|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$10,484.48
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$9,436.03 |
| Rate for Payer: Aetna American Axle |
$6,814.91
|
| Rate for Payer: Aetna Commercial |
$8,911.81
|
| Rate for Payer: Aetna Medicare |
$42.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,814.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.60
|
| Rate for Payer: BCBS Complete |
$23.23
|
| Rate for Payer: BCBS MAPPO |
$41.28
|
| Rate for Payer: BCBS Trust/PPO |
$109.51
|
| Rate for Payer: BCN Commercial |
$109.51
|
| Rate for Payer: BCN Medicare Advantage |
$41.28
|
| Rate for Payer: Cash Price |
$8,387.58
|
| Rate for Payer: Cash Price |
$8,387.58
|
| Rate for Payer: Cofinity Commercial |
$9,016.65
|
| Rate for Payer: Cofinity Commercial |
$7,339.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,339.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,387.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$9,436.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,339.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,863.36
|
| Rate for Payer: Mclaren Medicaid |
$22.13
|
| Rate for Payer: Mclaren Medicare |
$41.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.34
|
| Rate for Payer: Meridian Medicaid |
$23.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,911.81
|
| Rate for Payer: Nomi Health Commercial |
$123.84
|
| Rate for Payer: PACE Medicare |
$39.22
|
| Rate for Payer: PACE SWMI |
$41.28
|
| Rate for Payer: PHP Commercial |
$8,911.81
|
| Rate for Payer: PHP Medicare Advantage |
$41.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,814.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.89
|
| Rate for Payer: Priority Health Medicare |
$41.28
|
| Rate for Payer: Priority Health Narrow Network |
$93.51
|
| Rate for Payer: Priority Health SBD |
$6,605.22
|
| Rate for Payer: Railroad Medicare Medicare |
$41.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.28
|
| Rate for Payer: UHC Exchange |
$78.89
|
| Rate for Payer: UHC Medicare Advantage |
$41.28
|
| Rate for Payer: UHCCP Medicaid |
$22.13
|
| Rate for Payer: UMR Bronson Commercial |
$3,879.26
|
| Rate for Payer: VA VA |
$41.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,863.36
|
|
|
LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$10,484.48
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,613.17 |
| Max. Negotiated Rate |
$9,436.03 |
| Rate for Payer: Aetna American Axle |
$6,814.91
|
| Rate for Payer: Aetna Commercial |
$8,911.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,814.91
|
| Rate for Payer: Cash Price |
$8,387.58
|
| Rate for Payer: Cofinity Commercial |
$7,339.14
|
| Rate for Payer: Cofinity Commercial |
$9,016.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,339.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,387.58
|
| Rate for Payer: Healthscope Commercial |
$9,436.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,339.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,863.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,911.81
|
| Rate for Payer: PHP Commercial |
$8,911.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,814.91
|
| Rate for Payer: Priority Health SBD |
$6,605.22
|
| Rate for Payer: UMR Bronson Commercial |
$4,613.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,863.36
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$31,453.30
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,839.45 |
| Max. Negotiated Rate |
$28,307.97 |
| Rate for Payer: Aetna American Axle |
$20,444.64
|
| Rate for Payer: Aetna Commercial |
$26,735.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,444.64
|
| Rate for Payer: Cash Price |
$25,162.64
|
| Rate for Payer: Cofinity Commercial |
$22,017.31
|
| Rate for Payer: Cofinity Commercial |
$27,049.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$22,017.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,162.64
|
| Rate for Payer: Healthscope Commercial |
$28,307.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22,017.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,589.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,735.30
|
| Rate for Payer: PHP Commercial |
$26,735.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,444.64
|
| Rate for Payer: Priority Health SBD |
$19,815.58
|
| Rate for Payer: UMR Bronson Commercial |
$13,839.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,589.98
|
|
|
LUSPATERCEPT-AAMT 75 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$31,453.30
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
192115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$28,307.97 |
| Rate for Payer: Aetna American Axle |
$20,444.64
|
| Rate for Payer: Aetna Commercial |
$26,735.30
|
| Rate for Payer: Aetna Medicare |
$42.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,444.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.60
|
| Rate for Payer: BCBS Complete |
$23.23
|
| Rate for Payer: BCBS MAPPO |
$41.28
|
| Rate for Payer: BCBS Trust/PPO |
$109.51
|
| Rate for Payer: BCN Commercial |
$109.51
|
| Rate for Payer: BCN Medicare Advantage |
$41.28
|
| Rate for Payer: Cash Price |
$25,162.64
|
| Rate for Payer: Cash Price |
$25,162.64
|
| Rate for Payer: Cofinity Commercial |
$27,049.84
|
| Rate for Payer: Cofinity Commercial |
$22,017.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$22,017.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25,162.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$28,307.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22,017.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,589.98
|
| Rate for Payer: Mclaren Medicaid |
$22.13
|
| Rate for Payer: Mclaren Medicare |
$41.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.34
|
| Rate for Payer: Meridian Medicaid |
$23.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,735.30
|
| Rate for Payer: Nomi Health Commercial |
$123.84
|
| Rate for Payer: PACE Medicare |
$39.22
|
| Rate for Payer: PACE SWMI |
$41.28
|
| Rate for Payer: PHP Commercial |
$26,735.30
|
| Rate for Payer: PHP Medicare Advantage |
$41.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,444.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.89
|
| Rate for Payer: Priority Health Medicare |
$41.28
|
| Rate for Payer: Priority Health Narrow Network |
$93.51
|
| Rate for Payer: Priority Health SBD |
$19,815.58
|
| Rate for Payer: Railroad Medicare Medicare |
$41.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.28
|
| Rate for Payer: UHC Exchange |
$78.89
|
| Rate for Payer: UHC Medicare Advantage |
$41.28
|
| Rate for Payer: UHCCP Medicaid |
$22.13
|
| Rate for Payer: UMR Bronson Commercial |
$11,637.72
|
| Rate for Payer: VA VA |
$41.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,589.98
|
|
|
LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,655.36
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
10475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,334.67 |
| Max. Negotiated Rate |
$13,067.19 |
| Rate for Payer: Aetna American Axle |
$7,575.98
|
| Rate for Payer: Aetna Commercial |
$9,907.06
|
| Rate for Payer: Aetna Medicare |
$4,529.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,575.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,444.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,444.66
|
| Rate for Payer: BCBS Complete |
$2,451.40
|
| Rate for Payer: BCBS MAPPO |
$4,355.73
|
| Rate for Payer: BCBS Trust/PPO |
$11,744.49
|
| Rate for Payer: BCN Commercial |
$11,744.49
|
| Rate for Payer: BCN Medicare Advantage |
$4,355.73
|
| Rate for Payer: Cash Price |
$9,324.29
|
| Rate for Payer: Cash Price |
$9,324.29
|
| Rate for Payer: Cofinity Commercial |
$8,158.75
|
| Rate for Payer: Cofinity Commercial |
$10,023.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,158.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,324.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,355.73
|
| Rate for Payer: Healthscope Commercial |
$10,489.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,158.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,741.52
|
| Rate for Payer: Mclaren Medicaid |
$2,334.67
|
| Rate for Payer: Mclaren Medicare |
$4,355.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,573.52
|
| Rate for Payer: Meridian Medicaid |
$2,451.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,009.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,907.06
|
| Rate for Payer: Nomi Health Commercial |
$13,067.19
|
| Rate for Payer: PACE Medicare |
$4,137.94
|
| Rate for Payer: PACE SWMI |
$4,355.73
|
| Rate for Payer: PHP Commercial |
$9,907.06
|
| Rate for Payer: PHP Medicare Advantage |
$4,355.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,334.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,575.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,421.27
|
| Rate for Payer: Priority Health Medicare |
$4,355.73
|
| Rate for Payer: Priority Health Narrow Network |
$9,137.02
|
| Rate for Payer: Priority Health SBD |
$7,342.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4,355.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,260.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,355.73
|
| Rate for Payer: UHC Exchange |
$8,324.24
|
| Rate for Payer: UHC Medicare Advantage |
$4,355.73
|
| Rate for Payer: UHCCP Medicaid |
$2,334.67
|
| Rate for Payer: UMR Bronson Commercial |
$4,312.48
|
| Rate for Payer: VA VA |
$4,355.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,741.52
|
|
|
LYMPHOCYTE,ANTI-THYMO IMMUNE GLOBULIN 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,655.36
|
|
|
Service Code
|
HCPCS J7504
|
| Hospital Charge Code |
10475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,128.36 |
| Max. Negotiated Rate |
$10,489.82 |
| Rate for Payer: Aetna American Axle |
$7,575.98
|
| Rate for Payer: Aetna Commercial |
$9,907.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,575.98
|
| Rate for Payer: Cash Price |
$9,324.29
|
| Rate for Payer: Cofinity Commercial |
$10,023.61
|
| Rate for Payer: Cofinity Commercial |
$8,158.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,158.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,324.29
|
| Rate for Payer: Healthscope Commercial |
$10,489.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,158.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,741.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,907.06
|
| Rate for Payer: PHP Commercial |
$9,907.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,575.98
|
| Rate for Payer: Priority Health SBD |
$7,342.88
|
| Rate for Payer: UMR Bronson Commercial |
$5,128.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,741.52
|
|
|
LYSIS INTRANASAL SYNECHIA
|
Facility
|
OP
|
$1,568.21
|
|
|
Service Code
|
CPT 30560
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.15 |
| Max. Negotiated Rate |
$1,568.21 |
| Rate for Payer: Aetna Medicare |
$518.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.69
|
| Rate for Payer: BCBS Complete |
$280.81
|
| Rate for Payer: BCBS MAPPO |
$498.95
|
| Rate for Payer: BCBS Trust/PPO |
$372.53
|
| Rate for Payer: BCN Commercial |
$372.53
|
| Rate for Payer: BCN Medicare Advantage |
$498.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.95
|
| Rate for Payer: Mclaren Medicaid |
$267.44
|
| Rate for Payer: Mclaren Medicare |
$498.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.90
|
| Rate for Payer: Meridian Medicaid |
$280.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.79
|
| Rate for Payer: Nomi Health Commercial |
$1,047.80
|
| Rate for Payer: PACE Medicare |
$474.00
|
| Rate for Payer: PACE SWMI |
$498.95
|
| Rate for Payer: PHP Medicare Advantage |
$498.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,568.21
|
| Rate for Payer: Priority Health Medicare |
$498.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,254.57
|
| Rate for Payer: Railroad Medicare Medicare |
$498.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.36
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.95
|
| Rate for Payer: UHC Exchange |
$142.15
|
| Rate for Payer: UHC Medicare Advantage |
$498.95
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: VA VA |
$498.95
|
|
|
LYSIS OF LABIAL ADHESIONS
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 56441
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$149.13 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,660.74
|
| Rate for Payer: BCN Commercial |
$1,660.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.04
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$149.13
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
LYSIS OR EXCISION OF PENILE POST-CIRCUMCISION ADHESIONS
|
Facility
|
OP
|
$6,308.24
|
|
|
Service Code
|
CPT 54162
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$192.68 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,883.77
|
| Rate for Payer: BCN Commercial |
$1,883.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.95
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$192.68
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
OP
|
$753.46
|
|
|
Service Code
|
NDC 51079062484
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.78 |
| Max. Negotiated Rate |
$678.11 |
| Rate for Payer: Aetna American Axle |
$489.75
|
| Rate for Payer: Aetna Commercial |
$640.44
|
| Rate for Payer: Aetna Medicare |
$376.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.75
|
| Rate for Payer: BCBS Complete |
$301.38
|
| Rate for Payer: Cash Price |
$602.77
|
| Rate for Payer: Cofinity Commercial |
$527.42
|
| Rate for Payer: Cofinity Commercial |
$647.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$527.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.77
|
| Rate for Payer: Healthscope Commercial |
$678.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$527.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$565.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.44
|
| Rate for Payer: PHP Commercial |
$640.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.75
|
| Rate for Payer: Priority Health SBD |
$474.68
|
| Rate for Payer: UMR Bronson Commercial |
$278.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$565.10
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
IP
|
$3,767.30
|
|
|
Service Code
|
NDC 51079062485
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,657.61 |
| Max. Negotiated Rate |
$3,390.57 |
| Rate for Payer: Aetna American Axle |
$2,448.74
|
| Rate for Payer: Aetna Commercial |
$3,202.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,448.74
|
| Rate for Payer: Cash Price |
$3,013.84
|
| Rate for Payer: Cofinity Commercial |
$2,637.11
|
| Rate for Payer: Cofinity Commercial |
$3,239.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,637.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.84
|
| Rate for Payer: Healthscope Commercial |
$3,390.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,637.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,825.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.20
|
| Rate for Payer: PHP Commercial |
$3,202.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,448.74
|
| Rate for Payer: Priority Health SBD |
$2,373.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,657.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,825.48
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
IP
|
$2,310.34
|
|
|
Service Code
|
NDC 49884090278
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,016.55 |
| Max. Negotiated Rate |
$2,079.31 |
| Rate for Payer: Aetna American Axle |
$1,501.72
|
| Rate for Payer: Aetna Commercial |
$1,963.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,501.72
|
| Rate for Payer: Cash Price |
$1,848.27
|
| Rate for Payer: Cofinity Commercial |
$1,617.24
|
| Rate for Payer: Cofinity Commercial |
$1,986.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,617.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,848.27
|
| Rate for Payer: Healthscope Commercial |
$2,079.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,617.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,732.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,963.79
|
| Rate for Payer: PHP Commercial |
$1,963.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,501.72
|
| Rate for Payer: Priority Health SBD |
$1,455.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,016.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,732.76
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
OP
|
$2,310.34
|
|
|
Service Code
|
NDC 49884090278
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$854.83 |
| Max. Negotiated Rate |
$2,079.31 |
| Rate for Payer: Aetna American Axle |
$1,501.72
|
| Rate for Payer: Aetna Commercial |
$1,963.79
|
| Rate for Payer: Aetna Medicare |
$1,155.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,501.72
|
| Rate for Payer: BCBS Complete |
$924.14
|
| Rate for Payer: Cash Price |
$1,848.27
|
| Rate for Payer: Cofinity Commercial |
$1,617.24
|
| Rate for Payer: Cofinity Commercial |
$1,986.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,617.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,848.27
|
| Rate for Payer: Healthscope Commercial |
$2,079.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,617.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,732.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,963.79
|
| Rate for Payer: PHP Commercial |
$1,963.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,501.72
|
| Rate for Payer: Priority Health SBD |
$1,455.51
|
| Rate for Payer: UMR Bronson Commercial |
$854.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,732.76
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
IP
|
$462.07
|
|
|
Service Code
|
NDC 49884090252
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.31 |
| Max. Negotiated Rate |
$415.86 |
| Rate for Payer: Aetna American Axle |
$300.35
|
| Rate for Payer: Aetna Commercial |
$392.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.35
|
| Rate for Payer: Cash Price |
$369.66
|
| Rate for Payer: Cofinity Commercial |
$323.45
|
| Rate for Payer: Cofinity Commercial |
$397.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$323.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.66
|
| Rate for Payer: Healthscope Commercial |
$415.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.76
|
| Rate for Payer: PHP Commercial |
$392.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.35
|
| Rate for Payer: Priority Health SBD |
$291.10
|
| Rate for Payer: UMR Bronson Commercial |
$203.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.55
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
OP
|
$462.07
|
|
|
Service Code
|
NDC 49884090252
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.97 |
| Max. Negotiated Rate |
$415.86 |
| Rate for Payer: Aetna American Axle |
$300.35
|
| Rate for Payer: Aetna Commercial |
$392.76
|
| Rate for Payer: Aetna Medicare |
$231.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.35
|
| Rate for Payer: BCBS Complete |
$184.83
|
| Rate for Payer: Cash Price |
$369.66
|
| Rate for Payer: Cofinity Commercial |
$323.45
|
| Rate for Payer: Cofinity Commercial |
$397.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$323.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.66
|
| Rate for Payer: Healthscope Commercial |
$415.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.76
|
| Rate for Payer: PHP Commercial |
$392.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.35
|
| Rate for Payer: Priority Health SBD |
$291.10
|
| Rate for Payer: UMR Bronson Commercial |
$170.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.55
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
OP
|
$3,767.30
|
|
|
Service Code
|
NDC 51079062485
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,393.90 |
| Max. Negotiated Rate |
$3,390.57 |
| Rate for Payer: Aetna American Axle |
$2,448.74
|
| Rate for Payer: Aetna Commercial |
$3,202.20
|
| Rate for Payer: Aetna Medicare |
$1,883.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,448.74
|
| Rate for Payer: BCBS Complete |
$1,506.92
|
| Rate for Payer: Cash Price |
$3,013.84
|
| Rate for Payer: Cofinity Commercial |
$2,637.11
|
| Rate for Payer: Cofinity Commercial |
$3,239.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,637.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,013.84
|
| Rate for Payer: Healthscope Commercial |
$3,390.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,637.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,825.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,202.20
|
| Rate for Payer: PHP Commercial |
$3,202.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,448.74
|
| Rate for Payer: Priority Health SBD |
$2,373.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,393.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,825.48
|
|
|
MAFENIDE 50 GRAM TOPICAL PACKET
|
Facility
|
IP
|
$753.46
|
|
|
Service Code
|
NDC 51079062484
|
| Hospital Charge Code |
23233
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.52 |
| Max. Negotiated Rate |
$678.11 |
| Rate for Payer: Aetna American Axle |
$489.75
|
| Rate for Payer: Aetna Commercial |
$640.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.75
|
| Rate for Payer: Cash Price |
$602.77
|
| Rate for Payer: Cofinity Commercial |
$527.42
|
| Rate for Payer: Cofinity Commercial |
$647.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$527.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.77
|
| Rate for Payer: Healthscope Commercial |
$678.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$527.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$565.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.44
|
| Rate for Payer: PHP Commercial |
$640.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.75
|
| Rate for Payer: Priority Health SBD |
$474.68
|
| Rate for Payer: UMR Bronson Commercial |
$331.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$565.10
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
IP
|
$197.66
|
|
|
Service Code
|
NDC 51079062381
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.97 |
| Max. Negotiated Rate |
$177.89 |
| Rate for Payer: Aetna American Axle |
$128.48
|
| Rate for Payer: Aetna Commercial |
$168.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.48
|
| Rate for Payer: Cash Price |
$158.13
|
| Rate for Payer: Cofinity Commercial |
$138.36
|
| Rate for Payer: Cofinity Commercial |
$169.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.13
|
| Rate for Payer: Healthscope Commercial |
$177.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.01
|
| Rate for Payer: PHP Commercial |
$168.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.48
|
| Rate for Payer: Priority Health SBD |
$124.53
|
| Rate for Payer: UMR Bronson Commercial |
$86.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.24
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
IP
|
$1,703.50
|
|
|
Service Code
|
NDC 16571072348
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$749.54 |
| Max. Negotiated Rate |
$1,533.15 |
| Rate for Payer: Aetna American Axle |
$1,107.28
|
| Rate for Payer: Aetna Commercial |
$1,447.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,107.28
|
| Rate for Payer: Cash Price |
$1,362.80
|
| Rate for Payer: Cofinity Commercial |
$1,192.45
|
| Rate for Payer: Cofinity Commercial |
$1,465.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,192.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,362.80
|
| Rate for Payer: Healthscope Commercial |
$1,533.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,192.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,277.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,447.98
|
| Rate for Payer: PHP Commercial |
$1,447.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,107.28
|
| Rate for Payer: Priority Health SBD |
$1,073.20
|
| Rate for Payer: UMR Bronson Commercial |
$749.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,277.62
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
OP
|
$247.27
|
|
|
Service Code
|
NDC 16571072360
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.49 |
| Max. Negotiated Rate |
$222.54 |
| Rate for Payer: Aetna American Axle |
$160.73
|
| Rate for Payer: Aetna Commercial |
$210.18
|
| Rate for Payer: Aetna Medicare |
$123.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.73
|
| Rate for Payer: BCBS Complete |
$98.91
|
| Rate for Payer: Cash Price |
$197.82
|
| Rate for Payer: Cofinity Commercial |
$173.09
|
| Rate for Payer: Cofinity Commercial |
$212.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.82
|
| Rate for Payer: Healthscope Commercial |
$222.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.18
|
| Rate for Payer: PHP Commercial |
$210.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.73
|
| Rate for Payer: Priority Health SBD |
$155.78
|
| Rate for Payer: UMR Bronson Commercial |
$91.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.45
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
OP
|
$197.66
|
|
|
Service Code
|
NDC 51079062381
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.13 |
| Max. Negotiated Rate |
$177.89 |
| Rate for Payer: Aetna American Axle |
$128.48
|
| Rate for Payer: Aetna Commercial |
$168.01
|
| Rate for Payer: Aetna Medicare |
$98.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.48
|
| Rate for Payer: BCBS Complete |
$79.06
|
| Rate for Payer: Cash Price |
$158.13
|
| Rate for Payer: Cofinity Commercial |
$138.36
|
| Rate for Payer: Cofinity Commercial |
$169.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.13
|
| Rate for Payer: Healthscope Commercial |
$177.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.01
|
| Rate for Payer: PHP Commercial |
$168.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.48
|
| Rate for Payer: Priority Health SBD |
$124.53
|
| Rate for Payer: UMR Bronson Commercial |
$73.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.24
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
OP
|
$1,362.17
|
|
|
Service Code
|
NDC 51079062383
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,225.95 |
| Rate for Payer: Aetna American Axle |
$885.41
|
| Rate for Payer: Aetna Commercial |
$1,157.84
|
| Rate for Payer: Aetna Medicare |
$681.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.41
|
| Rate for Payer: BCBS Complete |
$544.87
|
| Rate for Payer: Cash Price |
$1,089.74
|
| Rate for Payer: Cofinity Commercial |
$1,171.47
|
| Rate for Payer: Cofinity Commercial |
$953.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.74
|
| Rate for Payer: Healthscope Commercial |
$1,225.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$953.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,021.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.84
|
| Rate for Payer: PHP Commercial |
$1,157.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.41
|
| Rate for Payer: Priority Health SBD |
$858.17
|
| Rate for Payer: UMR Bronson Commercial |
$504.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,021.63
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
IP
|
$247.27
|
|
|
Service Code
|
NDC 16571072360
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$222.54 |
| Rate for Payer: Aetna American Axle |
$160.73
|
| Rate for Payer: Aetna Commercial |
$210.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.73
|
| Rate for Payer: Cash Price |
$197.82
|
| Rate for Payer: Cofinity Commercial |
$173.09
|
| Rate for Payer: Cofinity Commercial |
$212.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.82
|
| Rate for Payer: Healthscope Commercial |
$222.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.18
|
| Rate for Payer: PHP Commercial |
$210.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.73
|
| Rate for Payer: Priority Health SBD |
$155.78
|
| Rate for Payer: UMR Bronson Commercial |
$108.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.45
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
OP
|
$1,703.50
|
|
|
Service Code
|
NDC 16571072348
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$630.30 |
| Max. Negotiated Rate |
$1,533.15 |
| Rate for Payer: Aetna American Axle |
$1,107.28
|
| Rate for Payer: Aetna Commercial |
$1,447.98
|
| Rate for Payer: Aetna Medicare |
$851.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,107.28
|
| Rate for Payer: BCBS Complete |
$681.40
|
| Rate for Payer: Cash Price |
$1,362.80
|
| Rate for Payer: Cofinity Commercial |
$1,192.45
|
| Rate for Payer: Cofinity Commercial |
$1,465.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,192.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,362.80
|
| Rate for Payer: Healthscope Commercial |
$1,533.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,192.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,277.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,447.98
|
| Rate for Payer: PHP Commercial |
$1,447.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,107.28
|
| Rate for Payer: Priority Health SBD |
$1,073.20
|
| Rate for Payer: UMR Bronson Commercial |
$630.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,277.62
|
|
|
MAFENIDE 85 MG/G TOPICAL CREAM
|
Facility
|
IP
|
$1,362.17
|
|
|
Service Code
|
NDC 51079062383
|
| Hospital Charge Code |
10478
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$599.35 |
| Max. Negotiated Rate |
$1,225.95 |
| Rate for Payer: Aetna American Axle |
$885.41
|
| Rate for Payer: Aetna Commercial |
$1,157.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.41
|
| Rate for Payer: Cash Price |
$1,089.74
|
| Rate for Payer: Cofinity Commercial |
$1,171.47
|
| Rate for Payer: Cofinity Commercial |
$953.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.74
|
| Rate for Payer: Healthscope Commercial |
$1,225.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$953.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,021.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.84
|
| Rate for Payer: PHP Commercial |
$1,157.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.41
|
| Rate for Payer: Priority Health SBD |
$858.17
|
| Rate for Payer: UMR Bronson Commercial |
$599.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,021.63
|
|
