|
GYNECOLOGIC PROCEDURES FOR MALIGNANCY
|
Facility
|
IP
|
$27,985.99
|
|
|
Service Code
|
APR-DRG 5114
|
| Min. Negotiated Rate |
$26,653.32 |
| Max. Negotiated Rate |
$27,985.99 |
| Rate for Payer: BCBS Complete |
$27,985.99
|
| Rate for Payer: Mclaren Medicaid |
$26,653.32
|
| Rate for Payer: Meridian Medicaid |
$27,985.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,653.32
|
| Rate for Payer: UHC Medicaid |
$26,653.32
|
| Rate for Payer: UHCCP Medicaid |
$26,653.32
|
|
|
GYNECOLOGIC PROCEDURES FOR MALIGNANCY
|
Facility
|
IP
|
$15,883.12
|
|
|
Service Code
|
APR-DRG 5113
|
| Min. Negotiated Rate |
$15,126.78 |
| Max. Negotiated Rate |
$15,883.12 |
| Rate for Payer: BCBS Complete |
$15,883.12
|
| Rate for Payer: Mclaren Medicaid |
$15,126.78
|
| Rate for Payer: Meridian Medicaid |
$15,883.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,126.78
|
| Rate for Payer: UHC Medicaid |
$15,126.78
|
| Rate for Payer: UHCCP Medicaid |
$15,126.78
|
|
|
GYNECOLOGIC PROCEDURES FOR MALIGNANCY
|
Facility
|
IP
|
$8,328.67
|
|
|
Service Code
|
APR-DRG 5111
|
| Min. Negotiated Rate |
$7,932.06 |
| Max. Negotiated Rate |
$8,328.67 |
| Rate for Payer: BCBS Complete |
$8,328.67
|
| Rate for Payer: Mclaren Medicaid |
$7,932.06
|
| Rate for Payer: Meridian Medicaid |
$8,328.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,932.06
|
| Rate for Payer: UHC Medicaid |
$7,932.06
|
| Rate for Payer: UHCCP Medicaid |
$7,932.06
|
|
|
GYNECOLOGIC PROCEDURES FOR MALIGNANCY
|
Facility
|
IP
|
$11,078.66
|
|
|
Service Code
|
APR-DRG 5112
|
| Min. Negotiated Rate |
$10,551.10 |
| Max. Negotiated Rate |
$11,078.66 |
| Rate for Payer: BCBS Complete |
$11,078.66
|
| Rate for Payer: Mclaren Medicaid |
$10,551.10
|
| Rate for Payer: Meridian Medicaid |
$11,078.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,551.10
|
| Rate for Payer: UHC Medicaid |
$10,551.10
|
| Rate for Payer: UHCCP Medicaid |
$10,551.10
|
|
|
GYNECOLOGIC PROCEDURES WITHOUT MALIGNANCY
|
Facility
|
IP
|
$7,948.52
|
|
|
Service Code
|
APR-DRG 5131
|
| Min. Negotiated Rate |
$7,570.02 |
| Max. Negotiated Rate |
$7,948.52 |
| Rate for Payer: BCBS Complete |
$7,948.52
|
| Rate for Payer: Mclaren Medicaid |
$7,570.02
|
| Rate for Payer: Meridian Medicaid |
$7,948.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,570.02
|
| Rate for Payer: UHC Medicaid |
$7,570.02
|
| Rate for Payer: UHCCP Medicaid |
$7,570.02
|
|
|
GYNECOLOGIC PROCEDURES WITHOUT MALIGNANCY
|
Facility
|
IP
|
$31,248.69
|
|
|
Service Code
|
APR-DRG 5134
|
| Min. Negotiated Rate |
$29,760.66 |
| Max. Negotiated Rate |
$31,248.69 |
| Rate for Payer: BCBS Complete |
$31,248.69
|
| Rate for Payer: Mclaren Medicaid |
$29,760.66
|
| Rate for Payer: Meridian Medicaid |
$31,248.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,760.66
|
| Rate for Payer: UHC Medicaid |
$29,760.66
|
| Rate for Payer: UHCCP Medicaid |
$29,760.66
|
|
|
GYNECOLOGIC PROCEDURES WITHOUT MALIGNANCY
|
Facility
|
IP
|
$15,671.86
|
|
|
Service Code
|
APR-DRG 5133
|
| Min. Negotiated Rate |
$14,925.58 |
| Max. Negotiated Rate |
$15,671.86 |
| Rate for Payer: BCBS Complete |
$15,671.86
|
| Rate for Payer: Mclaren Medicaid |
$14,925.58
|
| Rate for Payer: Meridian Medicaid |
$15,671.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,925.58
|
| Rate for Payer: UHC Medicaid |
$14,925.58
|
| Rate for Payer: UHCCP Medicaid |
$14,925.58
|
|
|
GYNECOLOGIC PROCEDURES WITHOUT MALIGNANCY
|
Facility
|
IP
|
$10,306.87
|
|
|
Service Code
|
APR-DRG 5132
|
| Min. Negotiated Rate |
$9,816.07 |
| Max. Negotiated Rate |
$10,306.87 |
| Rate for Payer: BCBS Complete |
$10,306.87
|
| Rate for Payer: Mclaren Medicaid |
$9,816.07
|
| Rate for Payer: Meridian Medicaid |
$10,306.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,816.07
|
| Rate for Payer: UHC Medicaid |
$9,816.07
|
| Rate for Payer: UHCCP Medicaid |
$9,816.07
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN
|
Facility
|
OP
|
$52.93
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
11931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.58 |
| Max. Negotiated Rate |
$47.64 |
| Rate for Payer: Aetna American Axle |
$34.40
|
| Rate for Payer: Aetna Commercial |
$44.99
|
| Rate for Payer: Aetna Medicare |
$26.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.40
|
| Rate for Payer: BCBS Complete |
$21.17
|
| Rate for Payer: BCBS Trust/PPO |
$41.91
|
| Rate for Payer: BCN Commercial |
$41.91
|
| Rate for Payer: Cash Price |
$42.34
|
| Rate for Payer: Cash Price |
$42.34
|
| Rate for Payer: Cofinity Advantage |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$45.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.34
|
| Rate for Payer: Healthscope Commercial |
$47.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.70
|
| Rate for Payer: PHP Commercial |
$44.99
|
| Rate for Payer: Priority Health SBD |
$33.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$26.93
|
| Rate for Payer: UHC Exchange |
$26.93
|
| Rate for Payer: UMR Bronson Commercial |
$19.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.70
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN
|
Facility
|
IP
|
$52.93
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
11931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$47.64 |
| Rate for Payer: Aetna American Axle |
$34.40
|
| Rate for Payer: Aetna Commercial |
$44.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.40
|
| Rate for Payer: Cash Price |
$42.34
|
| Rate for Payer: Cofinity Advantage |
$37.05
|
| Rate for Payer: Cofinity Commercial |
$45.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.34
|
| Rate for Payer: Healthscope Commercial |
$47.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.70
|
| Rate for Payer: PHP Commercial |
$44.99
|
| Rate for Payer: Priority Health SBD |
$33.35
|
| Rate for Payer: UMR Bronson Commercial |
$23.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.70
|
|
|
HAIR REMOVAL
|
Professional
|
Both
|
$84.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.00
|
| Rate for Payer: UMR Bronson Commercial |
$38.64
|
|
|
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT; WITH IMPLANT
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 28291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$6,263.09
|
| Rate for Payer: BCN Commercial |
$6,263.09
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT; WITHOUT IMPLANT
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,675.66
|
| Rate for Payer: BCN Commercial |
$2,675.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$320.15
|
|
|
Service Code
|
NDC 58657090101
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.46 |
| Max. Negotiated Rate |
$288.13 |
| Rate for Payer: Aetna American Axle |
$208.10
|
| Rate for Payer: Aetna Commercial |
$272.13
|
| Rate for Payer: Aetna Medicare |
$160.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.10
|
| Rate for Payer: BCBS Complete |
$128.06
|
| Rate for Payer: Cash Price |
$256.12
|
| Rate for Payer: Cofinity Advantage |
$224.10
|
| Rate for Payer: Cofinity Commercial |
$275.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$288.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.11
|
| Rate for Payer: PHP Commercial |
$272.13
|
| Rate for Payer: Priority Health SBD |
$201.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.10
|
| Rate for Payer: UHC Core |
$166.80
|
| Rate for Payer: UHC Exchange |
$125.82
|
| Rate for Payer: UMR Bronson Commercial |
$118.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.11
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
NDC 00904724161
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Advantage |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: UMR Bronson Commercial |
$125.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$411.35
|
|
|
Service Code
|
NDC 51079073420
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.99 |
| Max. Negotiated Rate |
$370.21 |
| Rate for Payer: Aetna American Axle |
$267.38
|
| Rate for Payer: Aetna Commercial |
$349.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.38
|
| Rate for Payer: Cash Price |
$329.08
|
| Rate for Payer: Cofinity Advantage |
$287.94
|
| Rate for Payer: Cofinity Commercial |
$353.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.08
|
| Rate for Payer: Healthscope Commercial |
$370.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.51
|
| Rate for Payer: PHP Commercial |
$349.65
|
| Rate for Payer: Priority Health SBD |
$259.15
|
| Rate for Payer: UMR Bronson Commercial |
$180.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.51
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$4.12
|
|
|
Service Code
|
NDC 51079073401
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna American Axle |
$2.68
|
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Advantage |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.09
|
| Rate for Payer: PHP Commercial |
$3.50
|
| Rate for Payer: Priority Health SBD |
$2.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.09
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$4.12
|
|
|
Service Code
|
NDC 51079073401
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna American Axle |
$2.68
|
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Advantage |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.09
|
| Rate for Payer: PHP Commercial |
$3.50
|
| Rate for Payer: Priority Health SBD |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.68
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: UHC Exchange |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$1.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.09
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$411.35
|
|
|
Service Code
|
NDC 51079073420
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$370.21 |
| Rate for Payer: Aetna American Axle |
$267.38
|
| Rate for Payer: Aetna Commercial |
$349.65
|
| Rate for Payer: Aetna Medicare |
$205.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.38
|
| Rate for Payer: BCBS Complete |
$164.54
|
| Rate for Payer: Cash Price |
$329.08
|
| Rate for Payer: Cofinity Advantage |
$287.94
|
| Rate for Payer: Cofinity Commercial |
$353.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.08
|
| Rate for Payer: Healthscope Commercial |
$370.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.51
|
| Rate for Payer: PHP Commercial |
$349.65
|
| Rate for Payer: Priority Health SBD |
$259.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.38
|
| Rate for Payer: UHC Core |
$214.31
|
| Rate for Payer: UHC Exchange |
$161.66
|
| Rate for Payer: UMR Bronson Commercial |
$152.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.51
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$3.21
|
|
|
Service Code
|
NDC 58657090110
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna American Axle |
$2.09
|
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.09
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cofinity Advantage |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.02
|
| Rate for Payer: UMR Bronson Commercial |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.41
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$3.21
|
|
|
Service Code
|
NDC 58657090110
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna American Axle |
$2.09
|
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.09
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cofinity Advantage |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$2.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.41
|
| Rate for Payer: PHP Commercial |
$2.73
|
| Rate for Payer: Priority Health SBD |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.09
|
| Rate for Payer: UHC Core |
$1.67
|
| Rate for Payer: UHC Exchange |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.41
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$325.85
|
|
|
Service Code
|
NDC 00378025701
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna American Axle |
$211.80
|
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna Medicare |
$162.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.80
|
| Rate for Payer: BCBS Complete |
$130.34
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Advantage |
$228.09
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.39
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health SBD |
$205.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.80
|
| Rate for Payer: UHC Core |
$169.77
|
| Rate for Payer: UHC Exchange |
$128.06
|
| Rate for Payer: UMR Bronson Commercial |
$120.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
NDC 00904724161
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Medicare |
$142.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: BCBS Complete |
$114.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Advantage |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.25
|
| Rate for Payer: UHC Core |
$148.49
|
| Rate for Payer: UHC Exchange |
$112.00
|
| Rate for Payer: UMR Bronson Commercial |
$105.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 00378025701
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.37 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna American Axle |
$211.80
|
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.80
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Advantage |
$228.09
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.39
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health SBD |
$205.29
|
| Rate for Payer: UMR Bronson Commercial |
$143.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$320.15
|
|
|
Service Code
|
NDC 58657090101
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.87 |
| Max. Negotiated Rate |
$288.13 |
| Rate for Payer: Aetna American Axle |
$208.10
|
| Rate for Payer: Aetna Commercial |
$272.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.10
|
| Rate for Payer: Cash Price |
$256.12
|
| Rate for Payer: Cofinity Advantage |
$224.10
|
| Rate for Payer: Cofinity Commercial |
$275.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$288.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.11
|
| Rate for Payer: PHP Commercial |
$272.13
|
| Rate for Payer: Priority Health SBD |
$201.69
|
| Rate for Payer: UMR Bronson Commercial |
$140.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.11
|
|
