$515.54
|
| Rate for Payer: Cofinity Commercial |
$633.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.19
|
| Rate for Payer: Healthscope Commercial |
$662.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.02
|
| Rate for Payer: PHP Commercial |
$626.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.72
|
| Rate for Payer: Priority Health SBD |
$463.99
|
| Rate for Payer: UMR Bronson Commercial |
$272.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.37
|
|
|
ESTRADIOL VALERATE 10 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$493.82
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$217.28 |
| Max. Negotiated Rate |
$444.44 |
| Rate for Payer: Aetna American Axle |
$320.98
|
| Rate for Payer: Aetna American Axle |
$374.32
|
| Rate for Payer: Aetna Commercial |
$419.75
|
| Rate for Payer: Aetna Commercial |
$489.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.32
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cash Price |
$460.70
|
| Rate for Payer: Cofinity Commercial |
$495.26
|
| Rate for Payer: Cofinity Commercial |
$403.12
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$424.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.70
|
| Rate for Payer: Healthscope Commercial |
$444.44
|
| Rate for Payer: Healthscope Commercial |
$518.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$431.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.75
|
| Rate for Payer: PHP Commercial |
$489.50
|
| Rate for Payer: PHP Commercial |
$419.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.32
|
| Rate for Payer: Priority Health SBD |
$311.11
|
| Rate for Payer: Priority Health SBD |
$362.80
|
| Rate for Payer: UMR Bronson Commercial |
$217.28
|
| Rate for Payer: UMR Bronson Commercial |
$253.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$431.91
|
|
|
ESTRADIOL VALERATE 10 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$493.82
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$444.44 |
| Rate for Payer: UMR Bronson Commercial |
$213.08
|
| Rate for Payer: Aetna American Axle |
$320.98
|
| Rate for Payer: Aetna American Axle |
$374.32
|
| Rate for Payer: Aetna Commercial |
$489.50
|
| Rate for Payer: Aetna Commercial |
$419.75
|
| Rate for Payer: Aetna Medicare |
$246.91
|
| Rate for Payer: Aetna Medicare |
$287.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.32
|
| Rate for Payer: BCBS Complete |
$230.35
|
| Rate for Payer: BCBS Complete |
$197.53
|
| Rate for Payer: BCBS Trust/PPO |
$20.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.22
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: Cash Price |
$460.70
|
| Rate for Payer: Cash Price |
$460.70
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cash Price |
$395.06
|
| Rate for Payer: Cofinity Commercial |
$495.26
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Cofinity Commercial |
$403.12
|
| Rate for Payer: Cofinity Commercial |
$424.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.06
|
| Rate for Payer: Healthscope Commercial |
$518.29
|
| Rate for Payer: Healthscope Commercial |
$444.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$431.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.50
|
| Rate for Payer: PHP Commercial |
$419.75
|
| Rate for Payer: PHP Commercial |
$489.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.32
|
| Rate for Payer: Priority Health SBD |
$362.80
|
| Rate for Payer: Priority Health SBD |
$311.11
|
| Rate for Payer: UMR Bronson Commercial |
$182.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$431.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.36
|
|
|
ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL
|
Facility
|
OP
|
$811.64
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$730.48 |
| Rate for Payer: Aetna American Axle |
$527.57
|
| Rate for Payer: Aetna American Axle |
$246.59
|
| Rate for Payer: Aetna Commercial |
$322.46
|
| Rate for Payer: Aetna Commercial |
$689.89
|
| Rate for Payer: Aetna Medicare |
$405.82
|
| Rate for Payer: Aetna Medicare |
$189.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.57
|
| Rate for Payer: BCBS Complete |
$324.66
|
| Rate for Payer: BCBS Complete |
$151.75
|
| Rate for Payer: BCBS Trust/PPO |
$20.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.22
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: Cash Price |
$303.50
|
| Rate for Payer: Cash Price |
$303.50
|
| Rate for Payer: Cash Price |
$649.31
|
| Rate for Payer: Cash Price |
$649.31
|
| Rate for Payer: Cofinity Commercial |
$265.56
|
| Rate for Payer: Cofinity Commercial |
$326.26
|
| Rate for Payer: Cofinity Commercial |
$698.01
|
| Rate for Payer: Cofinity Commercial |
$568.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$568.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.50
|
| Rate for Payer: Healthscope Commercial |
$341.43
|
| Rate for Payer: Healthscope Commercial |
$730.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$568.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.46
|
| Rate for Payer: PHP Commercial |
$689.89
|
| Rate for Payer: PHP Commercial |
$322.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.57
|
| Rate for Payer: Priority Health SBD |
$511.33
|
| Rate for Payer: Priority Health SBD |
$239.00
|
| Rate for Payer: UMR Bronson Commercial |
$140.37
|
| Rate for Payer: UMR Bronson Commercial |
$300.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.73
|
|
|
ESTRADIOL VALERATE 20 MG/ML INTRAMUSCULAR OIL
|
Facility
|
IP
|
$811.64
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$357.12 |
| Max. Negotiated Rate |
$730.48 |
| Rate for Payer: Aetna American Axle |
$527.57
|
| Rate for Payer: Aetna Commercial |
$689.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.57
|
| Rate for Payer: Cash Price |
$649.31
|
| Rate for Payer: Cofinity Commercial |
$568.15
|
| Rate for Payer: Cofinity Commercial |
$698.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$568.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$649.31
|
| Rate for Payer: Healthscope Commercial |
$730.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$568.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.89
|
| Rate for Payer: PHP Commercial |
$689.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.57
|
| Rate for Payer: Priority Health SBD |
$511.33
|
| Rate for Payer: UMR Bronson Commercial |
$357.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.73
|
|
|
ETEPLIRSEN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,120.00
|
|
|
Service Code
|
HCPCS J1428
|
| Hospital Charge Code |
180827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna American Axle |
$3,328.00
|
| Rate for Payer: Aetna American Axle |
$13,520.00
|
| Rate for Payer: Aetna Commercial |
$17,680.00
|
| Rate for Payer: Aetna Commercial |
$4,352.00
|
| Rate for Payer: Aetna Medicare |
$2,560.00
|
| Rate for Payer: Aetna Medicare |
$10,400.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,520.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,328.00
|
| Rate for Payer: BCBS Complete |
$8,320.00
|
| Rate for Payer: BCBS Complete |
$2,048.00
|
| Rate for Payer: Cash Price |
$16,640.00
|
| Rate for Payer: Cash Price |
$16,640.00
|
| Rate for Payer: Cash Price |
$4,096.00
|
| Rate for Payer: Cash Price |
$4,096.00
|
| Rate for Payer: Cofinity Commercial |
$4,403.20
|
| Rate for Payer: Cofinity Commercial |
$17,888.00
|
| Rate for Payer: Cofinity Commercial |
$14,560.00
|
| Rate for Payer: Cofinity Commercial |
$3,584.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,584.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,560.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,096.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,640.00
|
| Rate for Payer: Healthscope Commercial |
$4,608.00
|
| Rate for Payer: Healthscope Commercial |
$18,720.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,560.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,584.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,840.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,600.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,352.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,680.00
|
| Rate for Payer: PHP Commercial |
$4,352.00
|
| Rate for Payer: PHP Commercial |
$17,680.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,520.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,328.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.60
|
| Rate for Payer: Priority Health Narrow Network |
$135.68
|
| Rate for Payer: Priority Health Narrow Network |
$135.68
|
| Rate for Payer: Priority Health SBD |
$13,104.00
|
| Rate for Payer: Priority Health SBD |
$3,225.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,894.40
|
| Rate for Payer: UMR Bronson Commercial |
$7,696.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,600.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,840.00
|
|
|
ETEPLIRSEN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20,800.00
|
|
|
Service Code
|
HCPCS J1428
|
| Hospital Charge Code |
180827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,152.00 |
| Max. Negotiated Rate |
$18,720.00 |
| Rate for Payer: Aetna American Axle |
$13,520.00
|
| Rate for Payer: Aetna American Axle |
$3,328.00
|
| Rate for Payer: Aetna Commercial |
$17,680.00
|
| Rate for Payer: Aetna Commercial |
$4,352.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,520.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,328.00
|
| Rate for Payer: Cash Price |
$16,640.00
|
| Rate for Payer: Cash Price |
$4,096.00
|
| Rate for Payer: Cofinity Commercial |
$4,403.20
|
| Rate for Payer: Cofinity Commercial |
$3,584.00
|
| Rate for Payer: Cofinity Commercial |
$14,560.00
|
| Rate for Payer: Cofinity Commercial |
$17,888.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,560.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,584.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,640.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,096.00
|
| Rate for Payer: Healthscope Commercial |
$18,720.00
|
| Rate for Payer: Healthscope Commercial |
$4,608.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,560.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,584.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,600.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,840.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,352.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,680.00
|
| Rate for Payer: PHP Commercial |
$4,352.00
|
| Rate for Payer: PHP Commercial |
$17,680.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,520.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,328.00
|
| Rate for Payer: Priority Health SBD |
$13,104.00
|
| Rate for Payer: Priority Health SBD |
$3,225.60
|
| Rate for Payer: UMR Bronson Commercial |
$9,152.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,252.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,600.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,840.00
|
|
|
ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,657.64
|
|
|
Service Code
|
NDC 42023015701
|
| Hospital Charge Code |
9979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$613.33 |
| Max. Negotiated Rate |
$1,491.88 |
| Rate for Payer: Aetna American Axle |
$1,077.47
|
| Rate for Payer: Aetna Commercial |
$1,408.99
|
| Rate for Payer: Aetna Medicare |
$828.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.47
|
| Rate for Payer: BCBS Complete |
$663.06
|
| Rate for Payer: Cash Price |
$1,326.11
|
| Rate for Payer: Cofinity Commercial |
$1,160.35
|
| Rate for Payer: Cofinity Commercial |
$1,425.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,160.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,326.11
|
| Rate for Payer: Healthscope Commercial |
$1,491.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,160.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,243.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.99
|
| Rate for Payer: PHP Commercial |
$1,408.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.47
|
| Rate for Payer: Priority Health SBD |
$1,044.31
|
| Rate for Payer: UMR Bronson Commercial |
$613.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,243.23
|
|
|
ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,657.64
|
|
|
Service Code
|
NDC 42023015701
|
| Hospital Charge Code |
9979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$729.36 |
| Max. Negotiated Rate |
$1,491.88 |
| Rate for Payer: Aetna American Axle |
$1,077.47
|
| Rate for Payer: Aetna Commercial |
$1,408.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.47
|
| Rate for Payer: Cash Price |
$1,326.11
|
| Rate for Payer: Cofinity Commercial |
$1,160.35
|
| Rate for Payer: Cofinity Commercial |
$1,425.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,160.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,326.11
|
| Rate for Payer: Healthscope Commercial |
$1,491.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,160.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,243.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.99
|
| Rate for Payer: PHP Commercial |
$1,408.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.47
|
| Rate for Payer: Priority Health SBD |
$1,044.31
|
| Rate for Payer: UMR Bronson Commercial |
$729.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,243.23
|
|
|
ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,195.85
|
|
|
Service Code
|
NDC 25010021027
|
| Hospital Charge Code |
9979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,512.46 |
| Max. Negotiated Rate |
$10,976.26 |
| Rate for Payer: Aetna American Axle |
$7,927.30
|
| Rate for Payer: Aetna Commercial |
$10,366.47
|
| Rate for Payer: Aetna Medicare |
$6,097.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,927.30
|
| Rate for Payer: BCBS Complete |
$4,878.34
|
| Rate for Payer: Cash Price |
$9,756.68
|
| Rate for Payer: Cofinity Commercial |
$10,488.43
|
| Rate for Payer: Cofinity Commercial |
$8,537.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,537.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,756.68
|
| Rate for Payer: Healthscope Commercial |
$10,976.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,537.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,146.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,366.47
|
| Rate for Payer: PHP Commercial |
$10,366.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,927.30
|
| Rate for Payer: Priority Health SBD |
$7,683.39
|
| Rate for Payer: UMR Bronson Commercial |
$4,512.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,146.89
|
|
|
ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,763.19
|
|
|
Service Code
|
NDC 42023015789
|
| Hospital Charge Code |
9979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,415.80 |
| Max. Negotiated Rate |
$6,986.87 |
| Rate for Payer: Aetna American Axle |
$5,046.07
|
| Rate for Payer: Aetna Commercial |
$6,598.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,046.07
|
| Rate for Payer: Cash Price |
$6,210.55
|
| Rate for Payer: Cofinity Commercial |
$5,434.23
|
| Rate for Payer: Cofinity Commercial |
$6,676.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,434.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,210.55
|
| Rate for Payer: Healthscope Commercial |
$6,986.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,434.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,822.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,598.71
|
| Rate for Payer: PHP Commercial |
$6,598.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,046.07
|
| Rate for Payer: Priority Health SBD |
$4,890.81
|
| Rate for Payer: UMR Bronson Commercial |
$3,415.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,822.39
|
|
|
ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,763.19
|
|
|
Service Code
|
NDC 42023015789
|
| Hospital Charge Code |
9979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,872.38 |
| Max. Negotiated Rate |
$6,986.87 |
| Rate for Payer: Aetna American Axle |
$5,046.07
|
| Rate for Payer: Aetna Commercial |
$6,598.71
|
| Rate for Payer: Aetna Medicare |
$3,881.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,046.07
|
| Rate for Payer: BCBS Complete |
$3,105.28
|
| Rate for Payer: Cash Price |
$6,210.55
|
| Rate for Payer: Cofinity Commercial |
$5,434.23
|
| Rate for Payer: Cofinity Commercial |
$6,676.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,434.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,210.55
|
| Rate for Payer: Healthscope Commercial |
$6,986.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,434.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,822.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,598.71
|
| Rate for Payer: PHP Commercial |
$6,598.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,046.07
|
| Rate for Payer: Priority Health SBD |
$4,890.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,872.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,822.39
|
|
|
ETHACRYNATE SODIUM 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,195.85
|
|
|
Service Code
|
NDC 25010021027
|
| Hospital Charge Code |
9979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5,366.17 |
| Max. Negotiated Rate |
$10,976.26 |
| Rate for Payer: Aetna American Axle |
$7,927.30
|
| Rate for Payer: Aetna Commercial |
$10,366.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,927.30
|
| Rate for Payer: Cash Price |
$9,756.68
|
| Rate for Payer: Cofinity Commercial |
$10,488.43
|
| Rate for Payer: Cofinity Commercial |
$8,537.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,537.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,756.68
|
| Rate for Payer: Healthscope Commercial |
$10,976.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,537.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,146.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,366.47
|
| Rate for Payer: PHP Commercial |
$10,366.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,927.30
|
| Rate for Payer: Priority Health SBD |
$7,683.39
|
| Rate for Payer: UMR Bronson Commercial |
$5,366.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,146.89
|
|
|
ETHACRYNIC ACID 25 MG TABLET
|
Facility
|
IP
|
$8,410.84
|
|
|
Service Code
|
NDC 25010021515
|
| Hospital Charge Code |
9980
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,700.77 |
| Max. Negotiated Rate |
$7,569.76 |
| Rate for Payer: Aetna American Axle |
$5,467.05
|
| Rate for Payer: Aetna Commercial |
$7,149.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,467.05
|
| Rate for Payer: Cash Price |
$6,728.67
|
| Rate for Payer: Cofinity Commercial |
$5,887.59
|
| Rate for Payer: Cofinity Commercial |
$7,233.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,887.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,728.67
|
| Rate for Payer: Healthscope Commercial |
$7,569.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,887.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,308.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,149.21
|
| Rate for Payer: PHP Commercial |
$7,149.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,467.05
|
| Rate for Payer: Priority Health SBD |
$5,298.83
|
| Rate for Payer: UMR Bronson Commercial |
$3,700.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,308.13
|
|
|
ETHACRYNIC ACID 25 MG TABLET
|
Facility
|
OP
|
$8,410.84
|
|
|
Service Code
|
NDC 25010021515
|
| Hospital Charge Code |
9980
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,112.01 |
| Max. Negotiated Rate |
$7,569.76 |
| Rate for Payer: Aetna American Axle |
$5,467.05
|
| Rate for Payer: Aetna Commercial |
$7,149.21
|
| Rate for Payer: Aetna Medicare |
$4,205.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,467.05
|
| Rate for Payer: BCBS Complete |
$3,364.34
|
| Rate for Payer: Cash Price |
$6,728.67
|
| Rate for Payer: Cofinity Commercial |
$5,887.59
|
| Rate for Payer: Cofinity Commercial |
$7,233.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,887.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,728.67
|
| Rate for Payer: Healthscope Commercial |
$7,569.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,887.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,308.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,149.21
|
| Rate for Payer: PHP Commercial |
$7,149.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,467.05
|
| Rate for Payer: Priority Health SBD |
$5,298.83
|
| Rate for Payer: UMR Bronson Commercial |
$3,112.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,308.13
|
|
|
ETHACRYNIC ACID 25 MG TABLET
|
Facility
|
IP
|
$870.24
|
|
|
Service Code
|
NDC 68180015901
|
| Hospital Charge Code |
9980
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$382.91 |
| Max. Negotiated Rate |
$783.22 |
| Rate for Payer: Aetna American Axle |
$565.66
|
| Rate for Payer: Aetna Commercial |
$739.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.66
|
| Rate for Payer: Cash Price |
$696.19
|
| Rate for Payer: Cofinity Commercial |
$609.17
|
| Rate for Payer: Cofinity Commercial |
$748.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$609.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$696.19
|
| Rate for Payer: Healthscope Commercial |
$783.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$609.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$739.70
|
| Rate for Payer: PHP Commercial |
$739.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$565.66
|
| Rate for Payer: Priority Health SBD |
$548.25
|
| Rate for Payer: UMR Bronson Commercial |
$382.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.68
|
|
|
ETHACRYNIC ACID 25 MG TABLET
|
Facility
|
OP
|
$870.24
|
|
|
Service Code
|
NDC 68180015901
|
| Hospital Charge Code |
9980
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.99 |
| Max. Negotiated Rate |
$783.22 |
| Rate for Payer: Aetna American Axle |
$565.66
|
| Rate for Payer: Aetna Commercial |
$739.70
|
| Rate for Payer: Aetna Medicare |
$435.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.66
|
| Rate for Payer: BCBS Complete |
$348.10
|
| Rate for Payer: Cash Price |
$696.19
|
| Rate for Payer: Cofinity Commercial |
$609.17
|
| Rate for Payer: Cofinity Commercial |
$748.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$609.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$696.19
|
| Rate for Payer: Healthscope Commercial |
$783.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$609.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$739.70
|
| Rate for Payer: PHP Commercial |
$739.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$565.66
|
| Rate for Payer: Priority Health SBD |
$548.25
|
| Rate for Payer: UMR Bronson Commercial |
$321.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.68
|
|
|
ETHACRYNIC ACID 25 MG TABLET
|
Facility
|
OP
|
$3,429.53
|
|
|
Service Code
|
NDC 49884027601
|
| Hospital Charge Code |
9980
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,268.93 |
| Max. Negotiated Rate |
$3,086.58 |
| Rate for Payer: Aetna American Axle |
$2,229.19
|
| Rate for Payer: Aetna Commercial |
$2,915.10
|
| Rate for Payer: Aetna Medicare |
$1,714.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,229.19
|
| Rate for Payer: BCBS Complete |
$1,371.81
|
| Rate for Payer: Cash Price |
$2,743.62
|
| Rate for Payer: Cofinity Commercial |
$2,400.67
|
| Rate for Payer: Cofinity Commercial |
$2,949.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,400.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,743.62
|
| Rate for Payer: Healthscope Commercial |
$3,086.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,400.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,572.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,915.10
|
| Rate for Payer: PHP Commercial |
$2,915.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,229.19
|
| Rate for Payer: Priority Health SBD |
$2,160.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,268.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,572.15
|
|
|
ETHACRYNIC ACID 25 MG TABLET
|
Facility
|
IP
|
$3,429.53
|
|
|
Service Code
|
NDC 49884027601
|
| Hospital Charge Code |
9980
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,508.99 |
| Max. Negotiated Rate |
$3,086.58 |
| Rate for Payer: Aetna American Axle |
$2,229.19
|
| Rate for Payer: Aetna Commercial |
$2,915.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,229.19
|
| Rate for Payer: Cash Price |
$2,743.62
|
| Rate for Payer: Cofinity Commercial |
$2,400.67
|
| Rate for Payer: Cofinity Commercial |
$2,949.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,400.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,743.62
|
| Rate for Payer: Healthscope Commercial |
$3,086.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,400.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,572.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,915.10
|
| Rate for Payer: PHP Commercial |
$2,915.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,229.19
|
| Rate for Payer: Priority Health SBD |
$2,160.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,508.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,572.15
|
|
|
ETHAMBUTOL 100 MG TABLET
|
Facility
|
IP
|
$426.55
|
|
|
Service Code
|
NDC 54879000100
|
| Hospital Charge Code |
9982
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.68 |
| Max. Negotiated Rate |
$383.90 |
| Rate for Payer: Aetna American Axle |
$277.26
|
| Rate for Payer: Aetna Commercial |
$362.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.26
|
| Rate for Payer: Cash Price |
$341.24
|
| Rate for Payer: Cofinity Commercial |
$298.58
|
| Rate for Payer: Cofinity Commercial |
$366.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.24
|
| Rate for Payer: Healthscope Commercial |
$383.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.57
|
| Rate for Payer: PHP Commercial |
$362.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.26
|
| Rate for Payer: Priority Health SBD |
$268.73
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.91
|
|
