|
LARYNGO-TRACHEAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
IP
|
$7.61
|
|
|
Service Code
|
NDC 09900000914
|
| Hospital Charge Code |
180497
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Aetna American Axle |
$4.95
|
| Rate for Payer: Aetna Commercial |
$6.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.95
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Cofinity Commercial |
$5.33
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.09
|
| Rate for Payer: Healthscope Commercial |
$6.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.47
|
| Rate for Payer: PHP Commercial |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.95
|
| Rate for Payer: Priority Health SBD |
$4.79
|
| Rate for Payer: UMR Bronson Commercial |
$3.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.71
|
|
|
LARYNGO-TRACHEAL MUCOSAL ATOMIZATION DEVICE
|
Facility
|
OP
|
$7.61
|
|
|
Service Code
|
NDC 09900000914
|
| Hospital Charge Code |
180497
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$6.85 |
| Rate for Payer: Aetna American Axle |
$4.95
|
| Rate for Payer: Aetna Commercial |
$6.47
|
| Rate for Payer: Aetna Medicare |
$3.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.95
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Cofinity Commercial |
$5.33
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.09
|
| Rate for Payer: Healthscope Commercial |
$6.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.47
|
| Rate for Payer: PHP Commercial |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.95
|
| Rate for Payer: Priority Health SBD |
$4.79
|
| Rate for Payer: UMR Bronson Commercial |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.71
|
|
|
LASER COAGULATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED IF PERFORMED)
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 52647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$624.96 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$3,319.95
|
| Rate for Payer: BCN Commercial |
$3,319.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.46
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$624.96
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
LASER ENUCLEATION OF THE PROSTATE WITH MORCELLATION, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, INTERNAL URETHROTOMY AND TRANSURETHRAL RESECTION OF PROSTATE ARE INCLUDED IF PERFORMED)
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 52649
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$792.63 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$7,470.34
|
| Rate for Payer: BCN Commercial |
$7,470.34
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.89
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$792.63
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
LASER VAPORIZATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, INTERNAL URETHROTOMY AND TRANSURETHRAL RESECTION OF PROSTATE ARE INCLUDED IF PERFORMED)
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 52648
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$666.27 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$4,093.25
|
| Rate for Payer: BCN Commercial |
$4,093.25
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$732.90
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$666.27
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$861.95
|
|
|
Service Code
|
NDC 00013830304
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.92 |
| Max. Negotiated Rate |
$775.76 |
| Rate for Payer: Aetna American Axle |
$560.27
|
| Rate for Payer: Aetna Commercial |
$732.66
|
| Rate for Payer: Aetna Medicare |
$430.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.27
|
| Rate for Payer: BCBS Complete |
$344.78
|
| Rate for Payer: Cash Price |
$689.56
|
| Rate for Payer: Cofinity Commercial |
$603.36
|
| Rate for Payer: Cofinity Commercial |
$741.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$603.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.56
|
| Rate for Payer: Healthscope Commercial |
$775.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$603.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.66
|
| Rate for Payer: PHP Commercial |
$732.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.27
|
| Rate for Payer: Priority Health SBD |
$543.03
|
| Rate for Payer: UMR Bronson Commercial |
$318.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.46
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$50.75
|
|
|
Service Code
|
NDC 00517083001
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna Medicare |
$25.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: BCBS Complete |
$20.30
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$35.52
|
| Rate for Payer: Cofinity Commercial |
$43.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.60
|
| Rate for Payer: Healthscope Commercial |
$45.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.14
|
| Rate for Payer: PHP Commercial |
$43.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.99
|
| Rate for Payer: Priority Health SBD |
$31.97
|
| Rate for Payer: UMR Bronson Commercial |
$18.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.06
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$26.46
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.64 |
| Max. Negotiated Rate |
$23.81 |
| Rate for Payer: Aetna American Axle |
$17.20
|
| Rate for Payer: Aetna Commercial |
$22.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.20
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Cofinity Commercial |
$22.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.17
|
| Rate for Payer: Healthscope Commercial |
$23.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.49
|
| Rate for Payer: PHP Commercial |
$22.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.20
|
| Rate for Payer: Priority Health SBD |
$16.67
|
| Rate for Payer: UMR Bronson Commercial |
$11.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.84
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$50.75
|
|
|
Service Code
|
NDC 17478062512
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$35.52
|
| Rate for Payer: Cofinity Commercial |
$43.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.60
|
| Rate for Payer: Healthscope Commercial |
$45.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.14
|
| Rate for Payer: PHP Commercial |
$43.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.99
|
| Rate for Payer: Priority Health SBD |
$31.97
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.06
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$861.95
|
|
|
Service Code
|
NDC 00013830304
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$379.26 |
| Max. Negotiated Rate |
$775.76 |
| Rate for Payer: Aetna American Axle |
$560.27
|
| Rate for Payer: Aetna Commercial |
$732.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.27
|
| Rate for Payer: Cash Price |
$689.56
|
| Rate for Payer: Cofinity Commercial |
$603.36
|
| Rate for Payer: Cofinity Commercial |
$741.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$603.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.56
|
| Rate for Payer: Healthscope Commercial |
$775.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$603.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$732.66
|
| Rate for Payer: PHP Commercial |
$732.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.27
|
| Rate for Payer: Priority Health SBD |
$543.03
|
| Rate for Payer: UMR Bronson Commercial |
$379.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.46
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$11.21
|
|
|
Service Code
|
NDC 59762033302
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Aetna American Axle |
$7.29
|
| Rate for Payer: Aetna Commercial |
$9.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.29
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.53
|
| Rate for Payer: PHP Commercial |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.29
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.41
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$26.46
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$23.81 |
| Rate for Payer: Aetna American Axle |
$17.20
|
| Rate for Payer: Aetna Commercial |
$22.49
|
| Rate for Payer: Aetna Medicare |
$13.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.20
|
| Rate for Payer: BCBS Complete |
$10.58
|
| Rate for Payer: Cash Price |
$21.17
|
| Rate for Payer: Cofinity Commercial |
$18.52
|
| Rate for Payer: Cofinity Commercial |
$22.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.17
|
| Rate for Payer: Healthscope Commercial |
$23.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.49
|
| Rate for Payer: PHP Commercial |
$22.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.20
|
| Rate for Payer: Priority Health SBD |
$16.67
|
| Rate for Payer: UMR Bronson Commercial |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.84
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$59.85
|
|
|
Service Code
|
NDC 24208046325
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.33 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Aetna American Axle |
$38.90
|
| Rate for Payer: Aetna Commercial |
$50.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.90
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Cofinity Commercial |
$41.90
|
| Rate for Payer: Cofinity Commercial |
$51.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.88
|
| Rate for Payer: Healthscope Commercial |
$53.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.87
|
| Rate for Payer: PHP Commercial |
$50.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.90
|
| Rate for Payer: Priority Health SBD |
$37.71
|
| Rate for Payer: UMR Bronson Commercial |
$26.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.89
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$59.85
|
|
|
Service Code
|
NDC 24208046325
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.14 |
| Max. Negotiated Rate |
$53.86 |
| Rate for Payer: Aetna American Axle |
$38.90
|
| Rate for Payer: Aetna Commercial |
$50.87
|
| Rate for Payer: Aetna Medicare |
$29.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.90
|
| Rate for Payer: BCBS Complete |
$23.94
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Cofinity Commercial |
$41.90
|
| Rate for Payer: Cofinity Commercial |
$51.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.88
|
| Rate for Payer: Healthscope Commercial |
$53.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.87
|
| Rate for Payer: PHP Commercial |
$50.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.90
|
| Rate for Payer: Priority Health SBD |
$37.71
|
| Rate for Payer: UMR Bronson Commercial |
$22.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.89
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$50.75
|
|
|
Service Code
|
NDC 17478062512
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna Medicare |
$25.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: BCBS Complete |
$20.30
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$35.52
|
| Rate for Payer: Cofinity Commercial |
$43.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.60
|
| Rate for Payer: Healthscope Commercial |
$45.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.14
|
| Rate for Payer: PHP Commercial |
$43.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.99
|
| Rate for Payer: Priority Health SBD |
$31.97
|
| Rate for Payer: UMR Bronson Commercial |
$18.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.06
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
OP
|
$11.21
|
|
|
Service Code
|
NDC 59762033302
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$10.09 |
| Rate for Payer: Aetna American Axle |
$7.29
|
| Rate for Payer: Aetna Commercial |
$9.53
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.29
|
| Rate for Payer: BCBS Complete |
$4.48
|
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$10.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.53
|
| Rate for Payer: PHP Commercial |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.29
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.41
|
|
|
LATANOPROST 0.005 % EYE DROPS
|
Facility
|
IP
|
$50.75
|
|
|
Service Code
|
NDC 00517083001
|
| Hospital Charge Code |
18621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna American Axle |
$32.99
|
| Rate for Payer: Aetna Commercial |
$43.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.99
|
| Rate for Payer: Cash Price |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$35.52
|
| Rate for Payer: Cofinity Commercial |
$43.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.60
|
| Rate for Payer: Healthscope Commercial |
$45.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.14
|
| Rate for Payer: PHP Commercial |
$43.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.99
|
| Rate for Payer: Priority Health SBD |
$31.97
|
| Rate for Payer: UMR Bronson Commercial |
$22.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.06
|
|
|
LATERAL RETINACULAR RELEASE, OPEN
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 27425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$441.66 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$485.83
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$441.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
LAVAGE BY CANNULATION; MAXILLARY SINUS (ANTRUM PUNCTURE OR NATURAL OSTIUM)
|
Facility
|
OP
|
$715.11
|
|
|
Service Code
|
CPT 31000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.89 |
| Max. Negotiated Rate |
$715.11 |
| Rate for Payer: Aetna Medicare |
$236.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$284.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$284.40
|
| Rate for Payer: BCBS Complete |
$128.05
|
| Rate for Payer: BCBS MAPPO |
$227.52
|
| Rate for Payer: BCBS Trust/PPO |
$126.71
|
| Rate for Payer: BCN Commercial |
$126.71
|
| Rate for Payer: BCN Medicare Advantage |
$227.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.52
|
| Rate for Payer: Mclaren Medicaid |
$121.95
|
| Rate for Payer: Mclaren Medicare |
$227.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.90
|
| Rate for Payer: Meridian Medicaid |
$128.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.65
|
| Rate for Payer: Nomi Health Commercial |
$477.79
|
| Rate for Payer: PACE Medicare |
$216.14
|
| Rate for Payer: PACE SWMI |
$227.52
|
| Rate for Payer: PHP Medicare Advantage |
$227.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.11
|
| Rate for Payer: Priority Health Medicare |
$227.52
|
| Rate for Payer: Priority Health Narrow Network |
$572.09
|
| Rate for Payer: Railroad Medicare Medicare |
$227.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.38
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.52
|
| Rate for Payer: UHC Exchange |
$104.89
|
| Rate for Payer: UHC Medicare Advantage |
$227.52
|
| Rate for Payer: UHCCP Medicaid |
$121.95
|
| Rate for Payer: VA VA |
$227.52
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$527.25
|
|
|
Service Code
|
NDC 00955173730
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.99 |
| Max. Negotiated Rate |
$474.52 |
| Rate for Payer: Aetna American Axle |
$342.71
|
| Rate for Payer: Aetna Commercial |
$448.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.71
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cofinity Commercial |
$369.08
|
| Rate for Payer: Cofinity Commercial |
$453.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$369.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.80
|
| Rate for Payer: Healthscope Commercial |
$474.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.16
|
| Rate for Payer: PHP Commercial |
$448.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.71
|
| Rate for Payer: Priority Health SBD |
$332.17
|
| Rate for Payer: UMR Bronson Commercial |
$231.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.44
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
OP
|
$355.20
|
|
|
Service Code
|
NDC 50268047815
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.42 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna American Axle |
$230.88
|
| Rate for Payer: Aetna Commercial |
$301.92
|
| Rate for Payer: Aetna Medicare |
$177.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.88
|
| Rate for Payer: BCBS Complete |
$142.08
|
| Rate for Payer: Cash Price |
$284.16
|
| Rate for Payer: Cofinity Commercial |
$248.64
|
| Rate for Payer: Cofinity Commercial |
$305.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.16
|
| Rate for Payer: Healthscope Commercial |
$319.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.92
|
| Rate for Payer: PHP Commercial |
$301.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.88
|
| Rate for Payer: Priority Health SBD |
$223.78
|
| Rate for Payer: UMR Bronson Commercial |
$131.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.40
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
OP
|
$93.46
|
|
|
Service Code
|
NDC 23155004403
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$84.11 |
| Rate for Payer: Aetna American Axle |
$60.75
|
| Rate for Payer: Aetna Commercial |
$79.44
|
| Rate for Payer: Aetna Medicare |
$46.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.75
|
| Rate for Payer: BCBS Complete |
$37.38
|
| Rate for Payer: Cash Price |
$74.77
|
| Rate for Payer: Cofinity Commercial |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$80.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.77
|
| Rate for Payer: Healthscope Commercial |
$84.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.44
|
| Rate for Payer: PHP Commercial |
$79.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.75
|
| Rate for Payer: Priority Health SBD |
$58.88
|
| Rate for Payer: UMR Bronson Commercial |
$34.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.10
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$355.20
|
|
|
Service Code
|
NDC 50268047815
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.29 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna American Axle |
$230.88
|
| Rate for Payer: Aetna Commercial |
$301.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.88
|
| Rate for Payer: Cash Price |
$284.16
|
| Rate for Payer: Cofinity Commercial |
$248.64
|
| Rate for Payer: Cofinity Commercial |
$305.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.16
|
| Rate for Payer: Healthscope Commercial |
$319.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.92
|
| Rate for Payer: PHP Commercial |
$301.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.88
|
| Rate for Payer: Priority Health SBD |
$223.78
|
| Rate for Payer: UMR Bronson Commercial |
$156.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.40
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$7.11
|
|
|
Service Code
|
NDC 50268047811
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: Aetna American Axle |
$4.62
|
| Rate for Payer: Aetna Commercial |
$6.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.62
|
| Rate for Payer: Cash Price |
$5.69
|
| Rate for Payer: Cofinity Commercial |
$4.98
|
| Rate for Payer: Cofinity Commercial |
$6.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.69
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.04
|
| Rate for Payer: PHP Commercial |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.62
|
| Rate for Payer: Priority Health SBD |
$4.48
|
| Rate for Payer: UMR Bronson Commercial |
$3.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.33
|
|
|
LEFLUNOMIDE 20 MG TABLET
|
Facility
|
IP
|
$93.46
|
|
|
Service Code
|
NDC 23155004403
|
| Hospital Charge Code |
23873
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.12 |
| Max. Negotiated Rate |
$84.11 |
| Rate for Payer: Aetna American Axle |
$60.75
|
| Rate for Payer: Aetna Commercial |
$79.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.75
|
| Rate for Payer: Cash Price |
$74.77
|
| Rate for Payer: Cofinity Commercial |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$80.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.77
|
| Rate for Payer: Healthscope Commercial |
$84.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.44
|
| Rate for Payer: PHP Commercial |
$79.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.75
|
| Rate for Payer: Priority Health SBD |
$58.88
|
| Rate for Payer: UMR Bronson Commercial |
$41.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.10
|
|
