|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 72578000201
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.26 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna American Axle |
$146.64
|
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.64
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.64
|
| Rate for Payer: Priority Health SBD |
$142.13
|
| Rate for Payer: UMR Bronson Commercial |
$99.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$394.80
|
|
|
Service Code
|
NDC 60505004206
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.71 |
| Max. Negotiated Rate |
$355.32 |
| Rate for Payer: Aetna American Axle |
$256.62
|
| Rate for Payer: Aetna Commercial |
$335.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.62
|
| Rate for Payer: Cash Price |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.84
|
| Rate for Payer: Healthscope Commercial |
$355.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.58
|
| Rate for Payer: PHP Commercial |
$335.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.62
|
| Rate for Payer: Priority Health SBD |
$248.72
|
| Rate for Payer: UMR Bronson Commercial |
$173.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.10
|
|
|
ACYCLOVIR 800 MG TABLET
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 23155022801
|
| Hospital Charge Code |
8972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.85
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.22
|
| Rate for Payer: Priority Health SBD |
$171.77
|
| Rate for Payer: UMR Bronson Commercial |
$119.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
ACYCLOVIR 800 MG TABLET
|
Facility
|
IP
|
$352.50
|
|
|
Service Code
|
NDC 31722077801
|
| Hospital Charge Code |
8972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna American Axle |
$229.12
|
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.12
|
| Rate for Payer: Priority Health SBD |
$222.07
|
| Rate for Payer: UMR Bronson Commercial |
$155.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
ACYCLOVIR 800 MG TABLET
|
Facility
|
OP
|
$272.65
|
|
|
Service Code
|
NDC 23155022801
|
| Hospital Charge Code |
8972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$136.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: BCBS Complete |
$109.06
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.85
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.22
|
| Rate for Payer: Priority Health SBD |
$171.77
|
| Rate for Payer: UMR Bronson Commercial |
$100.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
ACYCLOVIR 800 MG TABLET
|
Facility
|
IP
|
$266.95
|
|
|
Service Code
|
NDC 61442011301
|
| Hospital Charge Code |
8972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.46 |
| Max. Negotiated Rate |
$240.25 |
| Rate for Payer: Aetna American Axle |
$173.52
|
| Rate for Payer: Aetna Commercial |
$226.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.52
|
| Rate for Payer: Cash Price |
$213.56
|
| Rate for Payer: Cofinity Commercial |
$186.87
|
| Rate for Payer: Cofinity Commercial |
$229.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.56
|
| Rate for Payer: Healthscope Commercial |
$240.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.91
|
| Rate for Payer: PHP Commercial |
$226.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.52
|
| Rate for Payer: Priority Health SBD |
$168.18
|
| Rate for Payer: UMR Bronson Commercial |
$117.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.21
|
|
|
ACYCLOVIR 800 MG TABLET
|
Facility
|
OP
|
$266.95
|
|
|
Service Code
|
NDC 60505530701
|
| Hospital Charge Code |
8972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.77 |
| Max. Negotiated Rate |
$240.25 |
| Rate for Payer: Aetna American Axle |
$173.52
|
| Rate for Payer: Aetna Commercial |
$226.91
|
| Rate for Payer: Aetna Medicare |
$133.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.52
|
| Rate for Payer: BCBS Complete |
$106.78
|
| Rate for Payer: Cash Price |
$213.56
|
| Rate for Payer: Cofinity Commercial |
$186.87
|
| Rate for Payer: Cofinity Commercial |
$229.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.56
|
| Rate for Payer: Healthscope Commercial |
$240.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.91
|
| Rate for Payer: PHP Commercial |
$226.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.52
|
| Rate for Payer: Priority Health SBD |
$168.18
|
| Rate for Payer: UMR Bronson Commercial |
$98.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.21
|
|
|
ACYCLOVIR 800 MG TABLET
|
Facility
|
IP
|
$266.95
|
|
|
Service Code
|
NDC 60505530701
|
| Hospital Charge Code |
8972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.46 |
| Max. Negotiated Rate |
$240.25 |
| Rate for Payer: Aetna American Axle |
$173.52
|
| Rate for Payer: Aetna Commercial |
$226.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.52
|
| Rate for Payer: Cash Price |
$213.56
|
| Rate for Payer: Cofinity Commercial |
$186.87
|
| Rate for Payer: Cofinity Commercial |
$229.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.56
|
| Rate for Payer: Healthscope Commercial |
$240.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.91
|
| Rate for Payer: PHP Commercial |
$226.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.52
|
| Rate for Payer: Priority Health SBD |
$168.18
|
| Rate for Payer: UMR Bronson Commercial |
$117.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.21
|
|
|
ACYCLOVIR 800 MG TABLET
|
Facility
|
OP
|
$352.50
|
|
|
Service Code
|
NDC 31722077801
|
| Hospital Charge Code |
8972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.43 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna American Axle |
$229.12
|
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna Medicare |
$176.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: BCBS Complete |
$141.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.12
|
| Rate for Payer: Priority Health SBD |
$222.07
|
| Rate for Payer: UMR Bronson Commercial |
$130.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
ACYCLOVIR 800 MG TABLET
|
Facility
|
OP
|
$266.95
|
|
|
Service Code
|
NDC 61442011301
|
| Hospital Charge Code |
8972
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.77 |
| Max. Negotiated Rate |
$240.25 |
| Rate for Payer: Aetna American Axle |
$173.52
|
| Rate for Payer: Aetna Commercial |
$226.91
|
| Rate for Payer: Aetna Medicare |
$133.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.52
|
| Rate for Payer: BCBS Complete |
$106.78
|
| Rate for Payer: Cash Price |
$213.56
|
| Rate for Payer: Cofinity Commercial |
$186.87
|
| Rate for Payer: Cofinity Commercial |
$229.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.56
|
| Rate for Payer: Healthscope Commercial |
$240.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.91
|
| Rate for Payer: PHP Commercial |
$226.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.52
|
| Rate for Payer: Priority Health SBD |
$168.18
|
| Rate for Payer: UMR Bronson Commercial |
$98.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.21
|
|
|
ACYCLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.18
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
8974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$17.26 |
| Rate for Payer: Aetna American Axle |
$12.47
|
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna Medicare |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.47
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.30
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: UMR Bronson Commercial |
$7.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
|
|
ACYCLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.18
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
8974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$17.26 |
| Rate for Payer: Aetna American Axle |
$12.47
|
| Rate for Payer: Aetna Commercial |
$16.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.47
|
| Rate for Payer: Cash Price |
$15.34
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.34
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.30
|
| Rate for Payer: PHP Commercial |
$16.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health SBD |
$12.08
|
| Rate for Payer: UMR Bronson Commercial |
$8.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.38
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.06
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Aetna American Axle |
$13.04
|
| Rate for Payer: Aetna American Axle |
$12.10
|
| Rate for Payer: Aetna American Axle |
$12.56
|
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$15.82
|
| Rate for Payer: Aetna Medicare |
$10.03
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.10
|
| Rate for Payer: BCBS Complete |
$7.44
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS Complete |
$8.02
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$14.89
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$16.75
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$18.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.05
|
| Rate for Payer: PHP Commercial |
$15.82
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: PHP Commercial |
$17.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: Priority Health SBD |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.72
|
| Rate for Payer: Priority Health SBD |
$12.64
|
| Rate for Payer: UMR Bronson Commercial |
$7.42
|
| Rate for Payer: UMR Bronson Commercial |
$6.89
|
| Rate for Payer: UMR Bronson Commercial |
$7.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.04
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.61
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Aetna American Axle |
$12.10
|
| Rate for Payer: Aetna American Axle |
$12.56
|
| Rate for Payer: Aetna American Axle |
$13.04
|
| Rate for Payer: Aetna Commercial |
$16.42
|
| Rate for Payer: Aetna Commercial |
$15.82
|
| Rate for Payer: Aetna Commercial |
$17.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.56
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Cash Price |
$14.89
|
| Rate for Payer: Cofinity Commercial |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.46
|
| Rate for Payer: Healthscope Commercial |
$17.39
|
| Rate for Payer: Healthscope Commercial |
$16.75
|
| Rate for Payer: Healthscope Commercial |
$18.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.42
|
| Rate for Payer: PHP Commercial |
$17.05
|
| Rate for Payer: PHP Commercial |
$16.42
|
| Rate for Payer: PHP Commercial |
$15.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: Priority Health SBD |
$12.64
|
| Rate for Payer: Priority Health SBD |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.72
|
| Rate for Payer: UMR Bronson Commercial |
$8.19
|
| Rate for Payer: UMR Bronson Commercial |
$8.83
|
| Rate for Payer: UMR Bronson Commercial |
$8.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.49
|
|
|
ADALIMUMAB 40 MG/0.8 ML SUBCUTANEOUS PEN KIT
|
Facility
|
IP
|
$5,185.36
|
|
|
Service Code
|
HCPCS J0139
|
| Hospital Charge Code |
116603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,281.56 |
| Max. Negotiated Rate |
$4,666.82 |
| Rate for Payer: Aetna American Axle |
$3,370.48
|
| Rate for Payer: Aetna Commercial |
$4,407.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,370.48
|
| Rate for Payer: Cash Price |
$4,148.29
|
| Rate for Payer: Cofinity Commercial |
$3,629.75
|
| Rate for Payer: Cofinity Commercial |
$4,459.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,629.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,148.29
|
| Rate for Payer: Healthscope Commercial |
$4,666.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,629.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,889.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,407.56
|
| Rate for Payer: PHP Commercial |
$4,407.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,370.48
|
| Rate for Payer: Priority Health SBD |
$3,266.78
|
| Rate for Payer: UMR Bronson Commercial |
$2,281.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,889.02
|
|
|
ADALIMUMAB 40 MG/0.8 ML SUBCUTANEOUS PEN KIT
|
Facility
|
OP
|
$5,185.36
|
|
|
Service Code
|
HCPCS J0139
|
| Hospital Charge Code |
116603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.17 |
| Max. Negotiated Rate |
$4,666.82 |
| Rate for Payer: Aetna American Axle |
$3,370.48
|
| Rate for Payer: Aetna Commercial |
$4,407.56
|
| Rate for Payer: Aetna Medicare |
$95.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,370.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.66
|
| Rate for Payer: BCBS Complete |
$51.63
|
| Rate for Payer: BCBS MAPPO |
$91.73
|
| Rate for Payer: BCN Medicare Advantage |
$91.73
|
| Rate for Payer: Cash Price |
$4,148.29
|
| Rate for Payer: Cash Price |
$4,148.29
|
| Rate for Payer: Cofinity Commercial |
$4,459.41
|
| Rate for Payer: Cofinity Commercial |
$3,629.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,629.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,148.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.73
|
| Rate for Payer: Healthscope Commercial |
$4,666.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,629.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,889.02
|
| Rate for Payer: Mclaren Medicaid |
$49.17
|
| Rate for Payer: Mclaren Medicare |
$91.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.32
|
| Rate for Payer: Meridian Medicaid |
$51.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,407.56
|
| Rate for Payer: PACE Medicare |
$87.14
|
| Rate for Payer: PACE SWMI |
$91.73
|
| Rate for Payer: PHP Commercial |
$4,407.56
|
| Rate for Payer: PHP Medicare Advantage |
$91.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,370.48
|
| Rate for Payer: Priority Health Medicare |
$91.73
|
| Rate for Payer: Priority Health SBD |
$3,266.78
|
| Rate for Payer: Railroad Medicare Medicare |
$91.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.73
|
| Rate for Payer: UHC Exchange |
$175.31
|
| Rate for Payer: UHC Medicare Advantage |
$91.73
|
| Rate for Payer: UHCCP Medicaid |
$49.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,918.58
|
| Rate for Payer: VA VA |
$91.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,889.02
|
|
|
ADALIMUMAB 80 MG/0.8 ML SUBCUTANEOUS PEN KIT
|
Facility
|
OP
|
$258.21
|
|
|
Service Code
|
HCPCS J0139
|
| Hospital Charge Code |
188067
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.17 |
| Max. Negotiated Rate |
$258.21 |
| Rate for Payer: Aetna Medicare |
$95.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.66
|
| Rate for Payer: BCBS Complete |
$51.63
|
| Rate for Payer: BCBS MAPPO |
$91.73
|
| Rate for Payer: BCN Medicare Advantage |
$91.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.73
|
| Rate for Payer: Mclaren Medicaid |
$49.17
|
| Rate for Payer: Mclaren Medicare |
$91.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.32
|
| Rate for Payer: Meridian Medicaid |
$51.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.49
|
| Rate for Payer: PACE Medicare |
$87.14
|
| Rate for Payer: PACE SWMI |
$91.73
|
| Rate for Payer: PHP Medicare Advantage |
$91.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.17
|
| Rate for Payer: Priority Health Medicare |
$91.73
|
| Rate for Payer: Railroad Medicare Medicare |
$91.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.73
|
| Rate for Payer: UHC Exchange |
$175.31
|
| Rate for Payer: UHC Medicare Advantage |
$91.73
|
| Rate for Payer: UHCCP Medicaid |
$49.17
|
| Rate for Payer: VA VA |
$91.73
|
|
|
ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 42831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
ADENOIDECTOMY, PRIMARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 42830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
ADENOIDECTOMY, SECONDARY; AGE 12 OR OVER
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 42836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
ADENOIDECTOMY, SECONDARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 42835
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
ADENOSINE 3 MG/250 ML NS IV
|
Facility
|
OP
|
$10.88
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
151056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Aetna American Axle |
$7.07
|
| Rate for Payer: Aetna Commercial |
$9.25
|
| Rate for Payer: Aetna Medicare |
$5.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.07
|
| Rate for Payer: BCBS Complete |
$4.35
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Cofinity Commercial |
$9.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.70
|
| Rate for Payer: Healthscope Commercial |
$9.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.25
|
| Rate for Payer: PHP Commercial |
$9.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.07
|
| Rate for Payer: Priority Health SBD |
$6.85
|
| Rate for Payer: UMR Bronson Commercial |
$4.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.16
|
|
|
ADENOSINE 3 MG/250 ML NS IV
|
Facility
|
IP
|
$10.88
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
151056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: Aetna American Axle |
$7.07
|
| Rate for Payer: Aetna Commercial |
$9.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.07
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Cofinity Commercial |
$9.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.70
|
| Rate for Payer: Healthscope Commercial |
$9.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.25
|
| Rate for Payer: PHP Commercial |
$9.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.07
|
| Rate for Payer: Priority Health SBD |
$6.85
|
| Rate for Payer: UMR Bronson Commercial |
$4.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.16
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna American Axle |
$16.42
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Medicare |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: UMR Bronson Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.95
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$22.73 |
| Rate for Payer: Aetna American Axle |
$16.42
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.42
|
| Rate for Payer: Cash Price |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$21.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$22.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.47
|
| Rate for Payer: PHP Commercial |
$21.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health SBD |
$15.91
|
| Rate for Payer: UMR Bronson Commercial |
$11.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.95
|
|
