|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW
|
Facility
|
OP
|
$6,292.24
|
|
|
Service Code
|
CPT 64718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,017.60 |
| Max. Negotiated Rate |
$6,292.24 |
| Rate for Payer: Aetna Medicare |
$2,023.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,432.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,432.12
|
| Rate for Payer: BCBS Complete |
$1,068.58
|
| Rate for Payer: BCBS MAPPO |
$1,945.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,833.04
|
| Rate for Payer: BCN Commercial |
$3,833.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,945.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,945.70
|
| Rate for Payer: Mclaren Medicaid |
$1,945.70
|
| Rate for Payer: Mclaren Medicare |
$1,945.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,042.98
|
| Rate for Payer: Meridian Medicaid |
$2,042.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,237.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,140.27
|
| Rate for Payer: Nomi Health Commercial |
$5,837.10
|
| Rate for Payer: PACE Medicare |
$1,848.41
|
| Rate for Payer: PACE SWMI |
$1,945.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,945.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,292.24
|
| Rate for Payer: Priority Health Medicare |
$1,945.70
|
| Rate for Payer: Priority Health Tiered Network |
$5,033.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1,945.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,945.70
|
| Rate for Payer: UHC Medicaid |
$1,017.60
|
| Rate for Payer: UHCCP Medicaid |
$1,017.60
|
| Rate for Payer: VA VA |
$1,945.70
|
|
|
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST
|
Facility
|
OP
|
$6,292.24
|
|
|
Service Code
|
CPT 64719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,017.60 |
| Max. Negotiated Rate |
$6,292.24 |
| Rate for Payer: Aetna Medicare |
$2,023.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,432.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,432.12
|
| Rate for Payer: BCBS Complete |
$1,068.58
|
| Rate for Payer: BCBS MAPPO |
$1,945.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,731.83
|
| Rate for Payer: BCN Commercial |
$1,731.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,945.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,945.70
|
| Rate for Payer: Mclaren Medicaid |
$1,945.70
|
| Rate for Payer: Mclaren Medicare |
$1,945.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,042.98
|
| Rate for Payer: Meridian Medicaid |
$2,042.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,237.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,140.27
|
| Rate for Payer: Nomi Health Commercial |
$5,837.10
|
| Rate for Payer: PACE Medicare |
$1,848.41
|
| Rate for Payer: PACE SWMI |
$1,945.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,945.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,292.24
|
| Rate for Payer: Priority Health Medicare |
$1,945.70
|
| Rate for Payer: Priority Health Tiered Network |
$5,033.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1,945.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,945.70
|
| Rate for Payer: UHC Medicaid |
$1,017.60
|
| Rate for Payer: UHCCP Medicaid |
$1,017.60
|
| Rate for Payer: VA VA |
$1,945.70
|
|
|
NEUROPLASTY; DIGITAL, 1 OR BOTH, SAME DIGIT
|
Facility
|
OP
|
$6,292.24
|
|
|
Service Code
|
CPT 64702
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,017.60 |
| Max. Negotiated Rate |
$6,292.24 |
| Rate for Payer: Aetna Medicare |
$2,023.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,432.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,432.12
|
| Rate for Payer: BCBS Complete |
$1,068.58
|
| Rate for Payer: BCBS MAPPO |
$1,945.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,731.83
|
| Rate for Payer: BCN Commercial |
$1,731.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,945.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,945.70
|
| Rate for Payer: Mclaren Medicaid |
$1,945.70
|
| Rate for Payer: Mclaren Medicare |
$1,945.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,042.98
|
| Rate for Payer: Meridian Medicaid |
$2,042.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,237.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,140.27
|
| Rate for Payer: Nomi Health Commercial |
$5,837.10
|
| Rate for Payer: PACE Medicare |
$1,848.41
|
| Rate for Payer: PACE SWMI |
$1,945.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,945.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,292.24
|
| Rate for Payer: Priority Health Medicare |
$1,945.70
|
| Rate for Payer: Priority Health Tiered Network |
$5,033.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1,945.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,945.70
|
| Rate for Payer: UHC Medicaid |
$1,017.60
|
| Rate for Payer: UHCCP Medicaid |
$1,017.60
|
| Rate for Payer: VA VA |
$1,945.70
|
|
|
NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG, OPEN; OTHER THAN SPECIFIED
|
Facility
|
OP
|
$6,292.24
|
|
|
Service Code
|
CPT 64708
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,017.60 |
| Max. Negotiated Rate |
$6,292.24 |
| Rate for Payer: Aetna Medicare |
$2,023.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,432.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,432.12
|
| Rate for Payer: BCBS Complete |
$1,068.58
|
| Rate for Payer: BCBS MAPPO |
$1,945.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,793.67
|
| Rate for Payer: BCN Commercial |
$1,793.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,945.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,945.70
|
| Rate for Payer: Mclaren Medicaid |
$1,945.70
|
| Rate for Payer: Mclaren Medicare |
$1,945.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,042.98
|
| Rate for Payer: Meridian Medicaid |
$2,042.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,237.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,140.27
|
| Rate for Payer: Nomi Health Commercial |
$5,837.10
|
| Rate for Payer: PACE Medicare |
$1,848.41
|
| Rate for Payer: PACE SWMI |
$1,945.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,945.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,292.24
|
| Rate for Payer: Priority Health Medicare |
$1,945.70
|
| Rate for Payer: Priority Health Tiered Network |
$5,033.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1,945.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,945.70
|
| Rate for Payer: UHC Medicaid |
$1,017.60
|
| Rate for Payer: UHCCP Medicaid |
$1,017.60
|
| Rate for Payer: VA VA |
$1,945.70
|
|
|
NEUROPLASTY; NERVE OF HAND OR FOOT
|
Facility
|
OP
|
$6,292.24
|
|
|
Service Code
|
CPT 64704
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,017.60 |
| Max. Negotiated Rate |
$6,292.24 |
| Rate for Payer: Aetna Medicare |
$2,023.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,432.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,432.12
|
| Rate for Payer: BCBS Complete |
$1,068.58
|
| Rate for Payer: BCBS MAPPO |
$1,945.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,731.83
|
| Rate for Payer: BCN Commercial |
$1,731.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,945.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,945.70
|
| Rate for Payer: Mclaren Medicaid |
$1,945.70
|
| Rate for Payer: Mclaren Medicare |
$1,945.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,042.98
|
| Rate for Payer: Meridian Medicaid |
$2,042.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,237.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,140.27
|
| Rate for Payer: Nomi Health Commercial |
$5,837.10
|
| Rate for Payer: PACE Medicare |
$1,848.41
|
| Rate for Payer: PACE SWMI |
$1,945.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,945.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,017.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,292.24
|
| Rate for Payer: Priority Health Medicare |
$1,945.70
|
| Rate for Payer: Priority Health Tiered Network |
$5,033.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1,945.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,945.70
|
| Rate for Payer: UHC Medicaid |
$1,017.60
|
| Rate for Payer: UHCCP Medicaid |
$1,017.60
|
| Rate for Payer: VA VA |
$1,945.70
|
|
|
NEUROSES EXCEPT DEPRESSIVE
|
Facility
|
IP
|
$30,646.30
|
|
|
Service Code
|
MSDRG 882
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$30,646.30 |
| Rate for Payer: Aetna Medicare |
$9,955.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,966.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,966.02
|
| Rate for Payer: BCBS MAPPO |
$9,572.82
|
| Rate for Payer: BCBS Trust/PPO |
$30,646.30
|
| Rate for Payer: BCN Commercial |
$30,646.30
|
| Rate for Payer: BCN Medicare Advantage |
$9,572.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,572.82
|
| Rate for Payer: Mclaren Medicare |
$9,572.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,051.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,008.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,530.10
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$9,094.18
|
| Rate for Payer: PACE SWMI |
$9,572.82
|
| Rate for Payer: PHP Medicare Advantage |
$9,572.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,311.95
|
| Rate for Payer: Priority Health Medicare |
$9,572.82
|
| Rate for Payer: Priority Health Tiered Network |
$13,849.56
|
| Rate for Payer: Railroad Medicare Medicare |
$9,572.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,502.94
|
| Rate for Payer: UHC Core |
$14,643.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,572.82
|
| Rate for Payer: UHC Exchange |
$11,958.91
|
| Rate for Payer: VA VA |
$9,572.82
|
|
|
NEVIRAPINE 200 MG TABLET
|
Facility
|
OP
|
$222.78
|
|
|
Service Code
|
NDC 31722050560
|
| Hospital Charge Code |
17403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$200.50 |
| Rate for Payer: Aetna American Axle |
$144.81
|
| Rate for Payer: Aetna Commercial |
$189.36
|
| Rate for Payer: Aetna Medicare |
$111.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.81
|
| Rate for Payer: BCBS Complete |
$89.11
|
| Rate for Payer: Cash Price |
$178.22
|
| Rate for Payer: Cofinity Advantage |
$155.95
|
| Rate for Payer: Cofinity Commercial |
$191.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.22
|
| Rate for Payer: Healthscope Commercial |
$200.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.09
|
| Rate for Payer: PHP Commercial |
$189.36
|
| Rate for Payer: Priority Health SBD |
$140.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.81
|
| Rate for Payer: UHC Core |
$116.07
|
| Rate for Payer: UHC Exchange |
$87.55
|
| Rate for Payer: UMR Bronson Commercial |
$82.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.09
|
|
|
NEVIRAPINE 200 MG TABLET
|
Facility
|
IP
|
$222.78
|
|
|
Service Code
|
NDC 31722050560
|
| Hospital Charge Code |
17403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.02 |
| Max. Negotiated Rate |
$200.50 |
| Rate for Payer: Aetna American Axle |
$144.81
|
| Rate for Payer: Aetna Commercial |
$189.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.81
|
| Rate for Payer: Cash Price |
$178.22
|
| Rate for Payer: Cofinity Advantage |
$155.95
|
| Rate for Payer: Cofinity Commercial |
$191.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.22
|
| Rate for Payer: Healthscope Commercial |
$200.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$167.09
|
| Rate for Payer: PHP Commercial |
$189.36
|
| Rate for Payer: Priority Health SBD |
$140.35
|
| Rate for Payer: UMR Bronson Commercial |
$98.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.09
|
|
|
NEVIRAPINE 200 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 33342000409
|
| Hospital Charge Code |
17403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Advantage |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$65.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
NEVIRAPINE 200 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 33342000409
|
| Hospital Charge Code |
17403
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$74.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Advantage |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.04
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.23
|
| Rate for Payer: UHC Core |
$77.13
|
| Rate for Payer: UHC Exchange |
$58.18
|
| Rate for Payer: UMR Bronson Commercial |
$54.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$676.23
|
|
|
Service Code
|
NDC 65862005724
|
| Hospital Charge Code |
24119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.21 |
| Max. Negotiated Rate |
$608.61 |
| Rate for Payer: Aetna American Axle |
$439.55
|
| Rate for Payer: Aetna Commercial |
$574.80
|
| Rate for Payer: Aetna Medicare |
$338.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.55
|
| Rate for Payer: BCBS Complete |
$270.49
|
| Rate for Payer: Cash Price |
$540.98
|
| Rate for Payer: Cofinity Advantage |
$473.36
|
| Rate for Payer: Cofinity Commercial |
$581.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.98
|
| Rate for Payer: Healthscope Commercial |
$608.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$540.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.17
|
| Rate for Payer: PHP Commercial |
$574.80
|
| Rate for Payer: Priority Health SBD |
$426.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.55
|
| Rate for Payer: UHC Core |
$352.32
|
| Rate for Payer: UHC Exchange |
$265.76
|
| Rate for Payer: UMR Bronson Commercial |
$250.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.17
|
|
|
NEVIRAPINE 50 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$676.23
|
|
|
Service Code
|
NDC 65862005724
|
| Hospital Charge Code |
24119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.54 |
| Max. Negotiated Rate |
$608.61 |
| Rate for Payer: Aetna American Axle |
$439.55
|
| Rate for Payer: Aetna Commercial |
$574.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.55
|
| Rate for Payer: Cash Price |
$540.98
|
| Rate for Payer: Cofinity Advantage |
$473.36
|
| Rate for Payer: Cofinity Commercial |
$581.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.98
|
| Rate for Payer: Healthscope Commercial |
$608.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.17
|
| Rate for Payer: PHP Commercial |
$574.80
|
| Rate for Payer: Priority Health SBD |
$426.02
|
| Rate for Payer: UMR Bronson Commercial |
$297.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.17
|
|
|
NEVIRAPINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$270.62
|
|
|
Service Code
|
NDC 33342023807
|
| Hospital Charge Code |
152490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$243.56 |
| Rate for Payer: Aetna American Axle |
$175.90
|
| Rate for Payer: Aetna Commercial |
$230.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.90
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cofinity Advantage |
$189.43
|
| Rate for Payer: Cofinity Commercial |
$232.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.50
|
| Rate for Payer: Healthscope Commercial |
$243.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.97
|
| Rate for Payer: PHP Commercial |
$230.03
|
| Rate for Payer: Priority Health SBD |
$170.49
|
| Rate for Payer: UMR Bronson Commercial |
$119.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.97
|
|
|
NEVIRAPINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,849.38
|
|
|
Service Code
|
NDC 47781031730
|
| Hospital Charge Code |
152490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$813.73 |
| Max. Negotiated Rate |
$1,664.44 |
| Rate for Payer: Aetna American Axle |
$1,202.10
|
| Rate for Payer: Aetna Commercial |
$1,571.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.10
|
| Rate for Payer: Cash Price |
$1,479.50
|
| Rate for Payer: Cofinity Advantage |
$1,294.57
|
| Rate for Payer: Cofinity Commercial |
$1,590.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,479.50
|
| Rate for Payer: Healthscope Commercial |
$1,664.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,294.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,387.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,571.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,387.04
|
| Rate for Payer: PHP Commercial |
$1,571.97
|
| Rate for Payer: Priority Health SBD |
$1,165.11
|
| Rate for Payer: UMR Bronson Commercial |
$813.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,387.04
|
|
|
NEVIRAPINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,849.38
|
|
|
Service Code
|
NDC 47781031730
|
| Hospital Charge Code |
152490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$684.27 |
| Max. Negotiated Rate |
$1,664.44 |
| Rate for Payer: Aetna American Axle |
$1,202.10
|
| Rate for Payer: Aetna Commercial |
$1,571.97
|
| Rate for Payer: Aetna Medicare |
$924.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.10
|
| Rate for Payer: BCBS Complete |
$739.75
|
| Rate for Payer: Cash Price |
$1,479.50
|
| Rate for Payer: Cofinity Advantage |
$1,294.57
|
| Rate for Payer: Cofinity Commercial |
$1,590.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,479.50
|
| Rate for Payer: Healthscope Commercial |
$1,664.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,294.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,387.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,479.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,571.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,387.04
|
| Rate for Payer: PHP Commercial |
$1,571.97
|
| Rate for Payer: Priority Health SBD |
$1,165.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,202.10
|
| Rate for Payer: UHC Core |
$963.53
|
| Rate for Payer: UHC Exchange |
$726.81
|
| Rate for Payer: UMR Bronson Commercial |
$684.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,387.04
|
|
|
NEVIRAPINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$270.62
|
|
|
Service Code
|
NDC 33342023807
|
| Hospital Charge Code |
152490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.13 |
| Max. Negotiated Rate |
$243.56 |
| Rate for Payer: Aetna American Axle |
$175.90
|
| Rate for Payer: Aetna Commercial |
$230.03
|
| Rate for Payer: Aetna Medicare |
$135.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.90
|
| Rate for Payer: BCBS Complete |
$108.25
|
| Rate for Payer: Cash Price |
$216.50
|
| Rate for Payer: Cofinity Advantage |
$189.43
|
| Rate for Payer: Cofinity Commercial |
$232.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.50
|
| Rate for Payer: Healthscope Commercial |
$243.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.97
|
| Rate for Payer: PHP Commercial |
$230.03
|
| Rate for Payer: Priority Health SBD |
$170.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.90
|
| Rate for Payer: UHC Core |
$140.99
|
| Rate for Payer: UHC Exchange |
$106.35
|
| Rate for Payer: UMR Bronson Commercial |
$100.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.97
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$283.01
|
|
|
Service Code
|
NDC 59651001890
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.52 |
| Max. Negotiated Rate |
$254.71 |
| Rate for Payer: Aetna American Axle |
$183.96
|
| Rate for Payer: Aetna Commercial |
$240.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.96
|
| Rate for Payer: Cash Price |
$226.41
|
| Rate for Payer: Cofinity Advantage |
$198.11
|
| Rate for Payer: Cofinity Commercial |
$243.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.41
|
| Rate for Payer: Healthscope Commercial |
$254.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.26
|
| Rate for Payer: PHP Commercial |
$240.56
|
| Rate for Payer: Priority Health SBD |
$178.30
|
| Rate for Payer: UMR Bronson Commercial |
$124.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.26
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$283.01
|
|
|
Service Code
|
NDC 59651001890
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.71 |
| Max. Negotiated Rate |
$254.71 |
| Rate for Payer: Aetna American Axle |
$183.96
|
| Rate for Payer: Aetna Commercial |
$240.56
|
| Rate for Payer: Aetna Medicare |
$141.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.96
|
| Rate for Payer: BCBS Complete |
$113.20
|
| Rate for Payer: Cash Price |
$226.41
|
| Rate for Payer: Cofinity Advantage |
$198.11
|
| Rate for Payer: Cofinity Commercial |
$243.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.41
|
| Rate for Payer: Healthscope Commercial |
$254.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.26
|
| Rate for Payer: PHP Commercial |
$240.56
|
| Rate for Payer: Priority Health SBD |
$178.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.96
|
| Rate for Payer: UHC Core |
$147.45
|
| Rate for Payer: UHC Exchange |
$111.22
|
| Rate for Payer: UMR Bronson Commercial |
$104.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.26
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$238.55
|
|
|
Service Code
|
NDC 65162032109
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.26 |
| Max. Negotiated Rate |
$214.69 |
| Rate for Payer: Aetna American Axle |
$155.06
|
| Rate for Payer: Aetna Commercial |
$202.77
|
| Rate for Payer: Aetna Medicare |
$119.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.06
|
| Rate for Payer: BCBS Complete |
$95.42
|
| Rate for Payer: Cash Price |
$190.84
|
| Rate for Payer: Cofinity Advantage |
$166.99
|
| Rate for Payer: Cofinity Commercial |
$205.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.84
|
| Rate for Payer: Healthscope Commercial |
$214.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.91
|
| Rate for Payer: PHP Commercial |
$202.77
|
| Rate for Payer: Priority Health SBD |
$150.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.06
|
| Rate for Payer: UHC Core |
$124.28
|
| Rate for Payer: UHC Exchange |
$93.75
|
| Rate for Payer: UMR Bronson Commercial |
$88.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.91
|
|
|
NIACIN ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$238.55
|
|
|
Service Code
|
NDC 65162032109
|
| Hospital Charge Code |
5545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.96 |
| Max. Negotiated Rate |
$214.69 |
| Rate for Payer: Aetna American Axle |
$155.06
|
| Rate for Payer: Aetna Commercial |
$202.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.06
|
| Rate for Payer: Cash Price |
$190.84
|
| Rate for Payer: Cofinity Advantage |
$166.99
|
| Rate for Payer: Cofinity Commercial |
$205.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.84
|
| Rate for Payer: Healthscope Commercial |
$214.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.91
|
| Rate for Payer: PHP Commercial |
$202.77
|
| Rate for Payer: Priority Health SBD |
$150.29
|
| Rate for Payer: UMR Bronson Commercial |
$104.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.91
|
|
|
NICARDIPINE 100 MCG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$112.23
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
301984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$101.01 |
| Rate for Payer: Aetna American Axle |
$72.95
|
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Medicare |
$56.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.95
|
| Rate for Payer: BCBS Complete |
$44.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cofinity Advantage |
$78.56
|
| Rate for Payer: Cofinity Commercial |
$96.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.78
|
| Rate for Payer: Healthscope Commercial |
$101.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.17
|
| Rate for Payer: PHP Commercial |
$95.40
|
| Rate for Payer: Priority Health SBD |
$70.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UMR Bronson Commercial |
$41.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.17
|
|
|
NICARDIPINE 100 MCG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$112.23
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
301984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$101.01 |
| Rate for Payer: Aetna American Axle |
$72.95
|
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.95
|
| Rate for Payer: Cash Price |
$89.78
|
| Rate for Payer: Cofinity Advantage |
$78.56
|
| Rate for Payer: Cofinity Commercial |
$96.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.78
|
| Rate for Payer: Healthscope Commercial |
$101.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.17
|
| Rate for Payer: PHP Commercial |
$95.40
|
| Rate for Payer: Priority Health SBD |
$70.70
|
| Rate for Payer: UMR Bronson Commercial |
$49.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.17
|
|
|
NICARDIPINE 10 MG/500 ML NS
|
Facility
|
IP
|
$1,860.80
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
151055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$818.75 |
| Max. Negotiated Rate |
$1,674.72 |
| Rate for Payer: Aetna American Axle |
$1,209.52
|
| Rate for Payer: Aetna Commercial |
$1,581.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.52
|
| Rate for Payer: Cash Price |
$1,488.64
|
| Rate for Payer: Cofinity Advantage |
$1,302.56
|
| Rate for Payer: Cofinity Commercial |
$1,600.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,488.64
|
| Rate for Payer: Healthscope Commercial |
$1,674.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,302.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,395.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,395.60
|
| Rate for Payer: PHP Commercial |
$1,581.68
|
| Rate for Payer: Priority Health SBD |
$1,172.30
|
| Rate for Payer: UMR Bronson Commercial |
$818.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,395.60
|
|
|
NICARDIPINE 10 MG/500 ML NS
|
Facility
|
OP
|
$1,860.80
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
151055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$1,674.72 |
| Rate for Payer: Aetna American Axle |
$1,209.52
|
| Rate for Payer: Aetna Commercial |
$1,581.68
|
| Rate for Payer: Aetna Medicare |
$930.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.52
|
| Rate for Payer: BCBS Complete |
$744.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$1,488.64
|
| Rate for Payer: Cash Price |
$1,488.64
|
| Rate for Payer: Cofinity Advantage |
$1,302.56
|
| Rate for Payer: Cofinity Commercial |
$1,600.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,488.64
|
| Rate for Payer: Healthscope Commercial |
$1,674.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,302.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,395.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,488.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,581.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,395.60
|
| Rate for Payer: PHP Commercial |
$1,581.68
|
| Rate for Payer: Priority Health SBD |
$1,172.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UMR Bronson Commercial |
$688.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,395.60
|
|
|
NICARDIPINE 20 MG/200 ML(0.1 MG/ML) IN SOD CHLOR(ISO) INTRAVENOUS SOLN
|
Facility
|
OP
|
$201.38
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna American Axle |
$130.90
|
| Rate for Payer: Aetna Commercial |
$171.17
|
| Rate for Payer: Aetna Medicare |
$100.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.90
|
| Rate for Payer: BCBS Complete |
$80.55
|
| Rate for Payer: BCBS Trust/PPO |
$0.19
|
| Rate for Payer: BCN Commercial |
$0.19
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cofinity Advantage |
$140.97
|
| Rate for Payer: Cofinity Commercial |
$173.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.10
|
| Rate for Payer: Healthscope Commercial |
$181.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.03
|
| Rate for Payer: PHP Commercial |
$171.17
|
| Rate for Payer: Priority Health SBD |
$126.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.12
|
| Rate for Payer: UHC Core |
$0.12
|
| Rate for Payer: UHC Exchange |
$0.12
|
| Rate for Payer: UMR Bronson Commercial |
$74.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.03
|
|
