|
GUAR GUM ORAL POWDER PACKET
|
Facility
|
IP
|
$3.32
|
|
|
Service Code
|
NDC 43900097647
|
| Hospital Charge Code |
30538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna American Axle |
$2.16
|
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.82
|
| Rate for Payer: PHP Commercial |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.49
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN
|
Facility
|
IP
|
$51.03
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
11931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna American Axle |
$33.17
|
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.17
|
| Rate for Payer: Cash Price |
$40.82
|
| Rate for Payer: Cofinity Commercial |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.82
|
| Rate for Payer: Healthscope Commercial |
$45.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.17
|
| Rate for Payer: Priority Health SBD |
$32.15
|
| Rate for Payer: UMR Bronson Commercial |
$22.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.27
|
|
|
HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN
|
Facility
|
OP
|
$51.03
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
11931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.88 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna American Axle |
$33.17
|
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna Medicare |
$25.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.17
|
| Rate for Payer: BCBS Complete |
$20.41
|
| Rate for Payer: BCBS Trust/PPO |
$34.59
|
| Rate for Payer: BCN Commercial |
$34.59
|
| Rate for Payer: Cash Price |
$40.82
|
| Rate for Payer: Cash Price |
$40.82
|
| Rate for Payer: Cofinity Commercial |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.82
|
| Rate for Payer: Healthscope Commercial |
$45.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.17
|
| Rate for Payer: Priority Health SBD |
$32.15
|
| Rate for Payer: UMR Bronson Commercial |
$18.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.27
|
|
|
HAIR REMOVAL
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 00170
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
|
|
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT; WITH IMPLANT
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 28291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$462.82 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$5,184.27
|
| Rate for Payer: BCN Commercial |
$5,184.27
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$509.10
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$462.82
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT; WITHOUT IMPLANT
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28289
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$443.99 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.39
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$443.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 00378025701
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.37 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna American Axle |
$211.80
|
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.80
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.80
|
| Rate for Payer: Priority Health SBD |
$205.29
|
| Rate for Payer: UMR Bronson Commercial |
$143.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$325.85
|
|
|
Service Code
|
NDC 00378025701
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna American Axle |
$211.80
|
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna Medicare |
$162.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.80
|
| Rate for Payer: BCBS Complete |
$130.34
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.80
|
| Rate for Payer: Priority Health SBD |
$205.29
|
| Rate for Payer: UMR Bronson Commercial |
$120.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$4.12
|
|
|
Service Code
|
NDC 51079073401
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna American Axle |
$2.68
|
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.68
|
| Rate for Payer: Priority Health SBD |
$2.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.09
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
NDC 00904724161
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.25
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: UMR Bronson Commercial |
$125.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$4.12
|
|
|
Service Code
|
NDC 51079073401
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna American Axle |
$2.68
|
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.68
|
| Rate for Payer: Priority Health SBD |
$2.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.09
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
IP
|
$411.35
|
|
|
Service Code
|
NDC 51079073420
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.99 |
| Max. Negotiated Rate |
$370.22 |
| Rate for Payer: Aetna American Axle |
$267.38
|
| Rate for Payer: Aetna Commercial |
$349.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.38
|
| Rate for Payer: Cash Price |
$329.08
|
| Rate for Payer: Cofinity Commercial |
$287.94
|
| Rate for Payer: Cofinity Commercial |
$353.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.08
|
| Rate for Payer: Healthscope Commercial |
$370.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.65
|
| Rate for Payer: PHP Commercial |
$349.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.38
|
| Rate for Payer: Priority Health SBD |
$259.15
|
| Rate for Payer: UMR Bronson Commercial |
$180.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.51
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
NDC 00904724161
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Medicare |
$142.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: BCBS Complete |
$114.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.25
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.25
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: UMR Bronson Commercial |
$105.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
HALOPERIDOL 1 MG TABLET
|
Facility
|
OP
|
$411.35
|
|
|
Service Code
|
NDC 51079073420
|
| Hospital Charge Code |
3579
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$370.22 |
| Rate for Payer: Aetna American Axle |
$267.38
|
| Rate for Payer: Aetna Commercial |
$349.65
|
| Rate for Payer: Aetna Medicare |
$205.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.38
|
| Rate for Payer: BCBS Complete |
$164.54
|
| Rate for Payer: Cash Price |
$329.08
|
| Rate for Payer: Cofinity Commercial |
$287.94
|
| Rate for Payer: Cofinity Commercial |
$353.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.08
|
| Rate for Payer: Healthscope Commercial |
$370.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.65
|
| Rate for Payer: PHP Commercial |
$349.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.38
|
| Rate for Payer: Priority Health SBD |
$259.15
|
| Rate for Payer: UMR Bronson Commercial |
$152.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.51
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$365.76
|
|
|
Service Code
|
NDC 00378032701
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.33 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna American Axle |
$237.74
|
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: Aetna Medicare |
$182.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: BCBS Complete |
$146.30
|
| Rate for Payer: Cash Price |
$292.61
|
| Rate for Payer: Cofinity Commercial |
$256.03
|
| Rate for Payer: Cofinity Commercial |
$314.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.61
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.90
|
| Rate for Payer: PHP Commercial |
$310.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.74
|
| Rate for Payer: Priority Health SBD |
$230.43
|
| Rate for Payer: UMR Bronson Commercial |
$135.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.32
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$425.60
|
|
|
Service Code
|
NDC 68382007901
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.47 |
| Max. Negotiated Rate |
$383.04 |
| Rate for Payer: Aetna American Axle |
$276.64
|
| Rate for Payer: Aetna Commercial |
$361.76
|
| Rate for Payer: Aetna Medicare |
$212.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.64
|
| Rate for Payer: BCBS Complete |
$170.24
|
| Rate for Payer: Cash Price |
$340.48
|
| Rate for Payer: Cofinity Commercial |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$366.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.48
|
| Rate for Payer: Healthscope Commercial |
$383.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.76
|
| Rate for Payer: PHP Commercial |
$361.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.64
|
| Rate for Payer: Priority Health SBD |
$268.13
|
| Rate for Payer: UMR Bronson Commercial |
$157.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.20
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$273.60
|
|
|
Service Code
|
NDC 51079073620
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$120.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$276.96
|
|
|
Service Code
|
NDC 60687016101
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.86 |
| Max. Negotiated Rate |
$249.26 |
| Rate for Payer: Aetna American Axle |
$180.02
|
| Rate for Payer: Aetna Commercial |
$235.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.02
|
| Rate for Payer: Cash Price |
$221.57
|
| Rate for Payer: Cofinity Commercial |
$193.87
|
| Rate for Payer: Cofinity Commercial |
$238.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.57
|
| Rate for Payer: Healthscope Commercial |
$249.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.42
|
| Rate for Payer: PHP Commercial |
$235.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.02
|
| Rate for Payer: Priority Health SBD |
$174.48
|
| Rate for Payer: UMR Bronson Commercial |
$121.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.72
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$2.77
|
|
|
Service Code
|
NDC 60687016111
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna American Axle |
$1.80
|
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.80
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.80
|
| Rate for Payer: Priority Health SBD |
$1.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$276.96
|
|
|
Service Code
|
NDC 60687016101
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$249.26 |
| Rate for Payer: Aetna American Axle |
$180.02
|
| Rate for Payer: Aetna Commercial |
$235.42
|
| Rate for Payer: Aetna Medicare |
$138.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.02
|
| Rate for Payer: BCBS Complete |
$110.78
|
| Rate for Payer: Cash Price |
$221.57
|
| Rate for Payer: Cofinity Commercial |
$193.87
|
| Rate for Payer: Cofinity Commercial |
$238.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.57
|
| Rate for Payer: Healthscope Commercial |
$249.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.42
|
| Rate for Payer: PHP Commercial |
$235.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.02
|
| Rate for Payer: Priority Health SBD |
$174.48
|
| Rate for Payer: UMR Bronson Commercial |
$102.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.72
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$2.77
|
|
|
Service Code
|
NDC 60687016111
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Aetna American Axle |
$1.80
|
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.80
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.80
|
| Rate for Payer: Priority Health SBD |
$1.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 51079073601
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna American Axle |
$1.78
|
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 51079073620
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.23 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$136.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$101.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 51079073601
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna American Axle |
$1.78
|
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
HALOPERIDOL 5 MG TABLET
|
Facility
|
IP
|
$365.76
|
|
|
Service Code
|
NDC 00378032701
|
| Hospital Charge Code |
3583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.93 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna American Axle |
$237.74
|
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: Cash Price |
$292.61
|
| Rate for Payer: Cofinity Commercial |
$256.03
|
| Rate for Payer: Cofinity Commercial |
$314.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.61
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.90
|
| Rate for Payer: PHP Commercial |
$310.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.74
|
| Rate for Payer: Priority Health SBD |
$230.43
|
| Rate for Payer: UMR Bronson Commercial |
$160.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.32
|
|
