|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$194.25
|
|
|
Service Code
|
NDC 70700026894
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna American Axle |
$126.26
|
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna Medicare |
$97.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.26
|
| Rate for Payer: BCBS Complete |
$77.70
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$135.98
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.26
|
| Rate for Payer: Priority Health SBD |
$122.38
|
| Rate for Payer: UMR Bronson Commercial |
$71.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.69
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 82036427408
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 82036427401
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$194.25
|
|
|
Service Code
|
NDC 70700026899
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna American Axle |
$126.26
|
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna Medicare |
$97.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.26
|
| Rate for Payer: BCBS Complete |
$77.70
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$135.98
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.26
|
| Rate for Payer: Priority Health SBD |
$122.38
|
| Rate for Payer: UMR Bronson Commercial |
$71.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.69
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$241.84
|
|
|
Service Code
|
NDC 00456430001
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.41 |
| Max. Negotiated Rate |
$217.66 |
| Rate for Payer: Aetna American Axle |
$157.20
|
| Rate for Payer: Aetna Commercial |
$205.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.20
|
| Rate for Payer: Cash Price |
$193.47
|
| Rate for Payer: Cofinity Commercial |
$169.29
|
| Rate for Payer: Cofinity Commercial |
$207.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.47
|
| Rate for Payer: Healthscope Commercial |
$217.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.56
|
| Rate for Payer: PHP Commercial |
$205.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.20
|
| Rate for Payer: Priority Health SBD |
$152.36
|
| Rate for Payer: UMR Bronson Commercial |
$106.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.38
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$241.84
|
|
|
Service Code
|
NDC 00456430001
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.48 |
| Max. Negotiated Rate |
$217.66 |
| Rate for Payer: Aetna American Axle |
$157.20
|
| Rate for Payer: Aetna Commercial |
$205.56
|
| Rate for Payer: Aetna Medicare |
$120.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.20
|
| Rate for Payer: BCBS Complete |
$96.74
|
| Rate for Payer: Cash Price |
$193.47
|
| Rate for Payer: Cofinity Commercial |
$169.29
|
| Rate for Payer: Cofinity Commercial |
$207.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.47
|
| Rate for Payer: Healthscope Commercial |
$217.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.56
|
| Rate for Payer: PHP Commercial |
$205.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.20
|
| Rate for Payer: Priority Health SBD |
$152.36
|
| Rate for Payer: UMR Bronson Commercial |
$89.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.38
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$206.46
|
|
|
Service Code
|
NDC 82036427401
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.39 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna Medicare |
$103.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: BCBS Complete |
$82.58
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UMR Bronson Commercial |
$76.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
|
FOSINOPRIL 20 MG TABLET
|
Facility
|
OP
|
$304.56
|
|
|
Service Code
|
NDC 69097085705
|
| Hospital Charge Code |
10095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.69 |
| Max. Negotiated Rate |
$274.10 |
| Rate for Payer: Aetna American Axle |
$197.96
|
| Rate for Payer: Aetna Commercial |
$258.88
|
| Rate for Payer: Aetna Medicare |
$152.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.96
|
| Rate for Payer: BCBS Complete |
$121.82
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Commercial |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$261.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.65
|
| Rate for Payer: Healthscope Commercial |
$274.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.88
|
| Rate for Payer: PHP Commercial |
$258.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.96
|
| Rate for Payer: Priority Health SBD |
$191.87
|
| Rate for Payer: UMR Bronson Commercial |
$112.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.42
|
|
|
FOSINOPRIL 20 MG TABLET
|
Facility
|
IP
|
$304.56
|
|
|
Service Code
|
NDC 69097085705
|
| Hospital Charge Code |
10095
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.01 |
| Max. Negotiated Rate |
$274.10 |
| Rate for Payer: Aetna American Axle |
$197.96
|
| Rate for Payer: Aetna Commercial |
$258.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.96
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Commercial |
$213.19
|
| Rate for Payer: Cofinity Commercial |
$261.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.65
|
| Rate for Payer: Healthscope Commercial |
$274.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.88
|
| Rate for Payer: PHP Commercial |
$258.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.96
|
| Rate for Payer: Priority Health SBD |
$191.87
|
| Rate for Payer: UMR Bronson Commercial |
$134.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.42
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.87
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
17764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna American Axle |
$12.92
|
| Rate for Payer: Aetna American Axle |
$9.85
|
| Rate for Payer: Aetna American Axle |
$10.09
|
| Rate for Payer: Aetna American Axle |
$18.23
|
| Rate for Payer: Aetna American Axle |
$108.76
|
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$23.84
|
| Rate for Payer: Aetna Commercial |
$142.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cofinity Commercial |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$117.12
|
| Rate for Payer: Cofinity Commercial |
$10.86
|
| Rate for Payer: Cofinity Commercial |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$143.90
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$24.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.86
|
| Rate for Payer: Healthscope Commercial |
$13.97
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Commercial |
$150.59
|
| Rate for Payer: Healthscope Commercial |
$25.24
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$23.84
|
| Rate for Payer: PHP Commercial |
$142.22
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: PHP Commercial |
$13.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health SBD |
$17.67
|
| Rate for Payer: Priority Health SBD |
$105.41
|
| Rate for Payer: Priority Health SBD |
$9.78
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$12.52
|
| Rate for Payer: UMR Bronson Commercial |
$6.67
|
| Rate for Payer: UMR Bronson Commercial |
$6.83
|
| Rate for Payer: UMR Bronson Commercial |
$8.74
|
| Rate for Payer: UMR Bronson Commercial |
$12.34
|
| Rate for Payer: UMR Bronson Commercial |
$73.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.90
|
|
|
FOSPHENYTOIN 100 MG PE/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.52
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
17764
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$13.97 |
| Rate for Payer: Aetna American Axle |
$10.09
|
| Rate for Payer: Aetna American Axle |
$12.92
|
| Rate for Payer: Aetna American Axle |
$108.76
|
| Rate for Payer: Aetna American Axle |
$9.85
|
| Rate for Payer: Aetna American Axle |
$18.23
|
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$23.84
|
| Rate for Payer: Aetna Commercial |
$142.22
|
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna Medicare |
$83.66
|
| Rate for Payer: Aetna Medicare |
$9.94
|
| Rate for Payer: Aetna Medicare |
$7.76
|
| Rate for Payer: Aetna Medicare |
$7.58
|
| Rate for Payer: Aetna Medicare |
$14.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.76
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: BCBS Complete |
$11.22
|
| Rate for Payer: BCBS Complete |
$66.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cash Price |
$22.44
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$10.86
|
| Rate for Payer: Cofinity Commercial |
$24.12
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$143.90
|
| Rate for Payer: Cofinity Commercial |
$117.12
|
| Rate for Payer: Cofinity Commercial |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Commercial |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$13.97
|
| Rate for Payer: Healthscope Commercial |
$150.59
|
| Rate for Payer: Healthscope Commercial |
$25.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$23.84
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: PHP Commercial |
$13.19
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$142.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: Priority Health SBD |
$9.78
|
| Rate for Payer: Priority Health SBD |
$17.67
|
| Rate for Payer: Priority Health SBD |
$12.52
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$105.41
|
| Rate for Payer: UMR Bronson Commercial |
$5.61
|
| Rate for Payer: UMR Bronson Commercial |
$61.91
|
| Rate for Payer: UMR Bronson Commercial |
$5.74
|
| Rate for Payer: UMR Bronson Commercial |
$7.35
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION
|
Facility
|
OP
|
$400.44
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
88010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$360.40 |
| Rate for Payer: Aetna American Axle |
$260.29
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna American Axle |
$59.04
|
| Rate for Payer: Aetna American Axle |
$60.54
|
| Rate for Payer: Aetna American Axle |
$34.54
|
| Rate for Payer: Aetna American Axle |
$42.46
|
| Rate for Payer: Aetna American Axle |
$40.21
|
| Rate for Payer: Aetna Commercial |
$52.58
|
| Rate for Payer: Aetna Commercial |
$79.17
|
| Rate for Payer: Aetna Commercial |
$55.53
|
| Rate for Payer: Aetna Commercial |
$77.21
|
| Rate for Payer: Aetna Commercial |
$45.17
|
| Rate for Payer: Aetna Commercial |
$340.37
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Medicare |
$30.93
|
| Rate for Payer: Aetna Medicare |
$32.66
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna Medicare |
$45.42
|
| Rate for Payer: Aetna Medicare |
$26.57
|
| Rate for Payer: Aetna Medicare |
$200.22
|
| Rate for Payer: Aetna Medicare |
$46.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.04
|
| Rate for Payer: BCBS Complete |
$26.13
|
| Rate for Payer: BCBS Complete |
$19.87
|
| Rate for Payer: BCBS Complete |
$21.26
|
| Rate for Payer: BCBS Complete |
$160.18
|
| Rate for Payer: BCBS Complete |
$37.26
|
| Rate for Payer: BCBS Complete |
$36.33
|
| Rate for Payer: BCBS Complete |
$24.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.85
|
| Rate for Payer: Cash Price |
$74.51
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$42.51
|
| Rate for Payer: Cash Price |
$320.35
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$320.35
|
| Rate for Payer: Cash Price |
$42.51
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cash Price |
$52.26
|
| Rate for Payer: Cash Price |
$52.26
|
| Rate for Payer: Cash Price |
$72.66
|
| Rate for Payer: Cash Price |
$72.66
|
| Rate for Payer: Cash Price |
$74.51
|
| Rate for Payer: Cofinity Commercial |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$80.10
|
| Rate for Payer: Cofinity Commercial |
$45.73
|
| Rate for Payer: Cofinity Commercial |
$344.38
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Cofinity Commercial |
$280.31
|
| Rate for Payer: Cofinity Commercial |
$56.18
|
| Rate for Payer: Cofinity Commercial |
$37.20
|
| Rate for Payer: Cofinity Commercial |
$78.11
|
| Rate for Payer: Cofinity Commercial |
$63.58
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.51
|
| Rate for Payer: Healthscope Commercial |
$55.67
|
| Rate for Payer: Healthscope Commercial |
$83.83
|
| Rate for Payer: Healthscope Commercial |
$58.80
|
| Rate for Payer: Healthscope Commercial |
$360.40
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$47.83
|
| Rate for Payer: Healthscope Commercial |
$81.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.17
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$52.58
|
| Rate for Payer: PHP Commercial |
$79.17
|
| Rate for Payer: PHP Commercial |
$45.17
|
| Rate for Payer: PHP Commercial |
$340.37
|
| Rate for Payer: PHP Commercial |
$55.53
|
| Rate for Payer: PHP Commercial |
$77.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.54
|
| Rate for Payer: Priority Health SBD |
$38.97
|
| Rate for Payer: Priority Health SBD |
$41.16
|
| Rate for Payer: Priority Health SBD |
$58.68
|
| Rate for Payer: Priority Health SBD |
$57.22
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$33.48
|
| Rate for Payer: Priority Health SBD |
$252.28
|
| Rate for Payer: UMR Bronson Commercial |
$24.17
|
| Rate for Payer: UMR Bronson Commercial |
$19.66
|
| Rate for Payer: UMR Bronson Commercial |
$148.16
|
| Rate for Payer: UMR Bronson Commercial |
$18.38
|
| Rate for Payer: UMR Bronson Commercial |
$22.89
|
| Rate for Payer: UMR Bronson Commercial |
$33.61
|
| Rate for Payer: UMR Bronson Commercial |
$34.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.12
|
|
|
FOSPHENYTOIN 500 MG PE/10 ML INJECTION SOLUTION
|
Facility
|
IP
|
$400.44
|
|
|
Service Code
|
HCPCS Q2009
|
| Hospital Charge Code |
88010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$176.19 |
| Max. Negotiated Rate |
$360.40 |
| Rate for Payer: Aetna American Axle |
$260.29
|
| Rate for Payer: Aetna American Axle |
$59.04
|
| Rate for Payer: Aetna American Axle |
$42.46
|
| Rate for Payer: Aetna American Axle |
$34.54
|
| Rate for Payer: Aetna American Axle |
$32.29
|
| Rate for Payer: Aetna American Axle |
$40.21
|
| Rate for Payer: Aetna American Axle |
$60.54
|
| Rate for Payer: Aetna Commercial |
$77.21
|
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Commercial |
$52.58
|
| Rate for Payer: Aetna Commercial |
$55.53
|
| Rate for Payer: Aetna Commercial |
$79.17
|
| Rate for Payer: Aetna Commercial |
$45.17
|
| Rate for Payer: Aetna Commercial |
$340.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.04
|
| Rate for Payer: Cash Price |
$49.49
|
| Rate for Payer: Cash Price |
$72.66
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$320.35
|
| Rate for Payer: Cash Price |
$42.51
|
| Rate for Payer: Cash Price |
$52.26
|
| Rate for Payer: Cash Price |
$74.51
|
| Rate for Payer: Cofinity Commercial |
$78.11
|
| Rate for Payer: Cofinity Commercial |
$280.31
|
| Rate for Payer: Cofinity Commercial |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$37.20
|
| Rate for Payer: Cofinity Commercial |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$344.38
|
| Rate for Payer: Cofinity Commercial |
$45.73
|
| Rate for Payer: Cofinity Commercial |
$56.18
|
| Rate for Payer: Cofinity Commercial |
$63.58
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Cofinity Commercial |
$80.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$63.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.35
|
| Rate for Payer: Healthscope Commercial |
$83.83
|
| Rate for Payer: Healthscope Commercial |
$58.80
|
| Rate for Payer: Healthscope Commercial |
$47.83
|
| Rate for Payer: Healthscope Commercial |
$55.67
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$360.40
|
| Rate for Payer: Healthscope Commercial |
$81.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.21
|
| Rate for Payer: PHP Commercial |
$55.53
|
| Rate for Payer: PHP Commercial |
$45.17
|
| Rate for Payer: PHP Commercial |
$52.58
|
| Rate for Payer: PHP Commercial |
$340.37
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: PHP Commercial |
$79.17
|
| Rate for Payer: PHP Commercial |
$77.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.46
|
| Rate for Payer: Priority Health SBD |
$33.48
|
| Rate for Payer: Priority Health SBD |
$31.29
|
| Rate for Payer: Priority Health SBD |
$252.28
|
| Rate for Payer: Priority Health SBD |
$58.68
|
| Rate for Payer: Priority Health SBD |
$57.22
|
| Rate for Payer: Priority Health SBD |
$41.16
|
| Rate for Payer: Priority Health SBD |
$38.97
|
| Rate for Payer: UMR Bronson Commercial |
$27.22
|
| Rate for Payer: UMR Bronson Commercial |
$40.98
|
| Rate for Payer: UMR Bronson Commercial |
$28.75
|
| Rate for Payer: UMR Bronson Commercial |
$39.97
|
| Rate for Payer: UMR Bronson Commercial |
$176.19
|
| Rate for Payer: UMR Bronson Commercial |
$23.38
|
| Rate for Payer: UMR Bronson Commercial |
$21.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.33
|
|
|
FRACTURE NASAL INFERIOR TURBINATE(S), THERAPEUTIC
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 30930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$112.54 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.82
|
| Rate for Payer: BCN Commercial |
$1,708.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.79
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$112.54
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
FRAXEL ARMS - BILATERAL
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 00166
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Medicare |
$510.00
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: UMR Bronson Commercial |
$469.20
|
|
|
FRAXEL CHEST
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 00155
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: UMR Bronson Commercial |
$375.36
|
|
|
FRAXEL FACE & NECK
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 00162
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Medicare |
$510.00
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: UMR Bronson Commercial |
$469.20
|
|
|
FRAXEL FULL FACE
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00152
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: UMR Bronson Commercial |
$281.52
|
|
|
FRAXEL HANDS
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 00154
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
FRAXEL LARGE SCAR
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 00161
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Medicare |
$408.00
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: UMR Bronson Commercial |
$375.36
|
|
|
FRAXEL MEDIUM SCAR
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
FRAXEL NECK
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00153
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
FRAXEL NECK & CHEST
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 00163
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna Medicare |
$612.00
|
| Rate for Payer: BCBS Complete |
$489.60
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.60
|
| Rate for Payer: UMR Bronson Commercial |
$563.04
|
|
|
FRAXEL PARTIAL TREATMENT - BILATERAL EYES
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00157
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
FRAXEL PARTIAL TREATMENT - PERI-ORAL
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 00156
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: UMR Bronson Commercial |
$234.60
|
|
