|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$192.70
|
|
|
Service Code
|
NDC 70752010810
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.79 |
| Max. Negotiated Rate |
$173.43 |
| Rate for Payer: Aetna American Axle |
$125.25
|
| Rate for Payer: Aetna Commercial |
$163.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.25
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Cofinity Advantage |
$134.89
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.16
|
| Rate for Payer: Healthscope Commercial |
$173.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.53
|
| Rate for Payer: PHP Commercial |
$163.79
|
| Rate for Payer: Priority Health SBD |
$121.40
|
| Rate for Payer: UMR Bronson Commercial |
$84.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.53
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
OP
|
$382.85
|
|
|
Service Code
|
NDC 49884006501
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.65 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna American Axle |
$248.85
|
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna Medicare |
$191.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: BCBS Complete |
$153.14
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Advantage |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.14
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health SBD |
$241.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.85
|
| Rate for Payer: UHC Core |
$199.46
|
| Rate for Payer: UHC Exchange |
$150.46
|
| Rate for Payer: UMR Bronson Commercial |
$141.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
OP
|
$192.70
|
|
|
Service Code
|
NDC 70752010810
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$173.43 |
| Rate for Payer: Aetna American Axle |
$125.25
|
| Rate for Payer: Aetna Commercial |
$163.79
|
| Rate for Payer: Aetna Medicare |
$96.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.25
|
| Rate for Payer: BCBS Complete |
$77.08
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Cofinity Advantage |
$134.89
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.16
|
| Rate for Payer: Healthscope Commercial |
$173.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.53
|
| Rate for Payer: PHP Commercial |
$163.79
|
| Rate for Payer: Priority Health SBD |
$121.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.25
|
| Rate for Payer: UHC Core |
$100.40
|
| Rate for Payer: UHC Exchange |
$75.73
|
| Rate for Payer: UMR Bronson Commercial |
$71.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.53
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$392.64
|
|
|
Service Code
|
NDC 69315013901
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.76 |
| Max. Negotiated Rate |
$353.38 |
| Rate for Payer: Aetna American Axle |
$255.22
|
| Rate for Payer: Aetna Commercial |
$333.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.22
|
| Rate for Payer: Cash Price |
$314.11
|
| Rate for Payer: Cofinity Advantage |
$274.85
|
| Rate for Payer: Cofinity Commercial |
$337.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.11
|
| Rate for Payer: Healthscope Commercial |
$353.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.48
|
| Rate for Payer: PHP Commercial |
$333.74
|
| Rate for Payer: Priority Health SBD |
$247.36
|
| Rate for Payer: UMR Bronson Commercial |
$172.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.48
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 49884006501
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.45 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna American Axle |
$248.85
|
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Advantage |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.14
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health SBD |
$241.20
|
| Rate for Payer: UMR Bronson Commercial |
$168.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 23155060601
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna American Axle |
$169.55
|
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.55
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Advantage |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health SBD |
$164.34
|
| Rate for Payer: UMR Bronson Commercial |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
OP
|
$385.70
|
|
|
Service Code
|
NDC 69076047501
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.71 |
| Max. Negotiated Rate |
$347.13 |
| Rate for Payer: Aetna American Axle |
$250.71
|
| Rate for Payer: Aetna Commercial |
$327.85
|
| Rate for Payer: Aetna Medicare |
$192.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.71
|
| Rate for Payer: BCBS Complete |
$154.28
|
| Rate for Payer: Cash Price |
$308.56
|
| Rate for Payer: Cofinity Advantage |
$269.99
|
| Rate for Payer: Cofinity Commercial |
$331.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.56
|
| Rate for Payer: Healthscope Commercial |
$347.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$308.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.27
|
| Rate for Payer: PHP Commercial |
$327.85
|
| Rate for Payer: Priority Health SBD |
$242.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.71
|
| Rate for Payer: UHC Core |
$200.95
|
| Rate for Payer: UHC Exchange |
$151.58
|
| Rate for Payer: UMR Bronson Commercial |
$142.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.27
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
IP
|
$407.04
|
|
|
Service Code
|
NDC 55111064801
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.10 |
| Max. Negotiated Rate |
$366.34 |
| Rate for Payer: Aetna American Axle |
$264.58
|
| Rate for Payer: Aetna Commercial |
$345.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.58
|
| Rate for Payer: Cash Price |
$325.63
|
| Rate for Payer: Cofinity Advantage |
$284.93
|
| Rate for Payer: Cofinity Commercial |
$350.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.63
|
| Rate for Payer: Healthscope Commercial |
$366.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.28
|
| Rate for Payer: PHP Commercial |
$345.98
|
| Rate for Payer: Priority Health SBD |
$256.44
|
| Rate for Payer: UMR Bronson Commercial |
$179.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.28
|
|
|
GLYCOPYRROLATE 1 MG TABLET
|
Facility
|
OP
|
$392.64
|
|
|
Service Code
|
NDC 69315013901
|
| Hospital Charge Code |
10130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$353.38 |
| Rate for Payer: Aetna American Axle |
$255.22
|
| Rate for Payer: Aetna Commercial |
$333.74
|
| Rate for Payer: Aetna Medicare |
$196.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.22
|
| Rate for Payer: BCBS Complete |
$157.06
|
| Rate for Payer: Cash Price |
$314.11
|
| Rate for Payer: Cofinity Advantage |
$274.85
|
| Rate for Payer: Cofinity Commercial |
$337.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.11
|
| Rate for Payer: Healthscope Commercial |
$353.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$314.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.48
|
| Rate for Payer: PHP Commercial |
$333.74
|
| Rate for Payer: Priority Health SBD |
$247.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.22
|
| Rate for Payer: UHC Core |
$204.57
|
| Rate for Payer: UHC Exchange |
$154.31
|
| Rate for Payer: UMR Bronson Commercial |
$145.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.48
|
|
|
GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,234.37
|
|
|
Service Code
|
HCPCS J1602
|
| Hospital Charge Code |
167346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,743.12 |
| Max. Negotiated Rate |
$5,610.93 |
| Rate for Payer: Aetna American Axle |
$4,052.34
|
| Rate for Payer: Aetna Commercial |
$5,299.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,052.34
|
| Rate for Payer: Cash Price |
$4,987.50
|
| Rate for Payer: Cofinity Advantage |
$4,364.06
|
| Rate for Payer: Cofinity Commercial |
$5,361.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,987.50
|
| Rate for Payer: Healthscope Commercial |
$5,610.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,364.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,675.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,299.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,675.78
|
| Rate for Payer: PHP Commercial |
$5,299.21
|
| Rate for Payer: Priority Health SBD |
$3,927.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,743.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,675.78
|
|
|
GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,234.37
|
|
|
Service Code
|
HCPCS J1602
|
| Hospital Charge Code |
167346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$5,610.93 |
| Rate for Payer: Aetna American Axle |
$4,052.34
|
| Rate for Payer: Aetna Commercial |
$5,299.21
|
| Rate for Payer: Aetna Medicare |
$11.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,052.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.11
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS MAPPO |
$11.29
|
| Rate for Payer: BCBS Trust/PPO |
$37.71
|
| Rate for Payer: BCN Commercial |
$37.71
|
| Rate for Payer: BCN Medicare Advantage |
$11.29
|
| Rate for Payer: Cash Price |
$4,987.50
|
| Rate for Payer: Cash Price |
$4,987.50
|
| Rate for Payer: Cofinity Advantage |
$4,364.06
|
| Rate for Payer: Cofinity Commercial |
$5,361.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,987.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.29
|
| Rate for Payer: Healthscope Commercial |
$5,610.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,364.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,675.78
|
| Rate for Payer: Mclaren Medicaid |
$11.29
|
| Rate for Payer: Mclaren Medicare |
$11.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.85
|
| Rate for Payer: Meridian Medicaid |
$11.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,299.21
|
| Rate for Payer: Nomi Health Commercial |
$33.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,675.78
|
| Rate for Payer: PACE Medicare |
$10.73
|
| Rate for Payer: PACE SWMI |
$11.29
|
| Rate for Payer: PHP Commercial |
$5,299.21
|
| Rate for Payer: PHP Medicare Advantage |
$11.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.83
|
| Rate for Payer: Priority Health Medicare |
$11.29
|
| Rate for Payer: Priority Health SBD |
$3,927.65
|
| Rate for Payer: Priority Health Tiered Network |
$27.86
|
| Rate for Payer: Railroad Medicare Medicare |
$11.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.19
|
| Rate for Payer: UHC Core |
$19.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.29
|
| Rate for Payer: UHC Exchange |
$19.19
|
| Rate for Payer: UHC Medicaid |
$5.90
|
| Rate for Payer: UHCCP Medicaid |
$5.90
|
| Rate for Payer: UMR Bronson Commercial |
$2,306.72
|
| Rate for Payer: VA VA |
$11.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,675.78
|
|
|
GOSERELIN 10.8 MG SUBCUTANEOUS IMPLANT
|
Facility
|
OP
|
$10,804.08
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
16254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,282.88 |
| Max. Negotiated Rate |
$9,723.67 |
| Rate for Payer: Aetna American Axle |
$7,022.65
|
| Rate for Payer: Aetna Commercial |
$9,183.47
|
| Rate for Payer: Aetna Medicare |
$5,402.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,022.65
|
| Rate for Payer: BCBS Complete |
$4,321.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,474.47
|
| Rate for Payer: BCN Commercial |
$2,474.47
|
| Rate for Payer: Cash Price |
$8,643.26
|
| Rate for Payer: Cash Price |
$8,643.26
|
| Rate for Payer: Cofinity Advantage |
$7,562.86
|
| Rate for Payer: Cofinity Commercial |
$9,291.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,643.26
|
| Rate for Payer: Healthscope Commercial |
$9,723.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,562.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,103.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,643.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,183.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,103.06
|
| Rate for Payer: PHP Commercial |
$9,183.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,313.97
|
| Rate for Payer: Priority Health SBD |
$6,806.57
|
| Rate for Payer: Priority Health Tiered Network |
$1,851.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,282.88
|
| Rate for Payer: UHC Core |
$1,282.88
|
| Rate for Payer: UHC Exchange |
$1,282.88
|
| Rate for Payer: UMR Bronson Commercial |
$3,997.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,103.06
|
|
|
GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT
|
Facility
|
OP
|
$3,364.48
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
10137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,244.86 |
| Max. Negotiated Rate |
$3,028.03 |
| Rate for Payer: Aetna American Axle |
$2,186.91
|
| Rate for Payer: Aetna Commercial |
$2,859.81
|
| Rate for Payer: Aetna Medicare |
$1,682.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,186.91
|
| Rate for Payer: BCBS Complete |
$1,345.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,474.47
|
| Rate for Payer: BCN Commercial |
$2,474.47
|
| Rate for Payer: Cash Price |
$2,691.58
|
| Rate for Payer: Cash Price |
$2,691.58
|
| Rate for Payer: Cofinity Advantage |
$2,355.14
|
| Rate for Payer: Cofinity Commercial |
$2,893.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,691.58
|
| Rate for Payer: Healthscope Commercial |
$3,028.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,355.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,523.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,691.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,859.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,523.36
|
| Rate for Payer: PHP Commercial |
$2,859.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,313.97
|
| Rate for Payer: Priority Health SBD |
$2,119.62
|
| Rate for Payer: Priority Health Tiered Network |
$1,851.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,282.88
|
| Rate for Payer: UHC Core |
$1,282.88
|
| Rate for Payer: UHC Exchange |
$1,282.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,244.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,523.36
|
|
|
GRAFT, BONE; NASAL, MAXILLARY OR MALAR AREAS (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 21210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,437.73
|
| Rate for Payer: BCN Commercial |
$3,437.73
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 21235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$6,599.66
|
| Rate for Payer: BCN Commercial |
$6,599.66
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
GRAFTING OF AUTOLOGOUS FAT HARVESTED BY LIPOSUCTION TECHNIQUE TO TRUNK, BREASTS, SCALP, ARMS, AND/OR LEGS; 50 CC OR LESS INJECTATE
|
Facility
|
OP
|
$11,418.88
|
|
|
Service Code
|
CPT 15771
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,846.70 |
| Max. Negotiated Rate |
$11,418.88 |
| Rate for Payer: Aetna Medicare |
$3,672.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$5,497.59
|
| Rate for Payer: BCN Commercial |
$5,497.59
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$3,707.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Nomi Health Commercial |
$10,592.94
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,418.88
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health Tiered Network |
$9,135.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
GRAFTING OF AUTOLOGOUS FAT HARVESTED BY LIPOSUCTION TECHNIQUE TO TRUNK, BREASTS, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 50 CC INJECTATE, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$774.41
|
|
|
Service Code
|
CPT 15772
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$774.41 |
| Max. Negotiated Rate |
$774.41 |
| Rate for Payer: BCBS Trust/PPO |
$774.41
|
| Rate for Payer: BCN Commercial |
$774.41
|
|
|
GRAFTING OF AUTOLOGOUS SOFT TISSUE, OTHER, HARVESTED BY DIRECT EXCISION (EG, FAT, DERMIS, FASCIA)
|
Facility
|
OP
|
$11,418.88
|
|
|
Service Code
|
CPT 15769
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,846.70 |
| Max. Negotiated Rate |
$11,418.88 |
| Rate for Payer: Aetna Medicare |
$3,672.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,144.67
|
| Rate for Payer: BCN Commercial |
$3,144.67
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$3,707.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Nomi Health Commercial |
$10,592.94
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,418.88
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health Tiered Network |
$9,135.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.09
|
|
|
Service Code
|
HCPCS J1626
|
| Hospital Charge Code |
117977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$24.38 |
| Rate for Payer: Aetna American Axle |
$17.61
|
| Rate for Payer: Aetna Commercial |
$23.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.61
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Cofinity Advantage |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$24.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.32
|
| Rate for Payer: PHP Commercial |
$23.03
|
| Rate for Payer: Priority Health SBD |
$17.07
|
| Rate for Payer: UMR Bronson Commercial |
$11.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.32
|
|
|
GRANISETRON HCL 1 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.09
|
|
|
Service Code
|
HCPCS J1626
|
| Hospital Charge Code |
117977
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$24.38 |
| Rate for Payer: Aetna American Axle |
$17.61
|
| Rate for Payer: Aetna American Axle |
$11.65
|
| Rate for Payer: Aetna Commercial |
$15.24
|
| Rate for Payer: Aetna Commercial |
$23.03
|
| Rate for Payer: Aetna Medicare |
$13.54
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.65
|
| Rate for Payer: BCBS Complete |
$7.17
|
| Rate for Payer: BCBS Complete |
$10.84
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Cash Price |
$14.34
|
| Rate for Payer: Cash Price |
$14.34
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Cofinity Advantage |
$18.96
|
| Rate for Payer: Cofinity Advantage |
$12.55
|
| Rate for Payer: Cofinity Commercial |
$15.42
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$24.38
|
| Rate for Payer: Healthscope Commercial |
$16.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.45
|
| Rate for Payer: PHP Commercial |
$15.24
|
| Rate for Payer: PHP Commercial |
$23.03
|
| Rate for Payer: Priority Health SBD |
$17.07
|
| Rate for Payer: Priority Health SBD |
$11.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UMR Bronson Commercial |
$10.02
|
| Rate for Payer: UMR Bronson Commercial |
$6.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.32
|
|
|
GRANISETRON HCL 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$75.13
|
|
|
Service Code
|
HCPCS J1626
|
| Hospital Charge Code |
12552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$67.62 |
| Rate for Payer: Aetna American Axle |
$48.83
|
| Rate for Payer: Aetna Commercial |
$63.86
|
| Rate for Payer: Aetna Medicare |
$37.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.83
|
| Rate for Payer: BCBS Complete |
$30.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$60.10
|
| Rate for Payer: Cash Price |
$60.10
|
| Rate for Payer: Cofinity Advantage |
$52.59
|
| Rate for Payer: Cofinity Commercial |
$64.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.10
|
| Rate for Payer: Healthscope Commercial |
$67.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.35
|
| Rate for Payer: PHP Commercial |
$63.86
|
| Rate for Payer: Priority Health SBD |
$47.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UMR Bronson Commercial |
$27.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.35
|
|
|
GRANISETRON HCL 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$75.13
|
|
|
Service Code
|
HCPCS J1626
|
| Hospital Charge Code |
12552
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$67.62 |
| Rate for Payer: Aetna American Axle |
$48.83
|
| Rate for Payer: Aetna Commercial |
$63.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.83
|
| Rate for Payer: Cash Price |
$60.10
|
| Rate for Payer: Cofinity Advantage |
$52.59
|
| Rate for Payer: Cofinity Commercial |
$64.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.10
|
| Rate for Payer: Healthscope Commercial |
$67.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.35
|
| Rate for Payer: PHP Commercial |
$63.86
|
| Rate for Payer: Priority Health SBD |
$47.33
|
| Rate for Payer: UMR Bronson Commercial |
$33.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.35
|
|
|
GRANISETRON HCL 1 MG TABLET
|
Facility
|
IP
|
$12.39
|
|
|
Service Code
|
HCPCS Q0166
|
| Hospital Charge Code |
14720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Aetna American Axle |
$8.05
|
| Rate for Payer: Aetna American Axle |
$161.04
|
| Rate for Payer: Aetna Commercial |
$10.53
|
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.04
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cash Price |
$198.21
|
| Rate for Payer: Cofinity Advantage |
$173.43
|
| Rate for Payer: Cofinity Advantage |
$8.67
|
| Rate for Payer: Cofinity Commercial |
$213.07
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.21
|
| Rate for Payer: Healthscope Commercial |
$11.15
|
| Rate for Payer: Healthscope Commercial |
$222.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.82
|
| Rate for Payer: PHP Commercial |
$10.53
|
| Rate for Payer: PHP Commercial |
$210.60
|
| Rate for Payer: Priority Health SBD |
$156.09
|
| Rate for Payer: Priority Health SBD |
$7.81
|
| Rate for Payer: UMR Bronson Commercial |
$5.45
|
| Rate for Payer: UMR Bronson Commercial |
$109.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.82
|
|
|
GRANISETRON HCL 1 MG TABLET
|
Facility
|
OP
|
$12.39
|
|
|
Service Code
|
HCPCS Q0166
|
| Hospital Charge Code |
14720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$97.43 |
| Rate for Payer: Aetna American Axle |
$8.05
|
| Rate for Payer: Aetna American Axle |
$161.04
|
| Rate for Payer: Aetna Commercial |
$10.53
|
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Medicare |
$6.20
|
| Rate for Payer: Aetna Medicare |
$123.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.04
|
| Rate for Payer: BCBS Complete |
$99.10
|
| Rate for Payer: BCBS Complete |
$4.96
|
| Rate for Payer: BCBS Trust/PPO |
$46.34
|
| Rate for Payer: BCBS Trust/PPO |
$46.34
|
| Rate for Payer: BCN Commercial |
$46.34
|
| Rate for Payer: BCN Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cash Price |
$198.21
|
| Rate for Payer: Cash Price |
$9.91
|
| Rate for Payer: Cash Price |
$198.21
|
| Rate for Payer: Cofinity Advantage |
$8.67
|
| Rate for Payer: Cofinity Advantage |
$173.43
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$213.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.21
|
| Rate for Payer: Healthscope Commercial |
$11.15
|
| Rate for Payer: Healthscope Commercial |
$222.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.29
|
| Rate for Payer: PHP Commercial |
$10.53
|
| Rate for Payer: PHP Commercial |
$210.60
|
| Rate for Payer: Priority Health SBD |
$7.81
|
| Rate for Payer: Priority Health SBD |
$156.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.43
|
| Rate for Payer: UHC Core |
$97.43
|
| Rate for Payer: UHC Core |
$97.43
|
| Rate for Payer: UHC Exchange |
$97.43
|
| Rate for Payer: UHC Exchange |
$97.43
|
| Rate for Payer: UMR Bronson Commercial |
$4.58
|
| Rate for Payer: UMR Bronson Commercial |
$91.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.82
|
|
|
GRANISETRON (PF) 1 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.55
|
|
|
Service Code
|
HCPCS J1626
|
| Hospital Charge Code |
117975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Aetna American Axle |
$17.91
|
| Rate for Payer: Aetna American Axle |
$58.60
|
| Rate for Payer: Aetna Commercial |
$23.42
|
| Rate for Payer: Aetna Commercial |
$76.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.60
|
| Rate for Payer: Cash Price |
$22.04
|
| Rate for Payer: Cash Price |
$72.13
|
| Rate for Payer: Cofinity Advantage |
$63.11
|
| Rate for Payer: Cofinity Advantage |
$19.29
|
| Rate for Payer: Cofinity Commercial |
$77.54
|
| Rate for Payer: Cofinity Commercial |
$23.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.13
|
| Rate for Payer: Healthscope Commercial |
$24.80
|
| Rate for Payer: Healthscope Commercial |
$81.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.62
|
| Rate for Payer: PHP Commercial |
$23.42
|
| Rate for Payer: PHP Commercial |
$76.64
|
| Rate for Payer: Priority Health SBD |
$56.80
|
| Rate for Payer: Priority Health SBD |
$17.36
|
| Rate for Payer: UMR Bronson Commercial |
$12.12
|
| Rate for Payer: UMR Bronson Commercial |
$39.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.62
|
|
