|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 62756-240-60
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna American Axle |
$1.78
|
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.92
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 68462-157-40
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna American Axle |
$2.94
|
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.84
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.16
|
| Rate for Payer: Priority Health SBD |
$2.85
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.39
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$81.94
|
|
|
Service Code
|
NDC 62756-240-64
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: Aetna American Axle |
$53.26
|
| Rate for Payer: Aetna Commercial |
$69.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.26
|
| Rate for Payer: Cash Price |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$57.36
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$73.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.65
|
| Rate for Payer: PHP Commercial |
$69.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.36
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: UMR Bronson Commercial |
$36.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.46
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna American Axle |
$70.85
|
| Rate for Payer: Aetna American Axle |
$117.65
|
| Rate for Payer: Aetna American Axle |
$64.35
|
| Rate for Payer: Aetna American Axle |
$107.90
|
| Rate for Payer: Aetna American Axle |
$37.70
|
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna American Axle |
$132.28
|
| Rate for Payer: Aetna Commercial |
$49.30
|
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna Commercial |
$141.10
|
| Rate for Payer: Aetna Commercial |
$153.85
|
| Rate for Payer: Aetna Commercial |
$172.98
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$85.14
|
| Rate for Payer: Cofinity Commercial |
$116.20
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Cofinity Commercial |
$175.01
|
| Rate for Payer: Cofinity Commercial |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$155.66
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$142.45
|
| Rate for Payer: Cofinity Commercial |
$142.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.80
|
| Rate for Payer: Healthscope Commercial |
$162.90
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$52.20
|
| Rate for Payer: Healthscope Commercial |
$149.40
|
| Rate for Payer: Healthscope Commercial |
$89.10
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Commercial |
$183.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.15
|
| Rate for Payer: PHP Commercial |
$84.15
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$172.98
|
| Rate for Payer: PHP Commercial |
$141.10
|
| Rate for Payer: PHP Commercial |
$49.30
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: PHP Commercial |
$153.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.30
|
| Rate for Payer: Priority Health SBD |
$68.67
|
| Rate for Payer: Priority Health SBD |
$36.54
|
| Rate for Payer: Priority Health SBD |
$128.20
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Priority Health SBD |
$114.03
|
| Rate for Payer: Priority Health SBD |
$62.37
|
| Rate for Payer: Priority Health SBD |
$104.58
|
| Rate for Payer: UMR Bronson Commercial |
$43.56
|
| Rate for Payer: UMR Bronson Commercial |
$47.96
|
| Rate for Payer: UMR Bronson Commercial |
$79.64
|
| Rate for Payer: UMR Bronson Commercial |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$73.04
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: UMR Bronson Commercial |
$89.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.75
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$62.50
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna American Axle |
$40.62
|
| Rate for Payer: Aetna American Axle |
$37.70
|
| Rate for Payer: Aetna American Axle |
$64.35
|
| Rate for Payer: Aetna American Axle |
$68.58
|
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna American Axle |
$132.28
|
| Rate for Payer: Aetna American Axle |
$117.65
|
| Rate for Payer: Aetna American Axle |
$107.90
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Commercial |
$153.85
|
| Rate for Payer: Aetna Commercial |
$172.98
|
| Rate for Payer: Aetna Commercial |
$84.15
|
| Rate for Payer: Aetna Commercial |
$53.12
|
| Rate for Payer: Aetna Commercial |
$89.68
|
| Rate for Payer: Aetna Commercial |
$141.10
|
| Rate for Payer: Aetna Commercial |
$49.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.35
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Complete |
$81.40
|
| Rate for Payer: BCBS Complete |
$25.00
|
| Rate for Payer: BCBS Complete |
$42.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$84.40
|
| Rate for Payer: Cash Price |
$84.40
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$162.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$155.66
|
| Rate for Payer: Cofinity Commercial |
$116.20
|
| Rate for Payer: Cofinity Commercial |
$142.76
|
| Rate for Payer: Cofinity Commercial |
$85.14
|
| Rate for Payer: Cofinity Commercial |
$90.73
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$142.45
|
| Rate for Payer: Cofinity Commercial |
$175.01
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$73.85
|
| Rate for Payer: Cofinity Commercial |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$43.75
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Commercial |
$89.10
|
| Rate for Payer: Healthscope Commercial |
$183.15
|
| Rate for Payer: Healthscope Commercial |
$149.40
|
| Rate for Payer: Healthscope Commercial |
$162.90
|
| Rate for Payer: Healthscope Commercial |
$52.20
|
| Rate for Payer: Healthscope Commercial |
$56.25
|
| Rate for Payer: Healthscope Commercial |
$94.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.12
|
| Rate for Payer: PHP Commercial |
$53.12
|
| Rate for Payer: PHP Commercial |
$89.68
|
| Rate for Payer: PHP Commercial |
$49.30
|
| Rate for Payer: PHP Commercial |
$172.98
|
| Rate for Payer: PHP Commercial |
$153.85
|
| Rate for Payer: PHP Commercial |
$84.15
|
| Rate for Payer: PHP Commercial |
$141.10
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.85
|
| Rate for Payer: Priority Health SBD |
$36.54
|
| Rate for Payer: Priority Health SBD |
$66.46
|
| Rate for Payer: Priority Health SBD |
$62.37
|
| Rate for Payer: Priority Health SBD |
$128.20
|
| Rate for Payer: Priority Health SBD |
$114.03
|
| Rate for Payer: Priority Health SBD |
$39.38
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Priority Health SBD |
$104.58
|
| Rate for Payer: UMR Bronson Commercial |
$66.97
|
| Rate for Payer: UMR Bronson Commercial |
$61.42
|
| Rate for Payer: UMR Bronson Commercial |
$75.30
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: UMR Bronson Commercial |
$39.04
|
| Rate for Payer: UMR Bronson Commercial |
$21.46
|
| Rate for Payer: UMR Bronson Commercial |
$23.12
|
| Rate for Payer: UMR Bronson Commercial |
$36.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.25
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$151.53
|
|
|
Service Code
|
NDC 51672-4091-3
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.67 |
| Max. Negotiated Rate |
$136.38 |
| Rate for Payer: Aetna American Axle |
$98.49
|
| Rate for Payer: Aetna Commercial |
$128.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.49
|
| Rate for Payer: Cash Price |
$121.22
|
| Rate for Payer: Cofinity Commercial |
$106.07
|
| Rate for Payer: Cofinity Commercial |
$130.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.22
|
| Rate for Payer: Healthscope Commercial |
$136.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.80
|
| Rate for Payer: PHP Commercial |
$128.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.07
|
| Rate for Payer: Priority Health SBD |
$95.46
|
| Rate for Payer: UMR Bronson Commercial |
$66.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.65
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$14.30
|
|
|
Service Code
|
NDC 9900-0003-46
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$12.87 |
| Rate for Payer: Aetna American Axle |
$9.30
|
| Rate for Payer: Aetna Commercial |
$12.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.30
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cofinity Commercial |
$10.01
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Healthscope Commercial |
$12.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.16
|
| Rate for Payer: PHP Commercial |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health SBD |
$9.01
|
| Rate for Payer: UMR Bronson Commercial |
$6.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.72
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$382.80
|
|
|
Service Code
|
NDC 0054-0064-47
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.43 |
| Max. Negotiated Rate |
$344.52 |
| Rate for Payer: Aetna American Axle |
$248.82
|
| Rate for Payer: Aetna Commercial |
$325.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.82
|
| Rate for Payer: Cash Price |
$306.24
|
| Rate for Payer: Cofinity Commercial |
$267.96
|
| Rate for Payer: Cofinity Commercial |
$329.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.24
|
| Rate for Payer: Healthscope Commercial |
$344.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.38
|
| Rate for Payer: PHP Commercial |
$325.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.96
|
| Rate for Payer: Priority Health SBD |
$241.16
|
| Rate for Payer: UMR Bronson Commercial |
$168.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.10
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 65162-691-79
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.32 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna American Axle |
$72.86
|
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.47
|
| Rate for Payer: Priority Health SBD |
$70.62
|
| Rate for Payer: UMR Bronson Commercial |
$49.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$220.88
|
|
|
Service Code
|
NDC 54838-555-50
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.19 |
| Max. Negotiated Rate |
$198.79 |
| Rate for Payer: Aetna American Axle |
$143.57
|
| Rate for Payer: Aetna Commercial |
$187.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.57
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cofinity Commercial |
$154.62
|
| Rate for Payer: Cofinity Commercial |
$189.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.70
|
| Rate for Payer: Healthscope Commercial |
$198.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.75
|
| Rate for Payer: PHP Commercial |
$187.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.62
|
| Rate for Payer: Priority Health SBD |
$139.15
|
| Rate for Payer: UMR Bronson Commercial |
$97.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.66
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
OP
|
$281.20
|
|
|
Service Code
|
NDC 0904-6551-61
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$253.08 |
| Rate for Payer: Aetna American Axle |
$182.78
|
| Rate for Payer: Aetna Commercial |
$239.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.78
|
| Rate for Payer: BCBS Complete |
$112.48
|
| Rate for Payer: Cash Price |
$224.96
|
| Rate for Payer: Cofinity Commercial |
$196.84
|
| Rate for Payer: Cofinity Commercial |
$241.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.96
|
| Rate for Payer: Healthscope Commercial |
$253.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.02
|
| Rate for Payer: PHP Commercial |
$239.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.84
|
| Rate for Payer: Priority Health SBD |
$177.16
|
| Rate for Payer: UMR Bronson Commercial |
$104.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.90
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$119.99
|
|
|
Service Code
|
NDC 45963-538-30
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$107.99 |
| Rate for Payer: Aetna American Axle |
$77.99
|
| Rate for Payer: Aetna Commercial |
$101.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.99
|
| Rate for Payer: Cash Price |
$95.99
|
| Rate for Payer: Cofinity Commercial |
$103.19
|
| Rate for Payer: Cofinity Commercial |
$83.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.99
|
| Rate for Payer: Healthscope Commercial |
$107.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.99
|
| Rate for Payer: PHP Commercial |
$101.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.99
|
| Rate for Payer: Priority Health SBD |
$75.59
|
| Rate for Payer: UMR Bronson Commercial |
$52.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.99
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$57.11
|
|
|
Service Code
|
NDC 65862-187-30
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$51.40 |
| Rate for Payer: Aetna American Axle |
$37.12
|
| Rate for Payer: Aetna Commercial |
$48.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.12
|
| Rate for Payer: Cash Price |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.69
|
| Rate for Payer: Healthscope Commercial |
$51.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.54
|
| Rate for Payer: PHP Commercial |
$48.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.98
|
| Rate for Payer: Priority Health SBD |
$35.98
|
| Rate for Payer: UMR Bronson Commercial |
$25.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.83
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$281.20
|
|
|
Service Code
|
NDC 0904-6551-61
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$253.08 |
| Rate for Payer: Aetna American Axle |
$182.78
|
| Rate for Payer: Aetna Commercial |
$239.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.78
|
| Rate for Payer: Cash Price |
$224.96
|
| Rate for Payer: Cofinity Commercial |
$196.84
|
| Rate for Payer: Cofinity Commercial |
$241.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.96
|
| Rate for Payer: Healthscope Commercial |
$253.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.02
|
| Rate for Payer: PHP Commercial |
$239.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.84
|
| Rate for Payer: Priority Health SBD |
$177.16
|
| Rate for Payer: UMR Bronson Commercial |
$123.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.90
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
OP
|
$3.31
|
|
|
Service Code
|
NDC 50268-621-11
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna American Axle |
$2.15
|
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.81
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
OP
|
$165.30
|
|
|
Service Code
|
NDC 50268-621-15
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.16 |
| Max. Negotiated Rate |
$148.77 |
| Rate for Payer: Aetna American Axle |
$107.44
|
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.44
|
| Rate for Payer: BCBS Complete |
$66.12
|
| Rate for Payer: Cash Price |
$132.24
|
| Rate for Payer: Cofinity Commercial |
$115.71
|
| Rate for Payer: Cofinity Commercial |
$142.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.24
|
| Rate for Payer: Healthscope Commercial |
$148.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.50
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.71
|
| Rate for Payer: Priority Health SBD |
$104.14
|
| Rate for Payer: UMR Bronson Commercial |
$61.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.98
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$82.08
|
|
|
Service Code
|
NDC 62756-130-01
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna American Axle |
$53.35
|
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.35
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cofinity Commercial |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$70.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.66
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.77
|
| Rate for Payer: PHP Commercial |
$69.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.46
|
| Rate for Payer: Priority Health SBD |
$51.71
|
| Rate for Payer: UMR Bronson Commercial |
$36.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.56
|
|
|
ONDANSETRON HCL 8 MG TABLET
|
Facility
|
IP
|
$141.08
|
|
|
Service Code
|
NDC 45963-539-30
|
| Hospital Charge Code |
10779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.08 |
| Max. Negotiated Rate |
$126.97 |
| Rate for Payer: Aetna American Axle |
$91.70
|
| Rate for Payer: Aetna Commercial |
$119.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.70
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cofinity Commercial |
$121.33
|
| Rate for Payer: Cofinity Commercial |
$98.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.86
|
| Rate for Payer: Healthscope Commercial |
$126.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.92
|
| Rate for Payer: PHP Commercial |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.76
|
| Rate for Payer: Priority Health SBD |
$88.88
|
| Rate for Payer: UMR Bronson Commercial |
$62.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.81
|
|
|
ONDANSETRON HCL 8 MG TABLET
|
Facility
|
IP
|
$141.65
|
|
|
Service Code
|
NDC 63304-459-30
|
| Hospital Charge Code |
10779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.33 |
| Max. Negotiated Rate |
$127.48 |
| Rate for Payer: Aetna American Axle |
$92.07
|
| Rate for Payer: Aetna Commercial |
$120.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.07
|
| Rate for Payer: Cash Price |
$113.32
|
| Rate for Payer: Cofinity Commercial |
$121.82
|
| Rate for Payer: Cofinity Commercial |
$99.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.32
|
| Rate for Payer: Healthscope Commercial |
$127.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.40
|
| Rate for Payer: PHP Commercial |
$120.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.16
|
| Rate for Payer: Priority Health SBD |
$89.24
|
| Rate for Payer: UMR Bronson Commercial |
$62.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.24
|
|
|
ONDANSETRON HCL 8 MG TABLET
|
Facility
|
IP
|
$105.05
|
|
|
Service Code
|
NDC 65862-188-30
|
| Hospital Charge Code |
10779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.22 |
| Max. Negotiated Rate |
$94.54 |
| Rate for Payer: Aetna American Axle |
$68.28
|
| Rate for Payer: Aetna Commercial |
$89.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.28
|
| Rate for Payer: Cash Price |
$84.04
|
| Rate for Payer: Cofinity Commercial |
$73.54
|
| Rate for Payer: Cofinity Commercial |
$90.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.04
|
| Rate for Payer: Healthscope Commercial |
$94.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.29
|
| Rate for Payer: PHP Commercial |
$89.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.54
|
| Rate for Payer: Priority Health SBD |
$66.18
|
| Rate for Payer: UMR Bronson Commercial |
$46.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.79
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION (CODE)
|
Facility
|
IP
|
$17.67
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
163708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$15.90 |
| Rate for Payer: Aetna American Axle |
$11.49
|
| Rate for Payer: Aetna American Axle |
$6.82
|
| Rate for Payer: Aetna American Axle |
$5.92
|
| Rate for Payer: Aetna Commercial |
$15.02
|
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.49
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$12.37
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Cofinity Commercial |
$7.35
|
| Rate for Payer: Cofinity Commercial |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Healthscope Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.74
|
| Rate for Payer: PHP Commercial |
$15.02
|
| Rate for Payer: PHP Commercial |
$8.92
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.35
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: Priority Health SBD |
$5.73
|
| Rate for Payer: Priority Health SBD |
$11.13
|
| Rate for Payer: UMR Bronson Commercial |
$7.77
|
| Rate for Payer: UMR Bronson Commercial |
$4.62
|
| Rate for Payer: UMR Bronson Commercial |
$4.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.82
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.70
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
105614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Aetna American Axle |
$6.96
|
| Rate for Payer: Aetna American Axle |
$6.79
|
| Rate for Payer: Aetna American Axle |
$11.38
|
| Rate for Payer: Aetna American Axle |
$11.49
|
| Rate for Payer: Aetna American Axle |
$11.24
|
| Rate for Payer: Aetna American Axle |
$8.06
|
| Rate for Payer: Aetna American Axle |
$14.72
|
| Rate for Payer: Aetna American Axle |
$7.02
|
| Rate for Payer: Aetna American Axle |
$6.82
|
| Rate for Payer: Aetna American Axle |
$5.92
|
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: Aetna Commercial |
$8.88
|
| Rate for Payer: Aetna Commercial |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna Commercial |
$15.02
|
| Rate for Payer: Aetna Commercial |
$14.70
|
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Aetna Commercial |
$10.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.38
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Commercial |
$8.99
|
| Rate for Payer: Cofinity Commercial |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$8.68
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$12.25
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$9.20
|
| Rate for Payer: Cofinity Commercial |
$7.35
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Cofinity Commercial |
$12.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$15.75
|
| Rate for Payer: Healthscope Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$9.63
|
| Rate for Payer: Healthscope Commercial |
$15.56
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.74
|
| Rate for Payer: PHP Commercial |
$14.70
|
| Rate for Payer: PHP Commercial |
$10.54
|
| Rate for Payer: PHP Commercial |
$8.88
|
| Rate for Payer: PHP Commercial |
$15.02
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Commercial |
$9.18
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: PHP Commercial |
$8.92
|
| Rate for Payer: PHP Commercial |
$14.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.25
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$14.27
|
| Rate for Payer: Priority Health SBD |
$6.58
|
| Rate for Payer: Priority Health SBD |
$10.89
|
| Rate for Payer: Priority Health SBD |
$5.73
|
| Rate for Payer: Priority Health SBD |
$11.13
|
| Rate for Payer: Priority Health SBD |
$6.74
|
| Rate for Payer: Priority Health SBD |
$11.02
|
| Rate for Payer: Priority Health SBD |
$7.81
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: UMR Bronson Commercial |
$7.61
|
| Rate for Payer: UMR Bronson Commercial |
$5.46
|
| Rate for Payer: UMR Bronson Commercial |
$7.77
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: UMR Bronson Commercial |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$4.75
|
| Rate for Payer: UMR Bronson Commercial |
$4.71
|
| Rate for Payer: UMR Bronson Commercial |
$9.97
|
| Rate for Payer: UMR Bronson Commercial |
$4.62
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.97
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
105614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Aetna American Axle |
$5.92
|
| Rate for Payer: Aetna American Axle |
$10.03
|
| Rate for Payer: Aetna American Axle |
$6.79
|
| Rate for Payer: Aetna American Axle |
$11.49
|
| Rate for Payer: Aetna American Axle |
$8.06
|
| Rate for Payer: Aetna American Axle |
$11.38
|
| Rate for Payer: Aetna American Axle |
$7.02
|
| Rate for Payer: Aetna American Axle |
$14.72
|
| Rate for Payer: Aetna American Axle |
$6.82
|
| Rate for Payer: Aetna American Axle |
$11.24
|
| Rate for Payer: Aetna American Axle |
$6.96
|
| Rate for Payer: Aetna Commercial |
$13.12
|
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: Aetna Commercial |
$8.88
|
| Rate for Payer: Aetna Commercial |
$14.70
|
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Commercial |
$15.02
|
| Rate for Payer: Aetna Commercial |
$14.88
|
| Rate for Payer: Aetna Commercial |
$10.54
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.24
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS Complete |
$4.28
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS Complete |
$6.17
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS Complete |
$7.00
|
| Rate for Payer: BCBS Complete |
$9.06
|
| Rate for Payer: BCBS Complete |
$4.96
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.32
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$9.20
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$8.68
|
| Rate for Payer: Cofinity Commercial |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$8.99
|
| Rate for Payer: Cofinity Commercial |
$12.25
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$12.37
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Cofinity Commercial |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Cofinity Commercial |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$7.35
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.14
|
| Rate for Payer: Healthscope Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$15.56
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$13.89
|
| Rate for Payer: Healthscope Commercial |
$9.63
|
| Rate for Payer: Healthscope Commercial |
$15.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.02
|
| Rate for Payer: PHP Commercial |
$8.92
|
| Rate for Payer: PHP Commercial |
$13.12
|
| Rate for Payer: PHP Commercial |
$14.88
|
| Rate for Payer: PHP Commercial |
$10.54
|
| Rate for Payer: PHP Commercial |
$9.18
|
| Rate for Payer: PHP Commercial |
$15.02
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Commercial |
$8.88
|
| Rate for Payer: PHP Commercial |
$14.70
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.49
|
| Rate for Payer: Priority Health SBD |
$14.27
|
| Rate for Payer: Priority Health SBD |
$11.13
|
| Rate for Payer: Priority Health SBD |
$6.74
|
| Rate for Payer: Priority Health SBD |
$11.02
|
| Rate for Payer: Priority Health SBD |
$6.62
|
| Rate for Payer: Priority Health SBD |
$5.73
|
| Rate for Payer: Priority Health SBD |
$7.81
|
| Rate for Payer: Priority Health SBD |
$6.58
|
| Rate for Payer: Priority Health SBD |
$9.72
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$10.89
|
| Rate for Payer: UMR Bronson Commercial |
$3.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.38
|
| Rate for Payer: UMR Bronson Commercial |
$4.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.87
|
| Rate for Payer: UMR Bronson Commercial |
$3.37
|
| Rate for Payer: UMR Bronson Commercial |
$5.71
|
| Rate for Payer: UMR Bronson Commercial |
$3.88
|
| Rate for Payer: UMR Bronson Commercial |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$6.48
|
| Rate for Payer: UMR Bronson Commercial |
$6.40
|
| Rate for Payer: UMR Bronson Commercial |
$6.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.57
|
|
|
OOPHORECTOMY, PARTIAL OR TOTAL, UNILATERAL OR BILATERAL;
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
CPT 58940
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$550.10 |
| Max. Negotiated Rate |
$5,042.00 |
| Rate for Payer: BCBS Trust/PPO |
$1,811.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.11
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Exchange |
$550.10
|
|
|
OPEN IMPLANTATION OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY, PULSE GENERATOR, AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY
|
Facility
|
OP
|
$86,891.22
|
|
|
Service Code
|
CPT 64582
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$822.86 |
| Max. Negotiated Rate |
$86,891.22 |
| Rate for Payer: Aetna Medicare |
$28,705.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,502.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,502.05
|
| Rate for Payer: BCBS Complete |
$15,854.38
|
| Rate for Payer: BCBS MAPPO |
$27,601.64
|
| Rate for Payer: BCBS Trust/PPO |
$39,034.23
|
| Rate for Payer: BCN Medicare Advantage |
$27,601.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,601.64
|
| Rate for Payer: Mclaren Medicaid |
$15,098.10
|
| Rate for Payer: Mclaren Medicare |
$27,601.64
|
| Rate for Payer: Meridian Medicaid |
$15,854.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,981.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,741.89
|
| Rate for Payer: PACE Medicare |
$26,221.56
|
| Rate for Payer: PACE SWMI |
$27,601.64
|
| Rate for Payer: PHP Medicare Advantage |
$27,601.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,098.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86,891.22
|
| Rate for Payer: Priority Health Medicare |
$27,601.64
|
| Rate for Payer: Priority Health Narrow Network |
$69,512.98
|
| Rate for Payer: Railroad Medicare Medicare |
$27,601.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$905.15
|
| Rate for Payer: UHC Core |
$30,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,601.64
|
| Rate for Payer: UHC Exchange |
$822.86
|
| Rate for Payer: UHC Medicare Advantage |
$28,429.69
|
| Rate for Payer: VA VA |
$27,601.64
|
|
