|
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE); NECK
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 37615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$496.82 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$638.95
|
| Rate for Payer: BCN Commercial |
$638.95
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$546.50
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$496.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
LIGATION OF PERFORATOR VEINS, SUBFASCIAL, RADICAL (LINTON TYPE), INCLUDING SKIN GRAFT, WHEN PERFORMED, OPEN,1 LEG
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 37760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$561.52 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.94
|
| Rate for Payer: BCN Commercial |
$2,317.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.67
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$561.52
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 37607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$361.30 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,986.82
|
| Rate for Payer: BCN Commercial |
$1,986.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.43
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$361.30
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
LIGATION OR BIOPSY, TEMPORAL ARTERY
|
Facility
|
OP
|
$4,989.41
|
|
|
Service Code
|
CPT 37609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$196.64 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,832.84
|
| Rate for Payer: BCN Commercial |
$2,832.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.30
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$196.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
LINACLOTIDE 145 MCG CAPSULE
|
Facility
|
IP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120130
|
| Hospital Charge Code |
163662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$859.49 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$859.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINACLOTIDE 145 MCG CAPSULE
|
Facility
|
OP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120130
|
| Hospital Charge Code |
163662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$722.75 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna Medicare |
$976.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: BCBS Complete |
$781.35
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$722.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINACLOTIDE 145 MCG CAPSULE
|
Facility
|
OP
|
$226.27
|
|
|
Service Code
|
NDC 00456120104
|
| Hospital Charge Code |
163662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.72 |
| Max. Negotiated Rate |
$203.64 |
| Rate for Payer: Aetna American Axle |
$147.08
|
| Rate for Payer: Aetna Commercial |
$192.33
|
| Rate for Payer: Aetna Medicare |
$113.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.08
|
| Rate for Payer: BCBS Complete |
$90.51
|
| Rate for Payer: Cash Price |
$181.02
|
| Rate for Payer: Cofinity Commercial |
$158.39
|
| Rate for Payer: Cofinity Commercial |
$194.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.02
|
| Rate for Payer: Healthscope Commercial |
$203.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.33
|
| Rate for Payer: PHP Commercial |
$192.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.08
|
| Rate for Payer: Priority Health SBD |
$142.55
|
| Rate for Payer: UMR Bronson Commercial |
$83.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.70
|
|
|
LINACLOTIDE 145 MCG CAPSULE
|
Facility
|
IP
|
$226.27
|
|
|
Service Code
|
NDC 00456120104
|
| Hospital Charge Code |
163662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.56 |
| Max. Negotiated Rate |
$203.64 |
| Rate for Payer: Aetna American Axle |
$147.08
|
| Rate for Payer: Aetna Commercial |
$192.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.08
|
| Rate for Payer: Cash Price |
$181.02
|
| Rate for Payer: Cofinity Commercial |
$158.39
|
| Rate for Payer: Cofinity Commercial |
$194.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.02
|
| Rate for Payer: Healthscope Commercial |
$203.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.33
|
| Rate for Payer: PHP Commercial |
$192.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.08
|
| Rate for Payer: Priority Health SBD |
$142.55
|
| Rate for Payer: UMR Bronson Commercial |
$99.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.70
|
|
|
LINACLOTIDE 290 MCG CAPSULE
|
Facility
|
OP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120230
|
| Hospital Charge Code |
163663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$722.75 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna Medicare |
$976.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: BCBS Complete |
$781.35
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$722.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINACLOTIDE 290 MCG CAPSULE
|
Facility
|
IP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120230
|
| Hospital Charge Code |
163663
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$859.49 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$859.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINACLOTIDE 72 MCG CAPSULE
|
Facility
|
IP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120330
|
| Hospital Charge Code |
182047
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$859.49 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$859.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINACLOTIDE 72 MCG CAPSULE
|
Facility
|
OP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120330
|
| Hospital Charge Code |
182047
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$722.75 |
| Max. Negotiated Rate |
$1,758.04 |
| Rate for Payer: Aetna American Axle |
$1,269.70
|
| Rate for Payer: Aetna Commercial |
$1,660.37
|
| Rate for Payer: Aetna Medicare |
$976.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.70
|
| Rate for Payer: BCBS Complete |
$781.35
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,367.37
|
| Rate for Payer: Cofinity Commercial |
$1,679.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,367.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,758.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,367.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,465.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: PHP Commercial |
$1,660.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health SBD |
$1,230.63
|
| Rate for Payer: UMR Bronson Commercial |
$722.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,465.04
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
IP
|
$4,697.89
|
|
|
Service Code
|
NDC 00597014061
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,067.07 |
| Max. Negotiated Rate |
$4,228.10 |
| Rate for Payer: Aetna American Axle |
$3,053.63
|
| Rate for Payer: Aetna Commercial |
$3,993.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,053.63
|
| Rate for Payer: Cash Price |
$3,758.31
|
| Rate for Payer: Cofinity Commercial |
$3,288.52
|
| Rate for Payer: Cofinity Commercial |
$4,040.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,288.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,758.31
|
| Rate for Payer: Healthscope Commercial |
$4,228.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,288.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,523.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,993.21
|
| Rate for Payer: PHP Commercial |
$3,993.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,053.63
|
| Rate for Payer: Priority Health SBD |
$2,959.67
|
| Rate for Payer: UMR Bronson Commercial |
$2,067.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,523.42
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
OP
|
$4,697.89
|
|
|
Service Code
|
NDC 00597014061
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,738.22 |
| Max. Negotiated Rate |
$4,228.10 |
| Rate for Payer: Aetna American Axle |
$3,053.63
|
| Rate for Payer: Aetna Commercial |
$3,993.21
|
| Rate for Payer: Aetna Medicare |
$2,348.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,053.63
|
| Rate for Payer: BCBS Complete |
$1,879.16
|
| Rate for Payer: Cash Price |
$3,758.31
|
| Rate for Payer: Cofinity Commercial |
$3,288.52
|
| Rate for Payer: Cofinity Commercial |
$4,040.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,288.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,758.31
|
| Rate for Payer: Healthscope Commercial |
$4,228.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,288.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,523.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,993.21
|
| Rate for Payer: PHP Commercial |
$3,993.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,053.63
|
| Rate for Payer: Priority Health SBD |
$2,959.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,738.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,523.42
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,691.09
|
|
|
Service Code
|
NDC 59762130804
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$625.70 |
| Max. Negotiated Rate |
$1,521.98 |
| Rate for Payer: Aetna American Axle |
$1,099.21
|
| Rate for Payer: Aetna Commercial |
$1,437.43
|
| Rate for Payer: Aetna Medicare |
$845.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,099.21
|
| Rate for Payer: BCBS Complete |
$676.44
|
| Rate for Payer: Cash Price |
$1,352.87
|
| Rate for Payer: Cofinity Commercial |
$1,183.76
|
| Rate for Payer: Cofinity Commercial |
$1,454.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,183.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.87
|
| Rate for Payer: Healthscope Commercial |
$1,521.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,183.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,268.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,437.43
|
| Rate for Payer: PHP Commercial |
$1,437.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.21
|
| Rate for Payer: Priority Health SBD |
$1,065.39
|
| Rate for Payer: UMR Bronson Commercial |
$625.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,268.32
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
NDC 59762130801
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Aetna American Axle |
$724.75
|
| Rate for Payer: Aetna Commercial |
$947.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.75
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cofinity Commercial |
$780.50
|
| Rate for Payer: Cofinity Commercial |
$958.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.00
|
| Rate for Payer: Healthscope Commercial |
$1,003.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$836.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.75
|
| Rate for Payer: PHP Commercial |
$947.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.75
|
| Rate for Payer: Priority Health SBD |
$702.45
|
| Rate for Payer: UMR Bronson Commercial |
$490.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$836.25
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2,352.65
|
|
|
Service Code
|
NDC 00009513601
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$870.48 |
| Max. Negotiated Rate |
$2,117.38 |
| Rate for Payer: Aetna American Axle |
$1,529.22
|
| Rate for Payer: Aetna Commercial |
$1,999.75
|
| Rate for Payer: Aetna Medicare |
$1,176.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,529.22
|
| Rate for Payer: BCBS Complete |
$941.06
|
| Rate for Payer: Cash Price |
$1,882.12
|
| Rate for Payer: Cofinity Commercial |
$1,646.86
|
| Rate for Payer: Cofinity Commercial |
$2,023.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,646.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,882.12
|
| Rate for Payer: Healthscope Commercial |
$2,117.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,646.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,764.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,999.75
|
| Rate for Payer: PHP Commercial |
$1,999.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,529.22
|
| Rate for Payer: Priority Health SBD |
$1,482.17
|
| Rate for Payer: UMR Bronson Commercial |
$870.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,764.49
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
NDC 59762130801
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.55 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Aetna American Axle |
$724.75
|
| Rate for Payer: Aetna Commercial |
$947.75
|
| Rate for Payer: Aetna Medicare |
$557.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.75
|
| Rate for Payer: BCBS Complete |
$446.00
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cofinity Commercial |
$780.50
|
| Rate for Payer: Cofinity Commercial |
$958.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.00
|
| Rate for Payer: Healthscope Commercial |
$1,003.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$836.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.75
|
| Rate for Payer: PHP Commercial |
$947.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.75
|
| Rate for Payer: Priority Health SBD |
$702.45
|
| Rate for Payer: UMR Bronson Commercial |
$412.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$836.25
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2,361.53
|
|
|
Service Code
|
NDC 00054031950
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$873.77 |
| Max. Negotiated Rate |
$2,125.38 |
| Rate for Payer: Aetna American Axle |
$1,534.99
|
| Rate for Payer: Aetna Commercial |
$2,007.30
|
| Rate for Payer: Aetna Medicare |
$1,180.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.99
|
| Rate for Payer: BCBS Complete |
$944.61
|
| Rate for Payer: Cash Price |
$1,889.22
|
| Rate for Payer: Cofinity Commercial |
$1,653.07
|
| Rate for Payer: Cofinity Commercial |
$2,030.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,653.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,889.22
|
| Rate for Payer: Healthscope Commercial |
$2,125.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,653.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,771.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,007.30
|
| Rate for Payer: PHP Commercial |
$2,007.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.99
|
| Rate for Payer: Priority Health SBD |
$1,487.76
|
| Rate for Payer: UMR Bronson Commercial |
$873.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,771.15
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2,361.53
|
|
|
Service Code
|
NDC 00054031950
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,039.07 |
| Max. Negotiated Rate |
$2,125.38 |
| Rate for Payer: Aetna American Axle |
$1,534.99
|
| Rate for Payer: Aetna Commercial |
$2,007.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.99
|
| Rate for Payer: Cash Price |
$1,889.22
|
| Rate for Payer: Cofinity Commercial |
$1,653.07
|
| Rate for Payer: Cofinity Commercial |
$2,030.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,653.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,889.22
|
| Rate for Payer: Healthscope Commercial |
$2,125.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,653.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,771.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,007.30
|
| Rate for Payer: PHP Commercial |
$2,007.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.99
|
| Rate for Payer: Priority Health SBD |
$1,487.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,039.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,771.15
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2,352.65
|
|
|
Service Code
|
NDC 00009513601
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,035.17 |
| Max. Negotiated Rate |
$2,117.38 |
| Rate for Payer: Aetna American Axle |
$1,529.22
|
| Rate for Payer: Aetna Commercial |
$1,999.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,529.22
|
| Rate for Payer: Cash Price |
$1,882.12
|
| Rate for Payer: Cofinity Commercial |
$1,646.86
|
| Rate for Payer: Cofinity Commercial |
$2,023.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,646.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,882.12
|
| Rate for Payer: Healthscope Commercial |
$2,117.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,646.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,764.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,999.75
|
| Rate for Payer: PHP Commercial |
$1,999.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,529.22
|
| Rate for Payer: Priority Health SBD |
$1,482.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,035.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,764.49
|
|
|
LINEZOLID 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,691.09
|
|
|
Service Code
|
NDC 59762130804
|
| Hospital Charge Code |
28225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$744.08 |
| Max. Negotiated Rate |
$1,521.98 |
| Rate for Payer: Cofinity Commercial |
$1,183.76
|
| Rate for Payer: Cofinity Commercial |
$1,454.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,183.76
|
| Rate for Payer: Aetna American Axle |
$1,099.21
|
| Rate for Payer: Aetna Commercial |
$1,437.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,099.21
|
| Rate for Payer: Cash Price |
$1,352.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,352.87
|
| Rate for Payer: Healthscope Commercial |
$1,521.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,183.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,268.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,437.43
|
| Rate for Payer: PHP Commercial |
$1,437.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,099.21
|
| Rate for Payer: Priority Health SBD |
$1,065.39
|
| Rate for Payer: UMR Bronson Commercial |
$744.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,268.32
|
|
|
LINEZOLID 600 MG/300 ML INTRAVENOUS (PEDS)
|
Facility
|
OP
|
$139.20
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
180001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: BCBS Complete |
$55.68
|
| Rate for Payer: BCBS Trust/PPO |
$8.28
|
| Rate for Payer: BCN Commercial |
$8.28
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
LINEZOLID 600 MG/300 ML INTRAVENOUS (PEDS)
|
Facility
|
IP
|
$139.20
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
180001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Cofinity Commercial |
$97.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.48
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$120.44
|
|
|
Service Code
|
NDC 67877041933
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.56 |
| Max. Negotiated Rate |
$108.40 |
| Rate for Payer: Aetna American Axle |
$78.29
|
| Rate for Payer: Aetna Commercial |
$102.37
|
| Rate for Payer: Aetna Medicare |
$60.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.29
|
| Rate for Payer: BCBS Complete |
$48.18
|
| Rate for Payer: Cash Price |
$96.35
|
| Rate for Payer: Cofinity Commercial |
$103.58
|
| Rate for Payer: Cofinity Commercial |
$84.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.35
|
| Rate for Payer: Healthscope Commercial |
$108.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.37
|
| Rate for Payer: PHP Commercial |
$102.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.29
|
| Rate for Payer: Priority Health SBD |
$75.88
|
| Rate for Payer: UMR Bronson Commercial |
$44.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.33
|
|
