|
LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA
|
Facility
|
OP
|
$8,919.33
|
|
|
Service Code
|
CPT 37607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$362.48 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,894.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$398.73
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$362.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
LIGATION OR BIOPSY, TEMPORAL ARTERY
|
Facility
|
OP
|
$4,536.73
|
|
|
Service Code
|
CPT 37609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$200.07 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,700.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.08
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$200.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$117,161.45
|
|
|
Service Code
|
MS-DRG 956
|
| Min. Negotiated Rate |
$28,878.00 |
| Max. Negotiated Rate |
$117,161.45 |
| Rate for Payer: Aetna Medicare |
$31,613.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,997.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,997.36
|
| Rate for Payer: BCBS MAPPO |
$30,397.89
|
| Rate for Payer: BCBS Trust/PPO |
$117,161.45
|
| Rate for Payer: BCN Medicare Advantage |
$30,397.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,397.89
|
| Rate for Payer: Mclaren Medicare |
$30,397.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,917.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,957.57
|
| Rate for Payer: PACE Medicare |
$28,878.00
|
| Rate for Payer: PACE SWMI |
$30,397.89
|
| Rate for Payer: PHP Medicare Advantage |
$30,397.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,651.86
|
| Rate for Payer: Priority Health Medicare |
$30,397.89
|
| Rate for Payer: Priority Health Narrow Network |
$44,521.49
|
| Rate for Payer: Railroad Medicare Medicare |
$30,397.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59,158.06
|
| Rate for Payer: UHC Core |
$48,508.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$30,397.89
|
| Rate for Payer: UHC Exchange |
$38,564.82
|
| Rate for Payer: UHC Medicare Advantage |
$31,309.83
|
| Rate for Payer: VA VA |
$30,397.89
|
|
|
LINACLOTIDE 145 MCG CAPSULE
|
Facility
|
IP
|
$1,771.79
|
|
|
Service Code
|
NDC 0456-1201-30
|
| Hospital Charge Code |
163662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$779.59 |
| Max. Negotiated Rate |
$1,594.61 |
| Rate for Payer: Aetna American Axle |
$1,151.66
|
| Rate for Payer: Aetna Commercial |
$1,506.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.66
|
| Rate for Payer: Cash Price |
$1,417.43
|
| Rate for Payer: Cofinity Commercial |
$1,240.25
|
| Rate for Payer: Cofinity Commercial |
$1,523.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,417.43
|
| Rate for Payer: Healthscope Commercial |
$1,594.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,240.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,328.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,506.02
|
| Rate for Payer: PHP Commercial |
$1,506.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,240.25
|
| Rate for Payer: Priority Health SBD |
$1,116.23
|
| Rate for Payer: UMR Bronson Commercial |
$779.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,328.84
|
|
|
LINACLOTIDE 145 MCG CAPSULE
|
Facility
|
IP
|
$226.27
|
|
|
Service Code
|
NDC 0456-1201-04
|
| Hospital Charge Code |
163662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$203.64 |
| Rate for Payer: Aetna American Axle |
$147.08
|
| Rate for Payer: Aetna Commercial |
$192.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.08
|
| Rate for Payer: Cash Price |
$181.02
|
| Rate for Payer: Cofinity Commercial |
$158.39
|
| Rate for Payer: Cofinity Commercial |
$194.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.02
|
| Rate for Payer: Healthscope Commercial |
$203.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.33
|
| Rate for Payer: PHP Commercial |
$192.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.39
|
| Rate for Payer: Priority Health SBD |
$142.55
|
| Rate for Payer: UMR Bronson Commercial |
$99.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.70
|
|
|
LINACLOTIDE 290 MCG CAPSULE
|
Facility
|
IP
|
$1,771.79
|
|
|
Service Code
|
NDC 0456-1202-30
|
| Hospital Charge Code |
163663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$779.59 |
| Max. Negotiated Rate |
$1,594.61 |
| Rate for Payer: Aetna American Axle |
$1,151.66
|
| Rate for Payer: Aetna Commercial |
$1,506.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.66
|
| Rate for Payer: Cash Price |
$1,417.43
|
| Rate for Payer: Cofinity Commercial |
$1,240.25
|
| Rate for Payer: Cofinity Commercial |
$1,523.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,417.43
|
| Rate for Payer: Healthscope Commercial |
$1,594.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,240.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,328.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,506.02
|
| Rate for Payer: PHP Commercial |
$1,506.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,240.25
|
| Rate for Payer: Priority Health SBD |
$1,116.23
|
| Rate for Payer: UMR Bronson Commercial |
$779.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,328.84
|
|
|
LINACLOTIDE 72 MCG CAPSULE
|
Facility
|
IP
|
$1,771.79
|
|
|
Service Code
|
NDC 0456-1203-30
|
| Hospital Charge Code |
182047
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$779.59 |
| Max. Negotiated Rate |
$1,594.61 |
| Rate for Payer: Aetna American Axle |
$1,151.66
|
| Rate for Payer: Aetna Commercial |
$1,506.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.66
|
| Rate for Payer: Cash Price |
$1,417.43
|
| Rate for Payer: Cofinity Commercial |
$1,240.25
|
| Rate for Payer: Cofinity Commercial |
$1,523.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,417.43
|
| Rate for Payer: Healthscope Commercial |
$1,594.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,240.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,328.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,506.02
|
| Rate for Payer: PHP Commercial |
$1,506.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,240.25
|
| Rate for Payer: Priority Health SBD |
$1,116.23
|
| Rate for Payer: UMR Bronson Commercial |
$779.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,328.84
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
IP
|
$4,697.89
|
|
|
Service Code
|
NDC 0597-0140-61
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,067.07 |
| Max. Negotiated Rate |
$4,228.10 |
| Rate for Payer: Aetna American Axle |
$3,053.63
|
| Rate for Payer: Aetna Commercial |
$3,993.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,053.63
|
| Rate for Payer: Cash Price |
$3,758.31
|
| Rate for Payer: Cofinity Commercial |
$3,288.52
|
| Rate for Payer: Cofinity Commercial |
$4,040.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,758.31
|
| Rate for Payer: Healthscope Commercial |
$4,228.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,288.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,523.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,993.21
|
| Rate for Payer: PHP Commercial |
$3,993.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,288.52
|
| Rate for Payer: Priority Health SBD |
$2,959.67
|
| Rate for Payer: UMR Bronson Commercial |
$2,067.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,523.42
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2,361.53
|
|
|
Service Code
|
NDC 0054-0319-50
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,039.07 |
| Max. Negotiated Rate |
$2,125.38 |
| Rate for Payer: Aetna American Axle |
$1,534.99
|
| Rate for Payer: Aetna Commercial |
$2,007.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.99
|
| Rate for Payer: Cash Price |
$1,889.22
|
| Rate for Payer: Cofinity Commercial |
$1,653.07
|
| Rate for Payer: Cofinity Commercial |
$2,030.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,889.22
|
| Rate for Payer: Healthscope Commercial |
$2,125.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,653.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,771.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,007.30
|
| Rate for Payer: PHP Commercial |
$2,007.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,653.07
|
| Rate for Payer: Priority Health SBD |
$1,487.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,039.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,771.15
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
NDC 59762-1308-1
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Aetna American Axle |
$724.75
|
| Rate for Payer: Aetna Commercial |
$947.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.75
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cofinity Commercial |
$780.50
|
| Rate for Payer: Cofinity Commercial |
$958.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.00
|
| Rate for Payer: Healthscope Commercial |
$1,003.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$836.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$947.75
|
| Rate for Payer: PHP Commercial |
$947.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.50
|
| Rate for Payer: Priority Health SBD |
$702.45
|
| Rate for Payer: UMR Bronson Commercial |
$490.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$836.25
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,694.42
|
|
|
Service Code
|
NDC 59762-1308-4
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$745.54 |
| Max. Negotiated Rate |
$1,524.98 |
| Rate for Payer: Aetna American Axle |
$1,101.37
|
| Rate for Payer: Aetna Commercial |
$1,440.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,101.37
|
| Rate for Payer: Cash Price |
$1,355.54
|
| Rate for Payer: Cofinity Commercial |
$1,186.09
|
| Rate for Payer: Cofinity Commercial |
$1,457.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,355.54
|
| Rate for Payer: Healthscope Commercial |
$1,524.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,186.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,270.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,440.26
|
| Rate for Payer: PHP Commercial |
$1,440.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.09
|
| Rate for Payer: Priority Health SBD |
$1,067.48
|
| Rate for Payer: UMR Bronson Commercial |
$745.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,270.82
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2,352.65
|
|
|
Service Code
|
NDC 0009-5136-01
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,035.17 |
| Max. Negotiated Rate |
$2,117.38 |
| Rate for Payer: Aetna American Axle |
$1,529.22
|
| Rate for Payer: Aetna Commercial |
$1,999.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,529.22
|
| Rate for Payer: Cash Price |
$1,882.12
|
| Rate for Payer: Cofinity Commercial |
$1,646.86
|
| Rate for Payer: Cofinity Commercial |
$2,023.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,882.12
|
| Rate for Payer: Healthscope Commercial |
$2,117.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,646.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,764.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,999.75
|
| Rate for Payer: PHP Commercial |
$1,999.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,646.86
|
| Rate for Payer: Priority Health SBD |
$1,482.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,035.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,764.49
|
|
|
LINEZOLID 600 MG/300 ML INTRAVENOUS (PEDS)
|
Facility
|
IP
|
$138.32
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
180001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$124.49 |
| Rate for Payer: Aetna American Axle |
$89.91
|
| Rate for Payer: Aetna Commercial |
$117.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.91
|
| Rate for Payer: Cash Price |
$110.66
|
| Rate for Payer: Cofinity Commercial |
$118.96
|
| Rate for Payer: Cofinity Commercial |
$96.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.66
|
| Rate for Payer: Healthscope Commercial |
$124.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.57
|
| Rate for Payer: PHP Commercial |
$117.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.82
|
| Rate for Payer: Priority Health SBD |
$87.14
|
| Rate for Payer: UMR Bronson Commercial |
$60.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.74
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$228.78
|
|
|
Service Code
|
NDC 0904-6553-04
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.66 |
| Max. Negotiated Rate |
$205.90 |
| Rate for Payer: Aetna American Axle |
$148.71
|
| Rate for Payer: Aetna Commercial |
$194.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.71
|
| Rate for Payer: Cash Price |
$183.02
|
| Rate for Payer: Cofinity Commercial |
$160.15
|
| Rate for Payer: Cofinity Commercial |
$196.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.02
|
| Rate for Payer: Healthscope Commercial |
$205.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.46
|
| Rate for Payer: PHP Commercial |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.15
|
| Rate for Payer: Priority Health SBD |
$144.13
|
| Rate for Payer: UMR Bronson Commercial |
$100.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.58
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$361.75
|
|
|
Service Code
|
NDC 60687-309-21
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.17 |
| Max. Negotiated Rate |
$325.58 |
| Rate for Payer: Aetna American Axle |
$235.14
|
| Rate for Payer: Aetna Commercial |
$307.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.14
|
| Rate for Payer: Cash Price |
$289.40
|
| Rate for Payer: Cofinity Commercial |
$253.22
|
| Rate for Payer: Cofinity Commercial |
$311.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.40
|
| Rate for Payer: Healthscope Commercial |
$325.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.49
|
| Rate for Payer: PHP Commercial |
$307.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.22
|
| Rate for Payer: Priority Health SBD |
$227.90
|
| Rate for Payer: UMR Bronson Commercial |
$159.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.31
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$361.31
|
|
|
Service Code
|
NDC 67877-419-84
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.98 |
| Max. Negotiated Rate |
$325.18 |
| Rate for Payer: Aetna American Axle |
$234.85
|
| Rate for Payer: Aetna Commercial |
$307.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.85
|
| Rate for Payer: Cash Price |
$289.05
|
| Rate for Payer: Cofinity Commercial |
$252.92
|
| Rate for Payer: Cofinity Commercial |
$310.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.05
|
| Rate for Payer: Healthscope Commercial |
$325.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$307.11
|
| Rate for Payer: PHP Commercial |
$307.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.92
|
| Rate for Payer: Priority Health SBD |
$227.63
|
| Rate for Payer: UMR Bronson Commercial |
$158.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.98
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$120.44
|
|
|
Service Code
|
NDC 67877-419-33
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.99 |
| Max. Negotiated Rate |
$108.40 |
| Rate for Payer: Aetna American Axle |
$78.29
|
| Rate for Payer: Aetna Commercial |
$102.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.29
|
| Rate for Payer: Cash Price |
$96.35
|
| Rate for Payer: Cofinity Commercial |
$103.58
|
| Rate for Payer: Cofinity Commercial |
$84.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.35
|
| Rate for Payer: Healthscope Commercial |
$108.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.37
|
| Rate for Payer: PHP Commercial |
$102.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.31
|
| Rate for Payer: Priority Health SBD |
$75.88
|
| Rate for Payer: UMR Bronson Commercial |
$52.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.33
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$354.09
|
|
|
Service Code
|
NDC 72606-001-03
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.80 |
| Max. Negotiated Rate |
$318.68 |
| Rate for Payer: Aetna American Axle |
$230.16
|
| Rate for Payer: Aetna Commercial |
$300.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.16
|
| Rate for Payer: Cash Price |
$283.27
|
| Rate for Payer: Cofinity Commercial |
$247.86
|
| Rate for Payer: Cofinity Commercial |
$304.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.27
|
| Rate for Payer: Healthscope Commercial |
$318.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.98
|
| Rate for Payer: PHP Commercial |
$300.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.86
|
| Rate for Payer: Priority Health SBD |
$223.08
|
| Rate for Payer: UMR Bronson Commercial |
$155.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.57
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$12.06
|
|
|
Service Code
|
NDC 60687-309-11
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$10.85 |
| Rate for Payer: Aetna American Axle |
$7.84
|
| Rate for Payer: Aetna Commercial |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.84
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cofinity Commercial |
$10.37
|
| Rate for Payer: Cofinity Commercial |
$8.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.65
|
| Rate for Payer: Healthscope Commercial |
$10.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.25
|
| Rate for Payer: PHP Commercial |
$10.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.44
|
| Rate for Payer: Priority Health SBD |
$7.60
|
| Rate for Payer: UMR Bronson Commercial |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
LINEZOLID IN 5% DEXTROSE IN WATER 600 MG/300 ML INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$138.32
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
112020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$124.49 |
| Rate for Payer: Aetna American Axle |
$89.91
|
| Rate for Payer: Aetna American Axle |
$176.44
|
| Rate for Payer: Aetna American Axle |
$51.92
|
| Rate for Payer: Aetna American Axle |
$71.54
|
| Rate for Payer: Aetna American Axle |
$42.96
|
| Rate for Payer: Aetna Commercial |
$67.89
|
| Rate for Payer: Aetna Commercial |
$93.55
|
| Rate for Payer: Aetna Commercial |
$117.57
|
| Rate for Payer: Aetna Commercial |
$230.72
|
| Rate for Payer: Aetna Commercial |
$56.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.92
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$217.15
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$88.05
|
| Rate for Payer: Cash Price |
$110.66
|
| Rate for Payer: Cofinity Commercial |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$94.65
|
| Rate for Payer: Cofinity Commercial |
$118.96
|
| Rate for Payer: Cofinity Commercial |
$96.82
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$77.04
|
| Rate for Payer: Cofinity Commercial |
$68.69
|
| Rate for Payer: Cofinity Commercial |
$190.01
|
| Rate for Payer: Cofinity Commercial |
$233.44
|
| Rate for Payer: Cofinity Commercial |
$55.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.66
|
| Rate for Payer: Healthscope Commercial |
$124.49
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Healthscope Commercial |
$244.30
|
| Rate for Payer: Healthscope Commercial |
$71.88
|
| Rate for Payer: Healthscope Commercial |
$99.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.72
|
| Rate for Payer: PHP Commercial |
$230.72
|
| Rate for Payer: PHP Commercial |
$117.57
|
| Rate for Payer: PHP Commercial |
$67.89
|
| Rate for Payer: PHP Commercial |
$56.18
|
| Rate for Payer: PHP Commercial |
$93.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.01
|
| Rate for Payer: Priority Health SBD |
$87.14
|
| Rate for Payer: Priority Health SBD |
$69.34
|
| Rate for Payer: Priority Health SBD |
$171.01
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: Priority Health SBD |
$50.32
|
| Rate for Payer: UMR Bronson Commercial |
$119.43
|
| Rate for Payer: UMR Bronson Commercial |
$48.43
|
| Rate for Payer: UMR Bronson Commercial |
$29.08
|
| Rate for Payer: UMR Bronson Commercial |
$35.14
|
| Rate for Payer: UMR Bronson Commercial |
$60.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.90
|
|
|
LIOTHYRONINE 25 MCG TABLET
|
Facility
|
IP
|
$620.64
|
|
|
Service Code
|
NDC 51862-321-01
|
| Hospital Charge Code |
4504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.08 |
| Max. Negotiated Rate |
$558.58 |
| Rate for Payer: Aetna American Axle |
$403.42
|
| Rate for Payer: Aetna Commercial |
$527.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.42
|
| Rate for Payer: Cash Price |
$496.51
|
| Rate for Payer: Cofinity Commercial |
$434.45
|
| Rate for Payer: Cofinity Commercial |
$533.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$496.51
|
| Rate for Payer: Healthscope Commercial |
$558.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$465.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$527.54
|
| Rate for Payer: PHP Commercial |
$527.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.45
|
| Rate for Payer: Priority Health SBD |
$391.00
|
| Rate for Payer: UMR Bronson Commercial |
$273.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$465.48
|
|
|
LIOTHYRONINE 50 MCG TABLET
|
Facility
|
IP
|
$530.50
|
|
|
Service Code
|
NDC 42794-020-12
|
| Hospital Charge Code |
4505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.42 |
| Max. Negotiated Rate |
$477.45 |
| Rate for Payer: Aetna American Axle |
$344.82
|
| Rate for Payer: Aetna Commercial |
$450.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.82
|
| Rate for Payer: Cash Price |
$424.40
|
| Rate for Payer: Cofinity Commercial |
$371.35
|
| Rate for Payer: Cofinity Commercial |
$456.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.40
|
| Rate for Payer: Healthscope Commercial |
$477.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$450.92
|
| Rate for Payer: PHP Commercial |
$450.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.35
|
| Rate for Payer: Priority Health SBD |
$334.22
|
| Rate for Payer: UMR Bronson Commercial |
$233.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.88
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
NDC 62756-589-88
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna American Axle |
$209.95
|
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.10
|
| Rate for Payer: Priority Health SBD |
$203.49
|
| Rate for Payer: UMR Bronson Commercial |
$142.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$340.10
|
|
|
Service Code
|
NDC 60793-115-01
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.64 |
| Max. Negotiated Rate |
$306.09 |
| Rate for Payer: Aetna American Axle |
$221.06
|
| Rate for Payer: Aetna Commercial |
$289.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.06
|
| Rate for Payer: Cash Price |
$272.08
|
| Rate for Payer: Cofinity Commercial |
$238.07
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.08
|
| Rate for Payer: Healthscope Commercial |
$306.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.08
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.07
|
| Rate for Payer: Priority Health SBD |
$214.26
|
| Rate for Payer: UMR Bronson Commercial |
$149.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.08
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$273.03
|
|
|
Service Code
|
NDC 42794-018-12
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$245.73 |
| Rate for Payer: Aetna American Axle |
$177.47
|
| Rate for Payer: Aetna Commercial |
$232.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.47
|
| Rate for Payer: Cash Price |
$218.42
|
| Rate for Payer: Cofinity Commercial |
$191.12
|
| Rate for Payer: Cofinity Commercial |
$234.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.42
|
| Rate for Payer: Healthscope Commercial |
$245.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.08
|
| Rate for Payer: PHP Commercial |
$232.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.12
|
| Rate for Payer: Priority Health SBD |
$172.01
|
| Rate for Payer: UMR Bronson Commercial |
$120.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.77
|
|
