|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
OP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna American Axle |
$7.55
|
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna Medicare |
$5.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.55
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: BCBS Trust/PPO |
$9.83
|
| Rate for Payer: BCN Commercial |
$9.83
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Advantage |
$8.13
|
| Rate for Payer: Cofinity Commercial |
$9.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.71
|
| Rate for Payer: PHP Commercial |
$9.88
|
| Rate for Payer: Priority Health SBD |
$7.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.02
|
| Rate for Payer: UHC Core |
$5.02
|
| Rate for Payer: UHC Exchange |
$5.02
|
| Rate for Payer: UMR Bronson Commercial |
$4.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
|
|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna American Axle |
$7.55
|
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.55
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Advantage |
$8.13
|
| Rate for Payer: Cofinity Commercial |
$9.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.71
|
| Rate for Payer: PHP Commercial |
$9.88
|
| Rate for Payer: Priority Health SBD |
$7.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
|
|
MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$102.85
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
29464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$92.56 |
| Rate for Payer: Aetna American Axle |
$66.85
|
| Rate for Payer: Aetna American Axle |
$87.46
|
| Rate for Payer: Aetna Commercial |
$87.42
|
| Rate for Payer: Aetna Commercial |
$114.37
|
| Rate for Payer: Aetna Medicare |
$51.42
|
| Rate for Payer: Aetna Medicare |
$67.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.46
|
| Rate for Payer: BCBS Complete |
$53.82
|
| Rate for Payer: BCBS Complete |
$41.14
|
| Rate for Payer: BCBS Trust/PPO |
$43.73
|
| Rate for Payer: BCBS Trust/PPO |
$43.73
|
| Rate for Payer: BCN Commercial |
$43.73
|
| Rate for Payer: BCN Commercial |
$43.73
|
| Rate for Payer: Cash Price |
$82.28
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Cash Price |
$82.28
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Cofinity Advantage |
$72.00
|
| Rate for Payer: Cofinity Advantage |
$94.19
|
| Rate for Payer: Cofinity Commercial |
$88.45
|
| Rate for Payer: Cofinity Commercial |
$115.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.64
|
| Rate for Payer: Healthscope Commercial |
$92.56
|
| Rate for Payer: Healthscope Commercial |
$121.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.14
|
| Rate for Payer: PHP Commercial |
$87.42
|
| Rate for Payer: PHP Commercial |
$114.37
|
| Rate for Payer: Priority Health SBD |
$64.80
|
| Rate for Payer: Priority Health SBD |
$84.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.28
|
| Rate for Payer: UHC Core |
$22.28
|
| Rate for Payer: UHC Core |
$22.28
|
| Rate for Payer: UHC Exchange |
$22.28
|
| Rate for Payer: UHC Exchange |
$22.28
|
| Rate for Payer: UMR Bronson Commercial |
$38.05
|
| Rate for Payer: UMR Bronson Commercial |
$49.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.91
|
|
|
MORPHINE (PF) 0.5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$102.85
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
29464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.25 |
| Max. Negotiated Rate |
$92.56 |
| Rate for Payer: Aetna American Axle |
$66.85
|
| Rate for Payer: Aetna American Axle |
$87.46
|
| Rate for Payer: Aetna Commercial |
$87.42
|
| Rate for Payer: Aetna Commercial |
$114.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.46
|
| Rate for Payer: Cash Price |
$82.28
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Cofinity Advantage |
$94.19
|
| Rate for Payer: Cofinity Advantage |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$115.71
|
| Rate for Payer: Cofinity Commercial |
$88.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.64
|
| Rate for Payer: Healthscope Commercial |
$92.56
|
| Rate for Payer: Healthscope Commercial |
$121.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.91
|
| Rate for Payer: PHP Commercial |
$87.42
|
| Rate for Payer: PHP Commercial |
$114.37
|
| Rate for Payer: Priority Health SBD |
$84.77
|
| Rate for Payer: Priority Health SBD |
$64.80
|
| Rate for Payer: UMR Bronson Commercial |
$45.25
|
| Rate for Payer: UMR Bronson Commercial |
$59.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.91
|
|
|
MORPHINE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$670.25
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
77009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$603.23 |
| Rate for Payer: Aetna American Axle |
$435.66
|
| Rate for Payer: Aetna Commercial |
$569.71
|
| Rate for Payer: Aetna Medicare |
$335.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.66
|
| Rate for Payer: BCBS Complete |
$268.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.73
|
| Rate for Payer: BCN Commercial |
$43.73
|
| Rate for Payer: Cash Price |
$536.20
|
| Rate for Payer: Cash Price |
$536.20
|
| Rate for Payer: Cofinity Advantage |
$469.18
|
| Rate for Payer: Cofinity Commercial |
$576.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.20
|
| Rate for Payer: Healthscope Commercial |
$603.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$536.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.69
|
| Rate for Payer: PHP Commercial |
$569.71
|
| Rate for Payer: Priority Health SBD |
$422.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.28
|
| Rate for Payer: UHC Core |
$22.28
|
| Rate for Payer: UHC Exchange |
$22.28
|
| Rate for Payer: UMR Bronson Commercial |
$247.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.69
|
|
|
MORPHINE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$670.25
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
77009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.91 |
| Max. Negotiated Rate |
$603.23 |
| Rate for Payer: Aetna American Axle |
$435.66
|
| Rate for Payer: Aetna Commercial |
$569.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.66
|
| Rate for Payer: Cash Price |
$536.20
|
| Rate for Payer: Cofinity Advantage |
$469.18
|
| Rate for Payer: Cofinity Commercial |
$576.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.20
|
| Rate for Payer: Healthscope Commercial |
$603.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.69
|
| Rate for Payer: PHP Commercial |
$569.71
|
| Rate for Payer: Priority Health SBD |
$422.26
|
| Rate for Payer: UMR Bronson Commercial |
$294.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.69
|
|
|
MORPHINE (PF) 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$66.50
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
159447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.26 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna American Axle |
$43.23
|
| Rate for Payer: Aetna Commercial |
$56.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.23
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: Cofinity Advantage |
$46.55
|
| Rate for Payer: Cofinity Commercial |
$57.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.20
|
| Rate for Payer: Healthscope Commercial |
$59.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.88
|
| Rate for Payer: PHP Commercial |
$56.52
|
| Rate for Payer: Priority Health SBD |
$41.90
|
| Rate for Payer: UMR Bronson Commercial |
$29.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.88
|
|
|
MORPHINE (PF) 1 MG/ML IN 0.9% SODIUM CHLORIDE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$66.50
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
159447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna American Axle |
$43.23
|
| Rate for Payer: Aetna Commercial |
$56.52
|
| Rate for Payer: Aetna Medicare |
$33.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.23
|
| Rate for Payer: BCBS Complete |
$26.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.83
|
| Rate for Payer: BCN Commercial |
$9.83
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: Cash Price |
$53.20
|
| Rate for Payer: Cofinity Advantage |
$46.55
|
| Rate for Payer: Cofinity Commercial |
$57.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.20
|
| Rate for Payer: Healthscope Commercial |
$59.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.88
|
| Rate for Payer: PHP Commercial |
$56.52
|
| Rate for Payer: Priority Health SBD |
$41.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.02
|
| Rate for Payer: UHC Core |
$5.02
|
| Rate for Payer: UHC Exchange |
$5.02
|
| Rate for Payer: UMR Bronson Commercial |
$24.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.88
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$212.80
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.63 |
| Max. Negotiated Rate |
$191.52 |
| Rate for Payer: Aetna American Axle |
$138.32
|
| Rate for Payer: Aetna Commercial |
$180.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.32
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cofinity Advantage |
$148.96
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.24
|
| Rate for Payer: Healthscope Commercial |
$191.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.60
|
| Rate for Payer: PHP Commercial |
$180.88
|
| Rate for Payer: Priority Health SBD |
$134.06
|
| Rate for Payer: UMR Bronson Commercial |
$93.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.60
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$212.80
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$191.52 |
| Rate for Payer: Aetna American Axle |
$138.32
|
| Rate for Payer: Aetna Commercial |
$180.88
|
| Rate for Payer: Aetna Medicare |
$106.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.32
|
| Rate for Payer: BCBS Complete |
$85.12
|
| Rate for Payer: BCBS Trust/PPO |
$43.73
|
| Rate for Payer: BCN Commercial |
$43.73
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cash Price |
$170.24
|
| Rate for Payer: Cofinity Advantage |
$148.96
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.24
|
| Rate for Payer: Healthscope Commercial |
$191.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.60
|
| Rate for Payer: PHP Commercial |
$180.88
|
| Rate for Payer: Priority Health SBD |
$134.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.28
|
| Rate for Payer: UHC Core |
$22.28
|
| Rate for Payer: UHC Exchange |
$22.28
|
| Rate for Payer: UMR Bronson Commercial |
$78.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.60
|
|
|
MORPHINE (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,041.92
|
|
|
Service Code
|
NDC 00641604001
|
| Hospital Charge Code |
27392
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$458.44 |
| Max. Negotiated Rate |
$937.73 |
| Rate for Payer: Aetna American Axle |
$677.25
|
| Rate for Payer: Aetna Commercial |
$885.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.25
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Cofinity Advantage |
$729.34
|
| Rate for Payer: Cofinity Commercial |
$896.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.54
|
| Rate for Payer: Healthscope Commercial |
$937.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$729.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$781.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$781.44
|
| Rate for Payer: PHP Commercial |
$885.63
|
| Rate for Payer: Priority Health SBD |
$656.41
|
| Rate for Payer: UMR Bronson Commercial |
$458.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$781.44
|
|
|
MORPHINE (PF) 25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,041.92
|
|
|
Service Code
|
NDC 00641604001
|
| Hospital Charge Code |
27392
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$385.51 |
| Max. Negotiated Rate |
$937.73 |
| Rate for Payer: Aetna American Axle |
$677.25
|
| Rate for Payer: Aetna Commercial |
$885.63
|
| Rate for Payer: Aetna Medicare |
$520.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.25
|
| Rate for Payer: BCBS Complete |
$416.77
|
| Rate for Payer: Cash Price |
$833.54
|
| Rate for Payer: Cofinity Advantage |
$729.34
|
| Rate for Payer: Cofinity Commercial |
$896.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.54
|
| Rate for Payer: Healthscope Commercial |
$937.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$729.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$781.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$833.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$781.44
|
| Rate for Payer: PHP Commercial |
$885.63
|
| Rate for Payer: Priority Health SBD |
$656.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$677.25
|
| Rate for Payer: UHC Core |
$542.84
|
| Rate for Payer: UHC Exchange |
$409.47
|
| Rate for Payer: UMR Bronson Commercial |
$385.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$781.44
|
|
|
MORPHINE (PF) 2 MG/2 ML (1 MG/ML) IN 0.9% SODIUM CHLORIDE INJ SYRINGE
|
Facility
|
OP
|
$31.50
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
159461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna American Axle |
$20.48
|
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna Medicare |
$15.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.48
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$43.73
|
| Rate for Payer: BCN Commercial |
$43.73
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cofinity Advantage |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$27.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$28.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.62
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.28
|
| Rate for Payer: UHC Core |
$22.28
|
| Rate for Payer: UHC Exchange |
$22.28
|
| Rate for Payer: UMR Bronson Commercial |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.62
|
|
|
MORPHINE (PF) 2 MG/2 ML (1 MG/ML) IN 0.9% SODIUM CHLORIDE INJ SYRINGE
|
Facility
|
IP
|
$31.50
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
159461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: Aetna American Axle |
$20.48
|
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.48
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cofinity Advantage |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$27.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$28.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.62
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: UMR Bronson Commercial |
$13.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.62
|
|
|
MORPHINE SULFATE 100 MG/0.5 ML TOPICAL GEL
|
Facility
|
OP
|
$17.49
|
|
|
Service Code
|
NDC 09900000372
|
| Hospital Charge Code |
161534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna American Axle |
$11.37
|
| Rate for Payer: Aetna Commercial |
$14.87
|
| Rate for Payer: Aetna Medicare |
$8.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.37
|
| Rate for Payer: BCBS Complete |
$7.00
|
| Rate for Payer: Cash Price |
$13.99
|
| Rate for Payer: Cofinity Advantage |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$15.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.12
|
| Rate for Payer: PHP Commercial |
$14.87
|
| Rate for Payer: Priority Health SBD |
$11.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.37
|
| Rate for Payer: UHC Core |
$9.11
|
| Rate for Payer: UHC Exchange |
$6.87
|
| Rate for Payer: UMR Bronson Commercial |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.12
|
|
|
MORPHINE SULFATE 100 MG/0.5 ML TOPICAL GEL
|
Facility
|
IP
|
$17.49
|
|
|
Service Code
|
NDC 09900000372
|
| Hospital Charge Code |
161534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$15.74 |
| Rate for Payer: Aetna American Axle |
$11.37
|
| Rate for Payer: Aetna Commercial |
$14.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.37
|
| Rate for Payer: Cash Price |
$13.99
|
| Rate for Payer: Cofinity Advantage |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$15.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.12
|
| Rate for Payer: PHP Commercial |
$14.87
|
| Rate for Payer: Priority Health SBD |
$11.02
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.12
|
|
|
MORPHINE SULFATE 30 MG/0.5 ML TOPICAL GEL
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
NDC 09900000371
|
| Hospital Charge Code |
161533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Aetna American Axle |
$8.58
|
| Rate for Payer: Aetna Commercial |
$11.22
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.58
|
| Rate for Payer: BCBS Complete |
$5.28
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cofinity Advantage |
$9.24
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.56
|
| Rate for Payer: Healthscope Commercial |
$11.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.90
|
| Rate for Payer: PHP Commercial |
$11.22
|
| Rate for Payer: Priority Health SBD |
$8.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.58
|
| Rate for Payer: UHC Core |
$6.88
|
| Rate for Payer: UHC Exchange |
$5.19
|
| Rate for Payer: UMR Bronson Commercial |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.90
|
|
|
MORPHINE SULFATE 30 MG/0.5 ML TOPICAL GEL
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
NDC 09900000371
|
| Hospital Charge Code |
161533
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Aetna American Axle |
$8.58
|
| Rate for Payer: Aetna Commercial |
$11.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.58
|
| Rate for Payer: Cash Price |
$10.56
|
| Rate for Payer: Cofinity Advantage |
$9.24
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.56
|
| Rate for Payer: Healthscope Commercial |
$11.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.90
|
| Rate for Payer: PHP Commercial |
$11.22
|
| Rate for Payer: Priority Health SBD |
$8.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.90
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna American Axle |
$7.59
|
| Rate for Payer: Aetna American Axle |
$7.55
|
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare |
$5.84
|
| Rate for Payer: Aetna Medicare |
$5.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.55
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: BCBS Complete |
$4.67
|
| Rate for Payer: BCBS Trust/PPO |
$9.83
|
| Rate for Payer: BCBS Trust/PPO |
$9.83
|
| Rate for Payer: BCN Commercial |
$9.83
|
| Rate for Payer: BCN Commercial |
$9.83
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Advantage |
$8.18
|
| Rate for Payer: Cofinity Advantage |
$8.13
|
| Rate for Payer: Cofinity Commercial |
$9.99
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Healthscope Commercial |
$10.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.71
|
| Rate for Payer: PHP Commercial |
$9.88
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health SBD |
$7.36
|
| Rate for Payer: Priority Health SBD |
$7.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.02
|
| Rate for Payer: UHC Core |
$5.02
|
| Rate for Payer: UHC Core |
$5.02
|
| Rate for Payer: UHC Exchange |
$5.02
|
| Rate for Payer: UHC Exchange |
$5.02
|
| Rate for Payer: UMR Bronson Commercial |
$4.32
|
| Rate for Payer: UMR Bronson Commercial |
$4.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna American Axle |
$7.55
|
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.55
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Advantage |
$8.13
|
| Rate for Payer: Cofinity Commercial |
$9.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.71
|
| Rate for Payer: PHP Commercial |
$9.88
|
| Rate for Payer: Priority Health SBD |
$7.32
|
| Rate for Payer: UMR Bronson Commercial |
$5.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
|
|
MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$86,946.16
|
|
|
Service Code
|
HCPCS J9350
|
| Hospital Charge Code |
202489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$342.32 |
| Max. Negotiated Rate |
$78,251.54 |
| Rate for Payer: Aetna American Axle |
$56,515.00
|
| Rate for Payer: Aetna American Axle |
$1,883.81
|
| Rate for Payer: Aetna Commercial |
$2,463.44
|
| Rate for Payer: Aetna Commercial |
$73,904.24
|
| Rate for Payer: Aetna Medicare |
$680.72
|
| Rate for Payer: Aetna Medicare |
$680.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,883.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56,515.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$818.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$818.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$818.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$818.17
|
| Rate for Payer: BCBS Complete |
$359.47
|
| Rate for Payer: BCBS Complete |
$359.47
|
| Rate for Payer: BCBS MAPPO |
$654.54
|
| Rate for Payer: BCBS MAPPO |
$654.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,125.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,125.15
|
| Rate for Payer: BCN Commercial |
$2,125.15
|
| Rate for Payer: BCN Commercial |
$2,125.15
|
| Rate for Payer: BCN Medicare Advantage |
$654.54
|
| Rate for Payer: BCN Medicare Advantage |
$654.54
|
| Rate for Payer: Cash Price |
$2,318.54
|
| Rate for Payer: Cash Price |
$69,556.93
|
| Rate for Payer: Cash Price |
$69,556.93
|
| Rate for Payer: Cash Price |
$2,318.54
|
| Rate for Payer: Cofinity Advantage |
$60,862.31
|
| Rate for Payer: Cofinity Advantage |
$2,028.72
|
| Rate for Payer: Cofinity Commercial |
$2,492.43
|
| Rate for Payer: Cofinity Commercial |
$74,773.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,318.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69,556.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$654.54
|
| Rate for Payer: Healthscope Commercial |
$2,608.35
|
| Rate for Payer: Healthscope Commercial |
$78,251.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60,862.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,028.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,173.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65,209.62
|
| Rate for Payer: Mclaren Medicaid |
$654.54
|
| Rate for Payer: Mclaren Medicaid |
$654.54
|
| Rate for Payer: Mclaren Medicare |
$654.54
|
| Rate for Payer: Mclaren Medicare |
$654.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$687.27
|
| Rate for Payer: Meridian Medicaid |
$687.27
|
| Rate for Payer: Meridian Medicaid |
$687.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$719.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$719.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,463.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73,904.24
|
| Rate for Payer: Nomi Health Commercial |
$1,963.62
|
| Rate for Payer: Nomi Health Commercial |
$1,963.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65,209.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,173.63
|
| Rate for Payer: PACE Medicare |
$621.81
|
| Rate for Payer: PACE Medicare |
$621.81
|
| Rate for Payer: PACE SWMI |
$654.54
|
| Rate for Payer: PACE SWMI |
$654.54
|
| Rate for Payer: PHP Commercial |
$2,463.44
|
| Rate for Payer: PHP Commercial |
$73,904.24
|
| Rate for Payer: PHP Medicare Advantage |
$654.54
|
| Rate for Payer: PHP Medicare Advantage |
$654.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,064.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,064.69
|
| Rate for Payer: Priority Health Medicare |
$654.54
|
| Rate for Payer: Priority Health Medicare |
$654.54
|
| Rate for Payer: Priority Health SBD |
$1,825.85
|
| Rate for Payer: Priority Health SBD |
$54,776.08
|
| Rate for Payer: Priority Health Tiered Network |
$1,651.75
|
| Rate for Payer: Priority Health Tiered Network |
$1,651.75
|
| Rate for Payer: Railroad Medicare Medicare |
$654.54
|
| Rate for Payer: Railroad Medicare Medicare |
$654.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,081.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,081.38
|
| Rate for Payer: UHC Core |
$1,081.38
|
| Rate for Payer: UHC Core |
$1,081.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$654.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$654.54
|
| Rate for Payer: UHC Exchange |
$1,081.38
|
| Rate for Payer: UHC Exchange |
$1,081.38
|
| Rate for Payer: UHC Medicaid |
$342.32
|
| Rate for Payer: UHC Medicaid |
$342.32
|
| Rate for Payer: UHCCP Medicaid |
$342.32
|
| Rate for Payer: UHCCP Medicaid |
$342.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,072.32
|
| Rate for Payer: UMR Bronson Commercial |
$32,170.08
|
| Rate for Payer: VA VA |
$654.54
|
| Rate for Payer: VA VA |
$654.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65,209.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,173.63
|
|
|
MOSUNETUZUMAB-AXGB 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,898.17
|
|
|
Service Code
|
HCPCS J9350
|
| Hospital Charge Code |
202489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,275.19 |
| Max. Negotiated Rate |
$2,608.35 |
| Rate for Payer: Aetna American Axle |
$1,883.81
|
| Rate for Payer: Aetna American Axle |
$56,515.00
|
| Rate for Payer: Aetna Commercial |
$2,463.44
|
| Rate for Payer: Aetna Commercial |
$73,904.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,883.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56,515.00
|
| Rate for Payer: Cash Price |
$2,318.54
|
| Rate for Payer: Cash Price |
$69,556.93
|
| Rate for Payer: Cofinity Advantage |
$60,862.31
|
| Rate for Payer: Cofinity Advantage |
$2,028.72
|
| Rate for Payer: Cofinity Commercial |
$74,773.70
|
| Rate for Payer: Cofinity Commercial |
$2,492.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,318.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69,556.93
|
| Rate for Payer: Healthscope Commercial |
$2,608.35
|
| Rate for Payer: Healthscope Commercial |
$78,251.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60,862.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,028.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,173.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65,209.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,463.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73,904.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,173.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65,209.62
|
| Rate for Payer: PHP Commercial |
$2,463.44
|
| Rate for Payer: PHP Commercial |
$73,904.24
|
| Rate for Payer: Priority Health SBD |
$54,776.08
|
| Rate for Payer: Priority Health SBD |
$1,825.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,275.19
|
| Rate for Payer: UMR Bronson Commercial |
$38,256.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,173.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65,209.62
|
|
|
MOUTH PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$26,822.37
|
|
|
Service Code
|
MSDRG 137
|
| Min. Negotiated Rate |
$12,426.14 |
| Max. Negotiated Rate |
$26,822.37 |
| Rate for Payer: Aetna Medicare |
$13,603.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,350.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,350.19
|
| Rate for Payer: BCBS MAPPO |
$13,080.15
|
| Rate for Payer: BCBS Trust/PPO |
$26,822.37
|
| Rate for Payer: BCN Commercial |
$26,822.37
|
| Rate for Payer: BCN Medicare Advantage |
$13,080.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,080.15
|
| Rate for Payer: Mclaren Medicare |
$13,080.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,734.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,042.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,388.17
|
| Rate for Payer: Nomi Health Commercial |
$19,262.28
|
| Rate for Payer: PACE Medicare |
$12,426.14
|
| Rate for Payer: PACE SWMI |
$13,080.15
|
| Rate for Payer: PHP Medicare Advantage |
$13,080.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,073.58
|
| Rate for Payer: Priority Health Medicare |
$13,080.15
|
| Rate for Payer: Priority Health Tiered Network |
$19,258.86
|
| Rate for Payer: Railroad Medicare Medicare |
$13,080.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,339.16
|
| Rate for Payer: UHC Core |
$20,362.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,080.15
|
| Rate for Payer: UHC Exchange |
$16,629.77
|
| Rate for Payer: VA VA |
$13,080.15
|
|
|
MOUTH PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,918.83
|
|
|
Service Code
|
MSDRG 138
|
| Min. Negotiated Rate |
$7,603.79 |
| Max. Negotiated Rate |
$15,918.83 |
| Rate for Payer: Aetna Medicare |
$8,324.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,004.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,004.99
|
| Rate for Payer: BCBS MAPPO |
$8,003.99
|
| Rate for Payer: BCBS Trust/PPO |
$15,918.83
|
| Rate for Payer: BCN Commercial |
$15,918.83
|
| Rate for Payer: BCN Medicare Advantage |
$8,003.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,003.99
|
| Rate for Payer: Mclaren Medicare |
$8,003.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,404.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,204.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,804.39
|
| Rate for Payer: Nomi Health Commercial |
$11,431.98
|
| Rate for Payer: PACE Medicare |
$7,603.79
|
| Rate for Payer: PACE SWMI |
$8,003.99
|
| Rate for Payer: PHP Medicare Advantage |
$8,003.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,287.44
|
| Rate for Payer: Priority Health Medicare |
$8,003.99
|
| Rate for Payer: Priority Health Tiered Network |
$11,429.95
|
| Rate for Payer: Railroad Medicare Medicare |
$8,003.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,445.06
|
| Rate for Payer: UHC Core |
$12,085.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,003.99
|
| Rate for Payer: UHC Exchange |
$9,869.61
|
| Rate for Payer: VA VA |
$8,003.99
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$91.91
|
|
|
Service Code
|
NDC 00781713593
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$82.72 |
| Rate for Payer: Aetna American Axle |
$59.74
|
| Rate for Payer: Aetna Commercial |
$78.12
|
| Rate for Payer: Aetna Medicare |
$45.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.74
|
| Rate for Payer: BCBS Complete |
$36.76
|
| Rate for Payer: Cash Price |
$73.53
|
| Rate for Payer: Cofinity Advantage |
$64.34
|
| Rate for Payer: Cofinity Commercial |
$79.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.53
|
| Rate for Payer: Healthscope Commercial |
$82.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.93
|
| Rate for Payer: PHP Commercial |
$78.12
|
| Rate for Payer: Priority Health SBD |
$57.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.74
|
| Rate for Payer: UHC Core |
$47.89
|
| Rate for Payer: UHC Exchange |
$36.12
|
| Rate for Payer: UMR Bronson Commercial |
$34.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.93
|
|
