|
ATROPINE 1 % EYE DROPS
|
Facility
|
IP
|
$102.45
|
|
|
Service Code
|
NDC 60219-1748-2
|
| Hospital Charge Code |
736
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$92.20 |
| Rate for Payer: Aetna American Axle |
$66.59
|
| Rate for Payer: Aetna Commercial |
$87.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.59
|
| Rate for Payer: Cash Price |
$81.96
|
| Rate for Payer: Cofinity Commercial |
$71.72
|
| Rate for Payer: Cofinity Commercial |
$88.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.96
|
| Rate for Payer: Healthscope Commercial |
$92.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.08
|
| Rate for Payer: PHP Commercial |
$87.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.72
|
| Rate for Payer: Priority Health SBD |
$64.54
|
| Rate for Payer: UMR Bronson Commercial |
$45.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.84
|
|
|
ATROPINE 1 % EYE OINTMENT
|
Facility
|
IP
|
$56.98
|
|
|
Service Code
|
NDC 24208-825-55
|
| Hospital Charge Code |
735
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$51.28 |
| Rate for Payer: Aetna American Axle |
$37.04
|
| Rate for Payer: Aetna Commercial |
$48.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.04
|
| Rate for Payer: Cash Price |
$45.58
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.58
|
| Rate for Payer: Healthscope Commercial |
$51.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.43
|
| Rate for Payer: PHP Commercial |
$48.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.89
|
| Rate for Payer: Priority Health SBD |
$35.90
|
| Rate for Payer: UMR Bronson Commercial |
$25.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.74
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
734
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.33 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna American Axle |
$19.69
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.20
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$13.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$88.44
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.91 |
| Max. Negotiated Rate |
$79.60 |
| Rate for Payer: Aetna American Axle |
$57.49
|
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.49
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cofinity Commercial |
$61.91
|
| Rate for Payer: Cofinity Commercial |
$76.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.75
|
| Rate for Payer: Healthscope Commercial |
$79.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.17
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.91
|
| Rate for Payer: Priority Health SBD |
$55.72
|
| Rate for Payer: UMR Bronson Commercial |
$38.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.33
|
|
|
ATROPINE 1 MG/ML INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$30.29
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
301597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$27.26 |
| Rate for Payer: Aetna American Axle |
$19.69
|
| Rate for Payer: Aetna Commercial |
$25.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.69
|
| Rate for Payer: BCBS Complete |
$12.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cash Price |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.23
|
| Rate for Payer: Healthscope Commercial |
$27.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.75
|
| Rate for Payer: PHP Commercial |
$25.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.20
|
| Rate for Payer: Priority Health SBD |
$19.08
|
| Rate for Payer: UMR Bronson Commercial |
$11.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.72
|
|
|
ATROPINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$88.44
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
195981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$79.60 |
| Rate for Payer: Aetna American Axle |
$57.49
|
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.49
|
| Rate for Payer: BCBS Complete |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.22
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cash Price |
$70.75
|
| Rate for Payer: Cofinity Commercial |
$76.06
|
| Rate for Payer: Cofinity Commercial |
$61.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.75
|
| Rate for Payer: Healthscope Commercial |
$79.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.17
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.91
|
| Rate for Payer: Priority Health SBD |
$55.72
|
| Rate for Payer: UMR Bronson Commercial |
$32.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.33
|
|
|
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, RIBS, SPINOUS PROCESS, OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
CPT 20936
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$354.06 |
| Max. Negotiated Rate |
$5,042.00 |
| Rate for Payer: BCBS Trust/PPO |
$354.06
|
| Rate for Payer: UHC Core |
$5,042.00
|
|
|
AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); MORSELIZED (THROUGH SEPARATE SKIN OR FASCIAL INCISION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
CPT 20937
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$163.07 |
| Max. Negotiated Rate |
$5,042.00 |
| Rate for Payer: BCBS Trust/PPO |
$612.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.38
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Exchange |
$163.07
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
|
IP
|
$223,597.84
|
|
|
Service Code
|
MS-DRG 016
|
| Min. Negotiated Rate |
$45,706.91 |
| Max. Negotiated Rate |
$223,597.84 |
| Rate for Payer: Aetna Medicare |
$50,037.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60,140.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60,140.68
|
| Rate for Payer: BCBS MAPPO |
$48,112.54
|
| Rate for Payer: BCBS Trust/PPO |
$223,597.84
|
| Rate for Payer: BCN Medicare Advantage |
$48,112.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48,112.54
|
| Rate for Payer: Mclaren Medicare |
$48,112.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50,518.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55,329.42
|
| Rate for Payer: PACE Medicare |
$45,706.91
|
| Rate for Payer: PACE SWMI |
$48,112.54
|
| Rate for Payer: PHP Medicare Advantage |
$48,112.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88,639.46
|
| Rate for Payer: Priority Health Medicare |
$48,112.54
|
| Rate for Payer: Priority Health Narrow Network |
$70,911.57
|
| Rate for Payer: Railroad Medicare Medicare |
$48,112.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94,223.96
|
| Rate for Payer: UHC Core |
$77,261.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$48,112.54
|
| Rate for Payer: UHC Exchange |
$61,424.09
|
| Rate for Payer: UHC Medicare Advantage |
$49,555.92
|
| Rate for Payer: VA VA |
$48,112.54
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$114,397.26
|
|
|
Service Code
|
MS-DRG 017
|
| Min. Negotiated Rate |
$45,706.91 |
| Max. Negotiated Rate |
$114,397.26 |
| Rate for Payer: Aetna Medicare |
$50,037.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60,140.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60,140.68
|
| Rate for Payer: BCBS MAPPO |
$48,112.54
|
| Rate for Payer: BCBS Trust/PPO |
$114,397.26
|
| Rate for Payer: BCN Medicare Advantage |
$48,112.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48,112.54
|
| Rate for Payer: Mclaren Medicare |
$48,112.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50,518.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55,329.42
|
| Rate for Payer: PACE Medicare |
$45,706.91
|
| Rate for Payer: PACE SWMI |
$48,112.54
|
| Rate for Payer: PHP Medicare Advantage |
$48,112.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88,639.46
|
| Rate for Payer: Priority Health Medicare |
$48,112.54
|
| Rate for Payer: Priority Health Narrow Network |
$70,911.57
|
| Rate for Payer: Railroad Medicare Medicare |
$48,112.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94,223.96
|
| Rate for Payer: UHC Core |
$77,261.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$48,112.54
|
| Rate for Payer: UHC Exchange |
$61,424.09
|
| Rate for Payer: UHC Medicare Advantage |
$49,555.92
|
| Rate for Payer: VA VA |
$48,112.54
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,934.95
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
198019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$5,341.46 |
| Rate for Payer: Aetna American Axle |
$3,857.72
|
| Rate for Payer: Aetna Commercial |
$5,044.71
|
| Rate for Payer: Aetna Medicare |
$79.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,857.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.02
|
| Rate for Payer: BCBS Complete |
$43.66
|
| Rate for Payer: BCBS MAPPO |
$76.02
|
| Rate for Payer: BCBS Trust/PPO |
$245.65
|
| Rate for Payer: BCN Medicare Advantage |
$76.02
|
| Rate for Payer: Cash Price |
$4,747.96
|
| Rate for Payer: Cash Price |
$4,747.96
|
| Rate for Payer: Cofinity Commercial |
$5,104.06
|
| Rate for Payer: Cofinity Commercial |
$4,154.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,747.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.02
|
| Rate for Payer: Healthscope Commercial |
$5,341.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,154.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,451.21
|
| Rate for Payer: Mclaren Medicaid |
$41.58
|
| Rate for Payer: Mclaren Medicare |
$76.02
|
| Rate for Payer: Meridian Medicaid |
$43.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,044.71
|
| Rate for Payer: PACE Medicare |
$72.22
|
| Rate for Payer: PACE SWMI |
$76.02
|
| Rate for Payer: PHP Commercial |
$5,044.71
|
| Rate for Payer: PHP Medicare Advantage |
$76.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,154.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.11
|
| Rate for Payer: Priority Health Medicare |
$76.02
|
| Rate for Payer: Priority Health Narrow Network |
$177.69
|
| Rate for Payer: Priority Health SBD |
$3,739.02
|
| Rate for Payer: Railroad Medicare Medicare |
$76.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.02
|
| Rate for Payer: UHC Medicare Advantage |
$78.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,195.93
|
| Rate for Payer: VA VA |
$76.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,451.21
|
|
|
AVALGLUCOSIDASE ALFA-NGPT 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,934.95
|
|
|
Service Code
|
HCPCS J0219
|
| Hospital Charge Code |
198019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,611.38 |
| Max. Negotiated Rate |
$5,341.46 |
| Rate for Payer: Aetna American Axle |
$3,857.72
|
| Rate for Payer: Aetna Commercial |
$5,044.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,857.72
|
| Rate for Payer: Cash Price |
$4,747.96
|
| Rate for Payer: Cofinity Commercial |
$4,154.46
|
| Rate for Payer: Cofinity Commercial |
$5,104.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,747.96
|
| Rate for Payer: Healthscope Commercial |
$5,341.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,154.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,451.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,044.71
|
| Rate for Payer: PHP Commercial |
$5,044.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,154.46
|
| Rate for Payer: Priority Health SBD |
$3,739.02
|
| Rate for Payer: UMR Bronson Commercial |
$2,611.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,451.21
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,398.25
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
182436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.53 |
| Max. Negotiated Rate |
$8,458.42 |
| Rate for Payer: Aetna American Axle |
$6,108.86
|
| Rate for Payer: Aetna Commercial |
$7,988.51
|
| Rate for Payer: Aetna Medicare |
$96.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,108.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.46
|
| Rate for Payer: BCBS Complete |
$53.06
|
| Rate for Payer: BCBS MAPPO |
$92.37
|
| Rate for Payer: BCBS Trust/PPO |
$298.49
|
| Rate for Payer: BCN Medicare Advantage |
$92.37
|
| Rate for Payer: Cash Price |
$7,518.60
|
| Rate for Payer: Cash Price |
$7,518.60
|
| Rate for Payer: Cofinity Commercial |
$8,082.50
|
| Rate for Payer: Cofinity Commercial |
$6,578.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,518.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.37
|
| Rate for Payer: Healthscope Commercial |
$8,458.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,578.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,048.69
|
| Rate for Payer: Mclaren Medicaid |
$50.53
|
| Rate for Payer: Mclaren Medicare |
$92.37
|
| Rate for Payer: Meridian Medicaid |
$53.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,988.51
|
| Rate for Payer: PACE Medicare |
$87.75
|
| Rate for Payer: PACE SWMI |
$92.37
|
| Rate for Payer: PHP Commercial |
$7,988.51
|
| Rate for Payer: PHP Medicare Advantage |
$92.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,578.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.95
|
| Rate for Payer: Priority Health Medicare |
$92.37
|
| Rate for Payer: Priority Health Narrow Network |
$213.56
|
| Rate for Payer: Priority Health SBD |
$5,920.90
|
| Rate for Payer: Railroad Medicare Medicare |
$92.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.37
|
| Rate for Payer: UHC Medicare Advantage |
$95.14
|
| Rate for Payer: UMR Bronson Commercial |
$3,477.35
|
| Rate for Payer: VA VA |
$92.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,048.69
|
|
|
AVELUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,398.25
|
|
|
Service Code
|
HCPCS J9023
|
| Hospital Charge Code |
182436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,135.23 |
| Max. Negotiated Rate |
$8,458.42 |
| Rate for Payer: Aetna American Axle |
$6,108.86
|
| Rate for Payer: Aetna Commercial |
$7,988.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,108.86
|
| Rate for Payer: Cash Price |
$7,518.60
|
| Rate for Payer: Cofinity Commercial |
$6,578.78
|
| Rate for Payer: Cofinity Commercial |
$8,082.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,518.60
|
| Rate for Payer: Healthscope Commercial |
$8,458.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,578.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,048.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,988.51
|
| Rate for Payer: PHP Commercial |
$7,988.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,578.78
|
| Rate for Payer: Priority Health SBD |
$5,920.90
|
| Rate for Payer: UMR Bronson Commercial |
$4,135.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,048.69
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$165.56
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.63
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$52.39
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11730
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$165.56
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.63
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$52.39
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
AXILLARY LYMPHADENECTOMY; SUPERFICIAL
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 38740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$694.18 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,532.46
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$763.60
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$694.18
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
|
IP
|
$457.77
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.42 |
| Max. Negotiated Rate |
$411.99 |
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$238.59
|
| Rate for Payer: Aetna Commercial |
$312.00
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.59
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$293.65
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$315.67
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$256.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.65
|
| Rate for Payer: Healthscope Commercial |
$330.35
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.00
|
| Rate for Payer: PHP Commercial |
$312.00
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,839.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.44
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$231.25
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: UMR Bronson Commercial |
$161.51
|
| Rate for Payer: UMR Bronson Commercial |
$201.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.30
|
|
|
AZACITIDINE 100 MG/10 ML SOLN
|
Facility
|
OP
|
$2,627.73
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
168892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2,364.96 |
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$238.59
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$312.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.59
|
| Rate for Payer: BCBS Complete |
$1,051.09
|
| Rate for Payer: BCBS Complete |
$183.11
|
| Rate for Payer: BCBS Complete |
$146.82
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$293.65
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cash Price |
$293.65
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$256.94
|
| Rate for Payer: Cofinity Commercial |
$315.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.65
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$330.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.00
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$312.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,839.41
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$231.25
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: UMR Bronson Commercial |
$972.26
|
| Rate for Payer: UMR Bronson Commercial |
$135.81
|
| Rate for Payer: UMR Bronson Commercial |
$169.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$2,627.73
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,156.20 |
| Max. Negotiated Rate |
$2,364.96 |
| Rate for Payer: Aetna American Axle |
$1,708.02
|
| Rate for Payer: Aetna American Axle |
$223.66
|
| Rate for Payer: Aetna American Axle |
$297.55
|
| Rate for Payer: Aetna American Axle |
$238.59
|
| Rate for Payer: Aetna Commercial |
$292.48
|
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Commercial |
$312.00
|
| Rate for Payer: Aetna Commercial |
$389.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$293.65
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cash Price |
$366.22
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Cofinity Commercial |
$315.67
|
| Rate for Payer: Cofinity Commercial |
$256.94
|
| Rate for Payer: Cofinity Commercial |
$320.44
|
| Rate for Payer: Cofinity Commercial |
$240.87
|
| Rate for Payer: Cofinity Commercial |
$295.93
|
| Rate for Payer: Cofinity Commercial |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$393.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.28
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Healthscope Commercial |
$411.99
|
| Rate for Payer: Healthscope Commercial |
$309.69
|
| Rate for Payer: Healthscope Commercial |
$330.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,839.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,970.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,233.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.10
|
| Rate for Payer: PHP Commercial |
$312.00
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Commercial |
$292.48
|
| Rate for Payer: PHP Commercial |
$389.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,839.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.87
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health SBD |
$216.78
|
| Rate for Payer: Priority Health SBD |
$288.40
|
| Rate for Payer: Priority Health SBD |
$231.25
|
| Rate for Payer: UMR Bronson Commercial |
$201.42
|
| Rate for Payer: UMR Bronson Commercial |
$151.40
|
| Rate for Payer: UMR Bronson Commercial |
$161.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,970.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.30
|
|
|
AZACITIDINE 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$332.92
|
|
|
Service Code
|
HCPCS J9025
|
| Hospital Charge Code |
78420
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$299.63 |
| Rate for Payer: Aetna American Axle |
$216.40
|
| Rate for Payer: Aetna American Axle |
$198.35
|
| Rate for Payer: Aetna American Axle |
$223.66
|
| Rate for Payer: Aetna American Axle |
$281.50
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$186.36
|
| Rate for Payer: Aetna Commercial |
$368.11
|
| Rate for Payer: Aetna Commercial |
$282.98
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$243.70
|
| Rate for Payer: Aetna Commercial |
$292.48
|
| Rate for Payer: Aetna Commercial |
$259.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.35
|
| Rate for Payer: BCBS Complete |
$173.23
|
| Rate for Payer: BCBS Complete |
$137.64
|
| Rate for Payer: BCBS Complete |
$114.68
|
| Rate for Payer: BCBS Complete |
$122.06
|
| Rate for Payer: BCBS Complete |
$133.17
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: Cash Price |
$346.46
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cash Price |
$275.28
|
| Rate for Payer: Cash Price |
$244.12
|
| Rate for Payer: Cash Price |
$244.12
|
| Rate for Payer: Cash Price |
$346.46
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cofinity Commercial |
$262.43
|
| Rate for Payer: Cofinity Commercial |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Cofinity Commercial |
$233.04
|
| Rate for Payer: Cofinity Commercial |
$286.31
|
| Rate for Payer: Cofinity Commercial |
$240.87
|
| Rate for Payer: Cofinity Commercial |
$295.93
|
| Rate for Payer: Cofinity Commercial |
$372.44
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Cofinity Commercial |
$200.69
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.28
|
| Rate for Payer: Healthscope Commercial |
$389.76
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$274.64
|
| Rate for Payer: Healthscope Commercial |
$299.63
|
| Rate for Payer: Healthscope Commercial |
$309.69
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$258.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$368.11
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$292.48
|
| Rate for Payer: PHP Commercial |
$243.70
|
| Rate for Payer: PHP Commercial |
$282.98
|
| Rate for Payer: PHP Commercial |
$259.38
|
| Rate for Payer: PHP Commercial |
$368.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.15
|
| Rate for Payer: Priority Health SBD |
$272.83
|
| Rate for Payer: Priority Health SBD |
$209.74
|
| Rate for Payer: Priority Health SBD |
$180.62
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$216.78
|
| Rate for Payer: Priority Health SBD |
$192.24
|
| Rate for Payer: UMR Bronson Commercial |
$123.18
|
| Rate for Payer: UMR Bronson Commercial |
$106.08
|
| Rate for Payer: UMR Bronson Commercial |
$160.24
|
| Rate for Payer: UMR Bronson Commercial |
$127.32
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$112.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$258.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.80
|
|
|
AZATHIOPRINE 50 MG TABLET
|
Facility
|
IP
|
$410.40
|
|
|
Service Code
|
HCPCS J7500
|
| Hospital Charge Code |
9183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$180.58 |
| Max. Negotiated Rate |
$369.36 |
| Rate for Payer: Aetna American Axle |
$266.76
|
| Rate for Payer: Aetna American Axle |
$165.98
|
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna American Axle |
$160.55
|
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna Commercial |
$217.06
|
| Rate for Payer: Aetna Commercial |
$348.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cash Price |
$204.29
|
| Rate for Payer: Cash Price |
$2.05
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Cofinity Commercial |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$352.94
|
| Rate for Payer: Cofinity Commercial |
$219.61
|
| Rate for Payer: Cofinity Commercial |
$178.75
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$172.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$229.82
|
| Rate for Payer: Healthscope Commercial |
$369.36
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$348.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.15
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: PHP Commercial |
$348.84
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: PHP Commercial |
$217.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.28
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: Priority Health SBD |
$258.55
|
| Rate for Payer: Priority Health SBD |
$155.61
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: Priority Health SBD |
$160.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.13
|
| Rate for Payer: UMR Bronson Commercial |
$112.36
|
| Rate for Payer: UMR Bronson Commercial |
$108.68
|
| Rate for Payer: UMR Bronson Commercial |
$97.39
|
| Rate for Payer: UMR Bronson Commercial |
$180.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.80
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$89.28
|
|
|
Service Code
|
NDC 59762-3140-1
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$80.35 |
| Rate for Payer: Aetna American Axle |
$58.03
|
| Rate for Payer: Aetna Commercial |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.03
|
| Rate for Payer: Cash Price |
$71.42
|
| Rate for Payer: Cofinity Commercial |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$80.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.89
|
| Rate for Payer: PHP Commercial |
$75.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.50
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.96
|
|
|
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$116.79
|
|
|
Service Code
|
NDC 0093-2026-31
|
| Hospital Charge Code |
15797
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.39 |
| Max. Negotiated Rate |
$105.11 |
| Rate for Payer: Aetna American Axle |
$75.91
|
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.91
|
| Rate for Payer: Cash Price |
$93.43
|
| Rate for Payer: Cofinity Commercial |
$100.44
|
| Rate for Payer: Cofinity Commercial |
$81.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.43
|
| Rate for Payer: Healthscope Commercial |
$105.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.27
|
| Rate for Payer: PHP Commercial |
$99.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.75
|
| Rate for Payer: Priority Health SBD |
$73.58
|
| Rate for Payer: UMR Bronson Commercial |
$51.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.59
|
|
|
AZITHROMYCIN 250 MG TABLET
|
Facility
|
IP
|
$775.20
|
|
|
Service Code
|
NDC 60687-282-01
|
| Hospital Charge Code |
20943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$341.09 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna American Axle |
$503.88
|
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.88
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$542.64
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$658.92
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.64
|
| Rate for Payer: Priority Health SBD |
$488.38
|
| Rate for Payer: UMR Bronson Commercial |
$341.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.40
|
|
