|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$70,153.78
|
|
|
Service Code
|
MSDRG 584
|
| Min. Negotiated Rate |
$17,570.24 |
| Max. Negotiated Rate |
$70,153.78 |
| Rate for Payer: Aetna Medicare |
$19,234.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,118.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,118.74
|
| Rate for Payer: BCBS MAPPO |
$18,494.99
|
| Rate for Payer: BCBS Trust/PPO |
$70,153.78
|
| Rate for Payer: BCN Commercial |
$70,153.78
|
| Rate for Payer: BCN Medicare Advantage |
$18,494.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,494.99
|
| Rate for Payer: Mclaren Medicare |
$18,494.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,419.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,269.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,344.49
|
| Rate for Payer: Nomi Health Commercial |
$27,615.03
|
| Rate for Payer: PACE Medicare |
$17,570.24
|
| Rate for Payer: PACE SWMI |
$18,494.99
|
| Rate for Payer: PHP Medicare Advantage |
$18,494.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,512.67
|
| Rate for Payer: Priority Health Medicare |
$18,494.99
|
| Rate for Payer: Priority Health Tiered Network |
$27,610.13
|
| Rate for Payer: Railroad Medicare Medicare |
$18,494.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,893.41
|
| Rate for Payer: UHC Core |
$29,192.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,494.99
|
| Rate for Payer: UHC Exchange |
$23,840.98
|
| Rate for Payer: VA VA |
$18,494.99
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$61,210.24
|
|
|
Service Code
|
MSDRG 585
|
| Min. Negotiated Rate |
$15,889.15 |
| Max. Negotiated Rate |
$61,210.24 |
| Rate for Payer: Aetna Medicare |
$17,394.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,906.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,906.78
|
| Rate for Payer: BCBS MAPPO |
$16,725.42
|
| Rate for Payer: BCBS Trust/PPO |
$61,210.24
|
| Rate for Payer: BCN Commercial |
$61,210.24
|
| Rate for Payer: BCN Medicare Advantage |
$16,725.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,725.42
|
| Rate for Payer: Mclaren Medicare |
$16,725.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,561.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,234.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,397.96
|
| Rate for Payer: Nomi Health Commercial |
$24,885.39
|
| Rate for Payer: PACE Medicare |
$15,889.15
|
| Rate for Payer: PACE SWMI |
$16,725.42
|
| Rate for Payer: PHP Medicare Advantage |
$16,725.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,101.22
|
| Rate for Payer: Priority Health Medicare |
$16,725.42
|
| Rate for Payer: Priority Health Tiered Network |
$24,880.97
|
| Rate for Payer: Railroad Medicare Medicare |
$16,725.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,444.33
|
| Rate for Payer: UHC Core |
$26,307.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,725.42
|
| Rate for Payer: UHC Exchange |
$21,484.39
|
| Rate for Payer: VA VA |
$16,725.42
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$12,665.21
|
|
|
Service Code
|
APR-DRG 3632
|
| Min. Negotiated Rate |
$12,062.11 |
| Max. Negotiated Rate |
$12,665.21 |
| Rate for Payer: BCBS Complete |
$12,665.21
|
| Rate for Payer: Mclaren Medicaid |
$12,062.11
|
| Rate for Payer: Meridian Medicaid |
$12,665.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,062.11
|
| Rate for Payer: UHC Medicaid |
$12,062.11
|
| Rate for Payer: UHCCP Medicaid |
$12,062.11
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$18,311.08
|
|
|
Service Code
|
APR-DRG 3633
|
| Min. Negotiated Rate |
$17,439.12 |
| Max. Negotiated Rate |
$18,311.08 |
| Rate for Payer: BCBS Complete |
$18,311.08
|
| Rate for Payer: Mclaren Medicaid |
$17,439.12
|
| Rate for Payer: Meridian Medicaid |
$18,311.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,439.12
|
| Rate for Payer: UHC Medicaid |
$17,439.12
|
| Rate for Payer: UHCCP Medicaid |
$17,439.12
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$8,856.51
|
|
|
Service Code
|
APR-DRG 3631
|
| Min. Negotiated Rate |
$8,434.77 |
| Max. Negotiated Rate |
$8,856.51 |
| Rate for Payer: BCBS Complete |
$8,856.51
|
| Rate for Payer: Mclaren Medicaid |
$8,434.77
|
| Rate for Payer: Meridian Medicaid |
$8,856.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,434.77
|
| Rate for Payer: UHC Medicaid |
$8,434.77
|
| Rate for Payer: UHCCP Medicaid |
$8,434.77
|
|
|
BREAST PROCEDURES EXCEPT MASTECTOMY
|
Facility
|
IP
|
$19,453.93
|
|
|
Service Code
|
APR-DRG 3634
|
| Min. Negotiated Rate |
$18,527.56 |
| Max. Negotiated Rate |
$19,453.93 |
| Rate for Payer: BCBS Complete |
$19,453.93
|
| Rate for Payer: Mclaren Medicaid |
$18,527.56
|
| Rate for Payer: Meridian Medicaid |
$19,453.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,527.56
|
| Rate for Payer: UHC Medicaid |
$18,527.56
|
| Rate for Payer: UHCCP Medicaid |
$18,527.56
|
|
|
BREAST REDUCTION
|
Facility
|
OP
|
$21,396.49
|
|
|
Service Code
|
CPT 19318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,460.32 |
| Max. Negotiated Rate |
$21,396.49 |
| Rate for Payer: Aetna Medicare |
$6,880.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,270.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,270.36
|
| Rate for Payer: BCBS Complete |
$3,633.67
|
| Rate for Payer: BCBS MAPPO |
$6,616.29
|
| Rate for Payer: BCBS Trust/PPO |
$8,235.74
|
| Rate for Payer: BCN Commercial |
$8,235.74
|
| Rate for Payer: BCN Medicare Advantage |
$6,616.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,616.29
|
| Rate for Payer: Mclaren Medicaid |
$6,616.29
|
| Rate for Payer: Mclaren Medicare |
$6,616.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,947.10
|
| Rate for Payer: Meridian Medicaid |
$6,947.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,608.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,277.92
|
| Rate for Payer: Nomi Health Commercial |
$19,848.87
|
| Rate for Payer: PACE Medicare |
$6,285.48
|
| Rate for Payer: PACE SWMI |
$6,616.29
|
| Rate for Payer: PHP Medicare Advantage |
$6,616.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,460.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,396.49
|
| Rate for Payer: Priority Health Medicare |
$6,616.29
|
| Rate for Payer: Priority Health Tiered Network |
$17,117.19
|
| Rate for Payer: Railroad Medicare Medicare |
$6,616.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,616.29
|
| Rate for Payer: UHC Medicaid |
$3,460.32
|
| Rate for Payer: UHCCP Medicaid |
$3,460.32
|
| Rate for Payer: VA VA |
$6,616.29
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$59,134.02
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26,018.97 |
| Max. Negotiated Rate |
$53,220.62 |
| Rate for Payer: Aetna American Axle |
$38,437.11
|
| Rate for Payer: Aetna Commercial |
$50,263.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38,437.11
|
| Rate for Payer: Cash Price |
$47,307.22
|
| Rate for Payer: Cofinity Advantage |
$41,393.81
|
| Rate for Payer: Cofinity Commercial |
$50,855.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47,307.22
|
| Rate for Payer: Healthscope Commercial |
$53,220.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41,393.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44,350.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50,263.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44,350.51
|
| Rate for Payer: PHP Commercial |
$50,263.92
|
| Rate for Payer: Priority Health SBD |
$37,254.43
|
| Rate for Payer: UMR Bronson Commercial |
$26,018.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44,350.51
|
|
|
BRENTUXIMAB VEDOTIN 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$59,134.02
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
153416
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.55 |
| Max. Negotiated Rate |
$53,220.62 |
| Rate for Payer: Aetna American Axle |
$38,437.11
|
| Rate for Payer: Aetna Commercial |
$50,263.92
|
| Rate for Payer: Aetna Medicare |
$279.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38,437.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$335.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$335.91
|
| Rate for Payer: BCBS Complete |
$147.59
|
| Rate for Payer: BCBS MAPPO |
$268.73
|
| Rate for Payer: BCBS Trust/PPO |
$854.37
|
| Rate for Payer: BCN Commercial |
$854.37
|
| Rate for Payer: BCN Medicare Advantage |
$268.73
|
| Rate for Payer: Cash Price |
$47,307.22
|
| Rate for Payer: Cash Price |
$47,307.22
|
| Rate for Payer: Cofinity Advantage |
$41,393.81
|
| Rate for Payer: Cofinity Commercial |
$50,855.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47,307.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.73
|
| Rate for Payer: Healthscope Commercial |
$53,220.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41,393.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44,350.51
|
| Rate for Payer: Mclaren Medicaid |
$268.73
|
| Rate for Payer: Mclaren Medicare |
$268.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$282.17
|
| Rate for Payer: Meridian Medicaid |
$282.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$295.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50,263.92
|
| Rate for Payer: Nomi Health Commercial |
$806.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44,350.51
|
| Rate for Payer: PACE Medicare |
$255.29
|
| Rate for Payer: PACE SWMI |
$268.73
|
| Rate for Payer: PHP Commercial |
$50,263.92
|
| Rate for Payer: PHP Medicare Advantage |
$268.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$815.74
|
| Rate for Payer: Priority Health Medicare |
$268.73
|
| Rate for Payer: Priority Health SBD |
$37,254.43
|
| Rate for Payer: Priority Health Tiered Network |
$652.59
|
| Rate for Payer: Railroad Medicare Medicare |
$268.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$442.94
|
| Rate for Payer: UHC Core |
$442.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$268.73
|
| Rate for Payer: UHC Exchange |
$442.94
|
| Rate for Payer: UHC Medicaid |
$140.55
|
| Rate for Payer: UHCCP Medicaid |
$140.55
|
| Rate for Payer: UMR Bronson Commercial |
$21,879.59
|
| Rate for Payer: VA VA |
$268.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44,350.51
|
|
|
BREXPIPRAZOLE 0.25 MG TABLET
|
Facility
|
IP
|
$5,353.76
|
|
|
Service Code
|
NDC 59148003513
|
| Hospital Charge Code |
174663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,355.65 |
| Max. Negotiated Rate |
$4,818.38 |
| Rate for Payer: Aetna American Axle |
$3,479.94
|
| Rate for Payer: Aetna Commercial |
$4,550.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.94
|
| Rate for Payer: Cash Price |
$4,283.01
|
| Rate for Payer: Cofinity Advantage |
$3,747.63
|
| Rate for Payer: Cofinity Commercial |
$4,604.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.01
|
| Rate for Payer: Healthscope Commercial |
$4,818.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,747.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,015.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.32
|
| Rate for Payer: PHP Commercial |
$4,550.70
|
| Rate for Payer: Priority Health SBD |
$3,372.87
|
| Rate for Payer: UMR Bronson Commercial |
$2,355.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,015.32
|
|
|
BREXPIPRAZOLE 0.25 MG TABLET
|
Facility
|
OP
|
$5,353.76
|
|
|
Service Code
|
NDC 59148003513
|
| Hospital Charge Code |
174663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,980.89 |
| Max. Negotiated Rate |
$4,818.38 |
| Rate for Payer: Aetna American Axle |
$3,479.94
|
| Rate for Payer: Aetna Commercial |
$4,550.70
|
| Rate for Payer: Aetna Medicare |
$2,676.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.94
|
| Rate for Payer: BCBS Complete |
$2,141.50
|
| Rate for Payer: Cash Price |
$4,283.01
|
| Rate for Payer: Cofinity Advantage |
$3,747.63
|
| Rate for Payer: Cofinity Commercial |
$4,604.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.01
|
| Rate for Payer: Healthscope Commercial |
$4,818.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,747.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,015.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,283.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.32
|
| Rate for Payer: PHP Commercial |
$4,550.70
|
| Rate for Payer: Priority Health SBD |
$3,372.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,479.94
|
| Rate for Payer: UHC Core |
$2,789.31
|
| Rate for Payer: UHC Exchange |
$2,104.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,980.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,015.32
|
|
|
BREXPIPRAZOLE 1 MG TABLET
|
Facility
|
OP
|
$5,353.76
|
|
|
Service Code
|
NDC 59148003713
|
| Hospital Charge Code |
174666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,980.89 |
| Max. Negotiated Rate |
$4,818.38 |
| Rate for Payer: Aetna American Axle |
$3,479.94
|
| Rate for Payer: Aetna Commercial |
$4,550.70
|
| Rate for Payer: Aetna Medicare |
$2,676.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.94
|
| Rate for Payer: BCBS Complete |
$2,141.50
|
| Rate for Payer: Cash Price |
$4,283.01
|
| Rate for Payer: Cofinity Advantage |
$3,747.63
|
| Rate for Payer: Cofinity Commercial |
$4,604.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.01
|
| Rate for Payer: Healthscope Commercial |
$4,818.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,747.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,015.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,283.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.32
|
| Rate for Payer: PHP Commercial |
$4,550.70
|
| Rate for Payer: Priority Health SBD |
$3,372.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,479.94
|
| Rate for Payer: UHC Core |
$2,789.31
|
| Rate for Payer: UHC Exchange |
$2,104.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,980.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,015.32
|
|
|
BREXPIPRAZOLE 1 MG TABLET
|
Facility
|
IP
|
$5,353.76
|
|
|
Service Code
|
NDC 59148003713
|
| Hospital Charge Code |
174666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,355.65 |
| Max. Negotiated Rate |
$4,818.38 |
| Rate for Payer: Aetna American Axle |
$3,479.94
|
| Rate for Payer: Aetna Commercial |
$4,550.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.94
|
| Rate for Payer: Cash Price |
$4,283.01
|
| Rate for Payer: Cofinity Advantage |
$3,747.63
|
| Rate for Payer: Cofinity Commercial |
$4,604.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.01
|
| Rate for Payer: Healthscope Commercial |
$4,818.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,747.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,015.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.32
|
| Rate for Payer: PHP Commercial |
$4,550.70
|
| Rate for Payer: Priority Health SBD |
$3,372.87
|
| Rate for Payer: UMR Bronson Commercial |
$2,355.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,015.32
|
|
|
BREXPIPRAZOLE 3 MG TABLET
|
Facility
|
IP
|
$5,353.76
|
|
|
Service Code
|
NDC 59148003913
|
| Hospital Charge Code |
174668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,355.65 |
| Max. Negotiated Rate |
$4,818.38 |
| Rate for Payer: Aetna American Axle |
$3,479.94
|
| Rate for Payer: Aetna Commercial |
$4,550.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.94
|
| Rate for Payer: Cash Price |
$4,283.01
|
| Rate for Payer: Cofinity Advantage |
$3,747.63
|
| Rate for Payer: Cofinity Commercial |
$4,604.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.01
|
| Rate for Payer: Healthscope Commercial |
$4,818.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,747.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,015.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.32
|
| Rate for Payer: PHP Commercial |
$4,550.70
|
| Rate for Payer: Priority Health SBD |
$3,372.87
|
| Rate for Payer: UMR Bronson Commercial |
$2,355.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,015.32
|
|
|
BREXPIPRAZOLE 3 MG TABLET
|
Facility
|
OP
|
$5,353.76
|
|
|
Service Code
|
NDC 59148003913
|
| Hospital Charge Code |
174668
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,980.89 |
| Max. Negotiated Rate |
$4,818.38 |
| Rate for Payer: Aetna American Axle |
$3,479.94
|
| Rate for Payer: Aetna Commercial |
$4,550.70
|
| Rate for Payer: Aetna Medicare |
$2,676.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.94
|
| Rate for Payer: BCBS Complete |
$2,141.50
|
| Rate for Payer: Cash Price |
$4,283.01
|
| Rate for Payer: Cofinity Advantage |
$3,747.63
|
| Rate for Payer: Cofinity Commercial |
$4,604.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.01
|
| Rate for Payer: Healthscope Commercial |
$4,818.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,747.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,015.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,283.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.32
|
| Rate for Payer: PHP Commercial |
$4,550.70
|
| Rate for Payer: Priority Health SBD |
$3,372.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,479.94
|
| Rate for Payer: UHC Core |
$2,789.31
|
| Rate for Payer: UHC Exchange |
$2,104.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,980.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,015.32
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
IP
|
$674.73
|
|
|
Service Code
|
NDC 00023917705
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.88 |
| Max. Negotiated Rate |
$607.26 |
| Rate for Payer: Aetna American Axle |
$438.57
|
| Rate for Payer: Aetna Commercial |
$573.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.57
|
| Rate for Payer: Cash Price |
$539.78
|
| Rate for Payer: Cofinity Advantage |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$580.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.78
|
| Rate for Payer: Healthscope Commercial |
$607.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$472.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.05
|
| Rate for Payer: PHP Commercial |
$573.52
|
| Rate for Payer: Priority Health SBD |
$425.08
|
| Rate for Payer: UMR Bronson Commercial |
$296.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.05
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
OP
|
$499.17
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.69 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Aetna American Axle |
$324.46
|
| Rate for Payer: Aetna Commercial |
$424.29
|
| Rate for Payer: Aetna Medicare |
$249.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.46
|
| Rate for Payer: BCBS Complete |
$199.67
|
| Rate for Payer: Cash Price |
$399.34
|
| Rate for Payer: Cofinity Advantage |
$349.42
|
| Rate for Payer: Cofinity Commercial |
$429.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.34
|
| Rate for Payer: Healthscope Commercial |
$449.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$374.38
|
| Rate for Payer: PHP Commercial |
$424.29
|
| Rate for Payer: Priority Health SBD |
$314.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.46
|
| Rate for Payer: UHC Core |
$260.07
|
| Rate for Payer: UHC Exchange |
$196.17
|
| Rate for Payer: UMR Bronson Commercial |
$184.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.38
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
IP
|
$499.17
|
|
|
Service Code
|
NDC 61314014405
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.63 |
| Max. Negotiated Rate |
$449.25 |
| Rate for Payer: Aetna American Axle |
$324.46
|
| Rate for Payer: Aetna Commercial |
$424.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.46
|
| Rate for Payer: Cash Price |
$399.34
|
| Rate for Payer: Cofinity Advantage |
$349.42
|
| Rate for Payer: Cofinity Commercial |
$429.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.34
|
| Rate for Payer: Healthscope Commercial |
$449.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$374.38
|
| Rate for Payer: PHP Commercial |
$424.29
|
| Rate for Payer: Priority Health SBD |
$314.48
|
| Rate for Payer: UMR Bronson Commercial |
$219.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.38
|
|
|
BRIMONIDINE 0.15 % EYE DROPS
|
Facility
|
OP
|
$674.73
|
|
|
Service Code
|
NDC 00023917705
|
| Hospital Charge Code |
31158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.65 |
| Max. Negotiated Rate |
$607.26 |
| Rate for Payer: Aetna American Axle |
$438.57
|
| Rate for Payer: Aetna Commercial |
$573.52
|
| Rate for Payer: Aetna Medicare |
$337.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.57
|
| Rate for Payer: BCBS Complete |
$269.89
|
| Rate for Payer: Cash Price |
$539.78
|
| Rate for Payer: Cofinity Advantage |
$472.31
|
| Rate for Payer: Cofinity Commercial |
$580.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.78
|
| Rate for Payer: Healthscope Commercial |
$607.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$472.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$539.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$573.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.05
|
| Rate for Payer: PHP Commercial |
$573.52
|
| Rate for Payer: Priority Health SBD |
$425.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.57
|
| Rate for Payer: UHC Core |
$351.53
|
| Rate for Payer: UHC Exchange |
$265.17
|
| Rate for Payer: UMR Bronson Commercial |
$249.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.05
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$262.78
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.23 |
| Max. Negotiated Rate |
$236.50 |
| Rate for Payer: Aetna American Axle |
$170.81
|
| Rate for Payer: Aetna Commercial |
$223.36
|
| Rate for Payer: Aetna Medicare |
$131.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.81
|
| Rate for Payer: BCBS Complete |
$105.11
|
| Rate for Payer: Cash Price |
$210.22
|
| Rate for Payer: Cofinity Advantage |
$183.95
|
| Rate for Payer: Cofinity Commercial |
$225.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.22
|
| Rate for Payer: Healthscope Commercial |
$236.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.09
|
| Rate for Payer: PHP Commercial |
$223.36
|
| Rate for Payer: Priority Health SBD |
$165.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.81
|
| Rate for Payer: UHC Core |
$136.91
|
| Rate for Payer: UHC Exchange |
$103.27
|
| Rate for Payer: UMR Bronson Commercial |
$97.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.09
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.34 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna American Axle |
$411.18
|
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.18
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Advantage |
$442.81
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.44
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: Priority Health SBD |
$398.53
|
| Rate for Payer: UMR Bronson Commercial |
$278.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$262.78
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.62 |
| Max. Negotiated Rate |
$236.50 |
| Rate for Payer: Aetna American Axle |
$170.81
|
| Rate for Payer: Aetna Commercial |
$223.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.81
|
| Rate for Payer: Cash Price |
$210.22
|
| Rate for Payer: Cofinity Advantage |
$183.95
|
| Rate for Payer: Cofinity Commercial |
$225.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.22
|
| Rate for Payer: Healthscope Commercial |
$236.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.09
|
| Rate for Payer: PHP Commercial |
$223.36
|
| Rate for Payer: Priority Health SBD |
$165.55
|
| Rate for Payer: UMR Bronson Commercial |
$115.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.09
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.06 |
| Max. Negotiated Rate |
$569.33 |
| Rate for Payer: Aetna American Axle |
$411.18
|
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: Aetna Medicare |
$316.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.18
|
| Rate for Payer: BCBS Complete |
$253.04
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Advantage |
$442.81
|
| Rate for Payer: Cofinity Commercial |
$544.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$569.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$506.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.44
|
| Rate for Payer: PHP Commercial |
$537.70
|
| Rate for Payer: Priority Health SBD |
$398.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.18
|
| Rate for Payer: UHC Core |
$329.58
|
| Rate for Payer: UHC Exchange |
$248.61
|
| Rate for Payer: UMR Bronson Commercial |
$234.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.44
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$49.92
|
|
|
Service Code
|
NDC 24208041105
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$44.93 |
| Rate for Payer: Aetna American Axle |
$32.45
|
| Rate for Payer: Aetna Commercial |
$42.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.45
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Cofinity Advantage |
$34.94
|
| Rate for Payer: Cofinity Commercial |
$42.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.94
|
| Rate for Payer: Healthscope Commercial |
$44.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.44
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: Priority Health SBD |
$31.45
|
| Rate for Payer: UMR Bronson Commercial |
$21.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.44
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$10.62
|
|
|
Service Code
|
NDC 70069023101
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna American Axle |
$6.90
|
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Aetna Medicare |
$5.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: BCBS Complete |
$4.25
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.03
|
| Rate for Payer: Priority Health SBD |
$6.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.90
|
| Rate for Payer: UHC Core |
$5.53
|
| Rate for Payer: UHC Exchange |
$4.17
|
| Rate for Payer: UMR Bronson Commercial |
$3.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
