|
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC
|
Facility
|
IP
|
$13,459.09
|
|
|
Service Code
|
MS-DRG 726
|
| Min. Negotiated Rate |
$5,837.46 |
| Max. Negotiated Rate |
$13,459.09 |
| Rate for Payer: Aetna Medicare |
$6,390.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,680.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,680.86
|
| Rate for Payer: BCBS MAPPO |
$6,144.69
|
| Rate for Payer: BCBS Trust/PPO |
$13,459.09
|
| Rate for Payer: BCN Medicare Advantage |
$6,144.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,144.69
|
| Rate for Payer: Mclaren Medicare |
$6,144.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,451.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,066.39
|
| Rate for Payer: PACE Medicare |
$5,837.46
|
| Rate for Payer: PACE SWMI |
$6,144.69
|
| Rate for Payer: PHP Medicare Advantage |
$6,144.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,488.36
|
| Rate for Payer: Priority Health Medicare |
$6,144.69
|
| Rate for Payer: Priority Health Narrow Network |
$8,390.69
|
| Rate for Payer: Railroad Medicare Medicare |
$6,144.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,149.15
|
| Rate for Payer: UHC Core |
$9,142.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,144.69
|
| Rate for Payer: UHC Exchange |
$7,268.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,329.03
|
| Rate for Payer: VA VA |
$6,144.69
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$18,588.51
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
185161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.72 |
| Max. Negotiated Rate |
$16,729.66 |
| Rate for Payer: Aetna American Axle |
$12,082.53
|
| Rate for Payer: Aetna Commercial |
$15,800.23
|
| Rate for Payer: Aetna Medicare |
$176.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,082.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.88
|
| Rate for Payer: BCBS Complete |
$97.36
|
| Rate for Payer: BCBS MAPPO |
$169.50
|
| Rate for Payer: BCBS Trust/PPO |
$547.72
|
| Rate for Payer: BCN Medicare Advantage |
$169.50
|
| Rate for Payer: Cash Price |
$14,870.81
|
| Rate for Payer: Cash Price |
$14,870.81
|
| Rate for Payer: Cofinity Commercial |
$13,011.96
|
| Rate for Payer: Cofinity Commercial |
$15,986.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,870.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.50
|
| Rate for Payer: Healthscope Commercial |
$16,729.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,011.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,941.38
|
| Rate for Payer: Mclaren Medicaid |
$92.72
|
| Rate for Payer: Mclaren Medicare |
$169.50
|
| Rate for Payer: Meridian Medicaid |
$97.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,800.23
|
| Rate for Payer: PACE Medicare |
$161.03
|
| Rate for Payer: PACE SWMI |
$169.50
|
| Rate for Payer: PHP Commercial |
$15,800.23
|
| Rate for Payer: PHP Medicare Advantage |
$169.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,011.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$500.92
|
| Rate for Payer: Priority Health Medicare |
$169.50
|
| Rate for Payer: Priority Health Narrow Network |
$400.74
|
| Rate for Payer: Priority Health SBD |
$11,710.76
|
| Rate for Payer: Railroad Medicare Medicare |
$169.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.50
|
| Rate for Payer: UHC Medicare Advantage |
$174.59
|
| Rate for Payer: UMR Bronson Commercial |
$6,877.75
|
| Rate for Payer: VA VA |
$169.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,941.38
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$18,588.51
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
185161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,178.94 |
| Max. Negotiated Rate |
$16,729.66 |
| Rate for Payer: Aetna American Axle |
$12,082.53
|
| Rate for Payer: Aetna Commercial |
$15,800.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,082.53
|
| Rate for Payer: Cash Price |
$14,870.81
|
| Rate for Payer: Cofinity Commercial |
$13,011.96
|
| Rate for Payer: Cofinity Commercial |
$15,986.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,870.81
|
| Rate for Payer: Healthscope Commercial |
$16,729.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,011.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,941.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,800.23
|
| Rate for Payer: PHP Commercial |
$15,800.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,011.96
|
| Rate for Payer: Priority Health SBD |
$11,710.76
|
| Rate for Payer: UMR Bronson Commercial |
$8,178.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,941.38
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$95.57
|
|
|
Service Code
|
NDC 0283-0914-02
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$86.01 |
| Rate for Payer: Aetna American Axle |
$62.12
|
| Rate for Payer: Aetna Commercial |
$81.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.12
|
| Rate for Payer: Cash Price |
$76.46
|
| Rate for Payer: Cofinity Commercial |
$82.19
|
| Rate for Payer: Cofinity Commercial |
$66.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.46
|
| Rate for Payer: Healthscope Commercial |
$86.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.23
|
| Rate for Payer: PHP Commercial |
$81.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.90
|
| Rate for Payer: Priority Health SBD |
$60.21
|
| Rate for Payer: UMR Bronson Commercial |
$42.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.68
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$129.14
|
|
|
Service Code
|
NDC 0283-0679-60
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$116.23 |
| Rate for Payer: Aetna American Axle |
$83.94
|
| Rate for Payer: Aetna Commercial |
$109.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.94
|
| Rate for Payer: Cash Price |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Cofinity Commercial |
$90.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.31
|
| Rate for Payer: Healthscope Commercial |
$116.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.77
|
| Rate for Payer: PHP Commercial |
$109.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.40
|
| Rate for Payer: Priority Health SBD |
$81.36
|
| Rate for Payer: UMR Bronson Commercial |
$56.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.86
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$100.09
|
|
|
Service Code
|
NDC 0283-0679-02
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.04 |
| Max. Negotiated Rate |
$90.08 |
| Rate for Payer: Aetna American Axle |
$65.06
|
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.06
|
| Rate for Payer: Cash Price |
$80.07
|
| Rate for Payer: Cofinity Commercial |
$70.06
|
| Rate for Payer: Cofinity Commercial |
$86.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.07
|
| Rate for Payer: Healthscope Commercial |
$90.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.08
|
| Rate for Payer: PHP Commercial |
$85.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.06
|
| Rate for Payer: Priority Health SBD |
$63.06
|
| Rate for Payer: UMR Bronson Commercial |
$44.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.07
|
|
|
BENZOCAINE 20 % MUCOSAL GEL
|
Facility
|
IP
|
$26.98
|
|
|
Service Code
|
NDC 0573-0225-67
|
| Hospital Charge Code |
19691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$24.28 |
| Rate for Payer: Aetna American Axle |
$17.54
|
| Rate for Payer: Aetna Commercial |
$22.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.54
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$24.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.93
|
| Rate for Payer: PHP Commercial |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.89
|
| Rate for Payer: Priority Health SBD |
$17.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.24
|
|
|
BENZOCAINE 20 % MUCOSAL GEL
|
Facility
|
IP
|
$10.38
|
|
|
Service Code
|
NDC 10310-0283-40
|
| Hospital Charge Code |
19691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna American Axle |
$6.75
|
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.82
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.27
|
| Rate for Payer: Priority Health SBD |
$6.54
|
| Rate for Payer: UMR Bronson Commercial |
$4.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.78
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
IP
|
$37.17
|
|
|
Service Code
|
NDC 0283-0610-43
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$33.45 |
| Rate for Payer: Aetna American Axle |
$24.16
|
| Rate for Payer: Aetna Commercial |
$31.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.16
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cofinity Commercial |
$26.02
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Healthscope Commercial |
$33.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.59
|
| Rate for Payer: PHP Commercial |
$31.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.02
|
| Rate for Payer: Priority Health SBD |
$23.42
|
| Rate for Payer: UMR Bronson Commercial |
$16.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.88
|
|
|
BENZOCAINE 20 % MUCOSAL SPRAY
|
Facility
|
IP
|
$34.86
|
|
|
Service Code
|
NDC 0283-0610-26
|
| Hospital Charge Code |
27666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$31.37 |
| Rate for Payer: Aetna American Axle |
$22.66
|
| Rate for Payer: Aetna Commercial |
$29.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.66
|
| Rate for Payer: Cash Price |
$27.89
|
| Rate for Payer: Cofinity Commercial |
$24.40
|
| Rate for Payer: Cofinity Commercial |
$29.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.89
|
| Rate for Payer: Healthscope Commercial |
$31.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.63
|
| Rate for Payer: PHP Commercial |
$29.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.40
|
| Rate for Payer: Priority Health SBD |
$21.96
|
| Rate for Payer: UMR Bronson Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.14
|
|
|
BENZOCAINE (BULK) POWDER
|
Facility
|
IP
|
$352.50
|
|
|
Service Code
|
NDC 0395-8049-62
|
| Hospital Charge Code |
984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna American Axle |
$229.12
|
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.62
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.75
|
| Rate for Payer: Priority Health SBD |
$222.08
|
| Rate for Payer: UMR Bronson Commercial |
$155.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
BENZOIN (BULK) TOPICAL TINCTURE
|
Facility
|
IP
|
$30.87
|
|
|
Service Code
|
NDC 0395-0247-92
|
| Hospital Charge Code |
165061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$27.78 |
| Rate for Payer: Aetna American Axle |
$20.07
|
| Rate for Payer: Aetna Commercial |
$26.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.07
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Cofinity Commercial |
$26.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.70
|
| Rate for Payer: Healthscope Commercial |
$27.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.24
|
| Rate for Payer: PHP Commercial |
$26.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.61
|
| Rate for Payer: Priority Health SBD |
$19.45
|
| Rate for Payer: UMR Bronson Commercial |
$13.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.15
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
NDC 0904-6564-60
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.15 |
| Max. Negotiated Rate |
$382.82 |
| Rate for Payer: Aetna American Axle |
$276.48
|
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$297.74
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$382.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.55
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.74
|
| Rate for Payer: Priority Health SBD |
$267.97
|
| Rate for Payer: UMR Bronson Commercial |
$187.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.01
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$373.65
|
|
|
Service Code
|
NDC 64380-712-06
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.41 |
| Max. Negotiated Rate |
$336.28 |
| Rate for Payer: Aetna American Axle |
$242.87
|
| Rate for Payer: Aetna Commercial |
$317.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.87
|
| Rate for Payer: Cash Price |
$298.92
|
| Rate for Payer: Cofinity Commercial |
$261.56
|
| Rate for Payer: Cofinity Commercial |
$321.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.92
|
| Rate for Payer: Healthscope Commercial |
$336.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$317.60
|
| Rate for Payer: PHP Commercial |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.56
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UMR Bronson Commercial |
$164.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.24
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$371.30
|
|
|
Service Code
|
NDC 67877-573-01
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$334.17 |
| Rate for Payer: Aetna American Axle |
$241.34
|
| Rate for Payer: Aetna Commercial |
$315.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.34
|
| Rate for Payer: Cash Price |
$297.04
|
| Rate for Payer: Cofinity Commercial |
$319.32
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.04
|
| Rate for Payer: Healthscope Commercial |
$334.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$259.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.60
|
| Rate for Payer: PHP Commercial |
$315.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.91
|
| Rate for Payer: Priority Health SBD |
$233.92
|
| Rate for Payer: UMR Bronson Commercial |
$163.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.48
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$302.10
|
|
|
Service Code
|
NDC 0904-7153-61
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.92 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna American Axle |
$196.36
|
| Rate for Payer: Aetna Commercial |
$256.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.36
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$211.47
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.78
|
| Rate for Payer: PHP Commercial |
$256.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.47
|
| Rate for Payer: Priority Health SBD |
$190.32
|
| Rate for Payer: UMR Bronson Commercial |
$132.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.58
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 42806-714-01
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Cofinity Commercial |
$92.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.86
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.12
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
BENZONATATE 100 MG CAPSULE
|
Facility
|
IP
|
$264.10
|
|
|
Service Code
|
NDC 62332-426-31
|
| Hospital Charge Code |
988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$237.69 |
| Rate for Payer: Aetna American Axle |
$171.66
|
| Rate for Payer: Aetna Commercial |
$224.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.66
|
| Rate for Payer: Cash Price |
$211.28
|
| Rate for Payer: Cofinity Commercial |
$227.13
|
| Rate for Payer: Cofinity Commercial |
$184.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.28
|
| Rate for Payer: Healthscope Commercial |
$237.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.48
|
| Rate for Payer: PHP Commercial |
$224.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.87
|
| Rate for Payer: Priority Health SBD |
$166.38
|
| Rate for Payer: UMR Bronson Commercial |
$116.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.08
|
|
|
BENZTROPINE 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$189.80
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
9259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.51 |
| Max. Negotiated Rate |
$170.82 |
| Rate for Payer: Aetna American Axle |
$123.37
|
| Rate for Payer: Aetna American Axle |
$65.91
|
| Rate for Payer: Aetna Commercial |
$161.33
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.37
|
| Rate for Payer: Cash Price |
$151.84
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$163.23
|
| Rate for Payer: Cofinity Commercial |
$132.86
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Healthscope Commercial |
$170.82
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.19
|
| Rate for Payer: PHP Commercial |
$161.33
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.98
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$119.57
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
| Rate for Payer: UMR Bronson Commercial |
$83.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$242.05
|
|
|
Service Code
|
NDC 76385-104-01
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.50 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna American Axle |
$157.33
|
| Rate for Payer: Aetna Commercial |
$205.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.33
|
| Rate for Payer: Cash Price |
$193.64
|
| Rate for Payer: Cofinity Commercial |
$169.44
|
| Rate for Payer: Cofinity Commercial |
$208.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.64
|
| Rate for Payer: Healthscope Commercial |
$217.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.74
|
| Rate for Payer: PHP Commercial |
$205.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.44
|
| Rate for Payer: Priority Health SBD |
$152.49
|
| Rate for Payer: UMR Bronson Commercial |
$106.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.54
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 69315-137-01
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna American Axle |
$105.40
|
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.83
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.50
|
| Rate for Payer: Priority Health SBD |
$102.15
|
| Rate for Payer: UMR Bronson Commercial |
$71.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 0603-2434-21
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.17 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.04
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$157.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$331.35
|
|
|
Service Code
|
NDC 69097-827-07
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$298.22 |
| Rate for Payer: Aetna American Axle |
$215.38
|
| Rate for Payer: Aetna Commercial |
$281.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.38
|
| Rate for Payer: Cash Price |
$265.08
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.08
|
| Rate for Payer: Healthscope Commercial |
$298.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.65
|
| Rate for Payer: PHP Commercial |
$281.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.94
|
| Rate for Payer: Priority Health SBD |
$208.75
|
| Rate for Payer: UMR Bronson Commercial |
$145.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.51
|
|
|
BESIFLOXACIN 0.6 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$695.91
|
|
|
Service Code
|
NDC 24208-446-05
|
| Hospital Charge Code |
97934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.20 |
| Max. Negotiated Rate |
$626.32 |
| Rate for Payer: Aetna American Axle |
$452.34
|
| Rate for Payer: Aetna Commercial |
$591.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.34
|
| Rate for Payer: Cash Price |
$556.73
|
| Rate for Payer: Cofinity Commercial |
$487.14
|
| Rate for Payer: Cofinity Commercial |
$598.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$556.73
|
| Rate for Payer: Healthscope Commercial |
$626.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$487.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$521.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$591.52
|
| Rate for Payer: PHP Commercial |
$591.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.14
|
| Rate for Payer: Priority Health SBD |
$438.42
|
| Rate for Payer: UMR Bronson Commercial |
$306.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$521.93
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$155.22
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$139.70 |
| Rate for Payer: Aetna American Axle |
$100.89
|
| Rate for Payer: Aetna American Axle |
$99.79
|
| Rate for Payer: Aetna American Axle |
$101.09
|
| Rate for Payer: Aetna American Axle |
$111.71
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna Commercial |
$146.08
|
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$137.49
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$120.30
|
| Rate for Payer: Cofinity Commercial |
$147.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Healthscope Commercial |
$154.67
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.08
|
| Rate for Payer: PHP Commercial |
$146.08
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.47
|
| Rate for Payer: Priority Health SBD |
$108.27
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: Priority Health SBD |
$97.79
|
| Rate for Payer: UMR Bronson Commercial |
$75.62
|
| Rate for Payer: UMR Bronson Commercial |
$67.55
|
| Rate for Payer: UMR Bronson Commercial |
$68.43
|
| Rate for Payer: UMR Bronson Commercial |
$68.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.90
|
|
