|
MYCOPHENOLATE SODIUM 180 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$2,802.09
|
|
|
Service Code
|
HCPCS J7518
|
| Hospital Charge Code |
38062
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,036.77 |
| Max. Negotiated Rate |
$2,521.88 |
| Rate for Payer: Aetna American Axle |
$1,821.36
|
| Rate for Payer: Aetna American Axle |
$911.50
|
| Rate for Payer: Aetna American Axle |
$864.36
|
| Rate for Payer: Aetna American Axle |
$183.77
|
| Rate for Payer: Aetna American Axle |
$9.12
|
| Rate for Payer: Aetna American Axle |
$315.28
|
| Rate for Payer: Aetna Commercial |
$412.28
|
| Rate for Payer: Aetna Commercial |
$2,381.78
|
| Rate for Payer: Aetna Commercial |
$1,191.95
|
| Rate for Payer: Aetna Commercial |
$1,130.31
|
| Rate for Payer: Aetna Commercial |
$240.31
|
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: Aetna Medicare |
$7.01
|
| Rate for Payer: Aetna Medicare |
$664.89
|
| Rate for Payer: Aetna Medicare |
$141.36
|
| Rate for Payer: Aetna Medicare |
$242.52
|
| Rate for Payer: Aetna Medicare |
$1,401.05
|
| Rate for Payer: Aetna Medicare |
$701.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,821.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.28
|
| Rate for Payer: BCBS Complete |
$194.02
|
| Rate for Payer: BCBS Complete |
$1,120.84
|
| Rate for Payer: BCBS Complete |
$560.92
|
| Rate for Payer: BCBS Complete |
$5.61
|
| Rate for Payer: BCBS Complete |
$113.09
|
| Rate for Payer: BCBS Complete |
$531.91
|
| Rate for Payer: Cash Price |
$1,121.84
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cash Price |
$2,241.67
|
| Rate for Payer: Cash Price |
$388.03
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cash Price |
$1,063.82
|
| Rate for Payer: Cofinity Commercial |
$417.13
|
| Rate for Payer: Cofinity Commercial |
$2,409.80
|
| Rate for Payer: Cofinity Commercial |
$1,143.61
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$1,961.46
|
| Rate for Payer: Cofinity Commercial |
$930.85
|
| Rate for Payer: Cofinity Commercial |
$1,205.98
|
| Rate for Payer: Cofinity Commercial |
$981.61
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Cofinity Commercial |
$243.14
|
| Rate for Payer: Cofinity Commercial |
$197.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$981.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$930.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,961.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,241.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.03
|
| Rate for Payer: Healthscope Commercial |
$1,262.07
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Healthscope Commercial |
$1,196.80
|
| Rate for Payer: Healthscope Commercial |
$2,521.88
|
| Rate for Payer: Healthscope Commercial |
$436.54
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,961.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$981.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,051.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,101.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,130.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,191.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,381.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$1,130.31
|
| Rate for Payer: PHP Commercial |
$2,381.78
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Commercial |
$1,191.95
|
| Rate for Payer: PHP Commercial |
$240.31
|
| Rate for Payer: PHP Commercial |
$412.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,821.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$911.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.12
|
| Rate for Payer: Priority Health SBD |
$883.45
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: Priority Health SBD |
$8.84
|
| Rate for Payer: Priority Health SBD |
$1,765.32
|
| Rate for Payer: Priority Health SBD |
$837.76
|
| Rate for Payer: Priority Health SBD |
$305.58
|
| Rate for Payer: UMR Bronson Commercial |
$179.46
|
| Rate for Payer: UMR Bronson Commercial |
$492.02
|
| Rate for Payer: UMR Bronson Commercial |
$518.85
|
| Rate for Payer: UMR Bronson Commercial |
$5.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,036.77
|
| Rate for Payer: UMR Bronson Commercial |
$104.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,101.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,051.72
|
|
|
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS; VAGINAL APPROACH
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 58145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$5,926.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND DONOR AREA)
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 69620
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION
|
Facility
|
OP
|
$637.52
|
|
|
Service Code
|
CPT 69420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.39 |
| Max. Negotiated Rate |
$637.52 |
| Rate for Payer: Aetna Medicare |
$235.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.10
|
| Rate for Payer: BCBS Complete |
$127.46
|
| Rate for Payer: BCBS MAPPO |
$226.48
|
| Rate for Payer: BCN Medicare Advantage |
$226.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.48
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Mclaren Medicare |
$226.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.80
|
| Rate for Payer: Meridian Medicaid |
$127.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.45
|
| Rate for Payer: PACE Medicare |
$215.16
|
| Rate for Payer: PACE SWMI |
$226.48
|
| Rate for Payer: PHP Medicare Advantage |
$226.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Medicare |
$226.48
|
| Rate for Payer: Railroad Medicare Medicare |
$226.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.48
|
| Rate for Payer: UHC Exchange |
$432.83
|
| Rate for Payer: UHC Medicare Advantage |
$226.48
|
| Rate for Payer: UHCCP Medicaid |
$121.39
|
| Rate for Payer: VA VA |
$226.48
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 69421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
OP
|
$203.30
|
|
|
Service Code
|
NDC 76385013401
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.22 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna American Axle |
$132.15
|
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna Medicare |
$101.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: BCBS Complete |
$81.32
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.15
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UMR Bronson Commercial |
$75.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.47
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
OP
|
$199.50
|
|
|
Service Code
|
NDC 69097086807
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.81 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna American Axle |
$129.68
|
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: Aetna Medicare |
$99.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: BCBS Complete |
$79.80
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.68
|
| Rate for Payer: Priority Health SBD |
$125.69
|
| Rate for Payer: UMR Bronson Commercial |
$73.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$203.30
|
|
|
Service Code
|
NDC 76385013401
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.45 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna American Axle |
$132.15
|
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.15
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UMR Bronson Commercial |
$89.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.47
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$1,221.37
|
|
|
Service Code
|
NDC 00904707161
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.40 |
| Max. Negotiated Rate |
$1,099.23 |
| Rate for Payer: Aetna American Axle |
$793.89
|
| Rate for Payer: Aetna Commercial |
$1,038.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.89
|
| Rate for Payer: Cash Price |
$977.10
|
| Rate for Payer: Cofinity Commercial |
$1,050.38
|
| Rate for Payer: Cofinity Commercial |
$854.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$854.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.10
|
| Rate for Payer: Healthscope Commercial |
$1,099.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$854.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$916.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.16
|
| Rate for Payer: PHP Commercial |
$1,038.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.89
|
| Rate for Payer: Priority Health SBD |
$769.46
|
| Rate for Payer: UMR Bronson Commercial |
$537.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$916.03
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
OP
|
$1,221.37
|
|
|
Service Code
|
NDC 00904707161
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$451.91 |
| Max. Negotiated Rate |
$1,099.23 |
| Rate for Payer: Aetna American Axle |
$793.89
|
| Rate for Payer: Aetna Commercial |
$1,038.16
|
| Rate for Payer: Aetna Medicare |
$610.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.89
|
| Rate for Payer: BCBS Complete |
$488.55
|
| Rate for Payer: Cash Price |
$977.10
|
| Rate for Payer: Cofinity Commercial |
$1,050.38
|
| Rate for Payer: Cofinity Commercial |
$854.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$854.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$977.10
|
| Rate for Payer: Healthscope Commercial |
$1,099.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$854.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$916.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,038.16
|
| Rate for Payer: PHP Commercial |
$1,038.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.89
|
| Rate for Payer: Priority Health SBD |
$769.46
|
| Rate for Payer: UMR Bronson Commercial |
$451.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$916.03
|
|
|
NADOLOL 40 MG TABLET
|
Facility
|
IP
|
$199.50
|
|
|
Service Code
|
NDC 69097086807
|
| Hospital Charge Code |
5331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna American Axle |
$129.68
|
| Rate for Payer: Aetna Commercial |
$169.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.68
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$139.65
|
| Rate for Payer: Cofinity Commercial |
$171.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$179.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.57
|
| Rate for Payer: PHP Commercial |
$169.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.68
|
| Rate for Payer: Priority Health SBD |
$125.69
|
| Rate for Payer: UMR Bronson Commercial |
$87.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.62
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$148.50
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.34 |
| Max. Negotiated Rate |
$133.65 |
| Rate for Payer: Aetna American Axle |
$96.53
|
| Rate for Payer: Aetna American Axle |
$96.03
|
| Rate for Payer: Aetna American Axle |
$91.32
|
| Rate for Payer: Aetna American Axle |
$303.74
|
| Rate for Payer: Aetna Commercial |
$126.22
|
| Rate for Payer: Aetna Commercial |
$397.20
|
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Commercial |
$119.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.53
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Cofinity Commercial |
$120.82
|
| Rate for Payer: Cofinity Commercial |
$401.87
|
| Rate for Payer: Cofinity Commercial |
$327.10
|
| Rate for Payer: Cofinity Commercial |
$103.95
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Commercial |
$127.71
|
| Rate for Payer: Cofinity Commercial |
$98.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Healthscope Commercial |
$133.65
|
| Rate for Payer: Healthscope Commercial |
$126.44
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Healthscope Commercial |
$420.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.22
|
| Rate for Payer: PHP Commercial |
$126.22
|
| Rate for Payer: PHP Commercial |
$397.20
|
| Rate for Payer: PHP Commercial |
$119.42
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.32
|
| Rate for Payer: Priority Health SBD |
$294.39
|
| Rate for Payer: Priority Health SBD |
$88.51
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: Priority Health SBD |
$93.56
|
| Rate for Payer: UMR Bronson Commercial |
$65.34
|
| Rate for Payer: UMR Bronson Commercial |
$205.61
|
| Rate for Payer: UMR Bronson Commercial |
$65.01
|
| Rate for Payer: UMR Bronson Commercial |
$61.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.38
|
|
|
NAFCILLIN 10 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$147.74
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5334
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna American Axle |
$96.03
|
| Rate for Payer: Aetna American Axle |
$236.06
|
| Rate for Payer: Aetna American Axle |
$303.74
|
| Rate for Payer: Aetna American Axle |
$91.32
|
| Rate for Payer: Aetna American Axle |
$96.53
|
| Rate for Payer: Aetna Commercial |
$119.42
|
| Rate for Payer: Aetna Commercial |
$397.20
|
| Rate for Payer: Aetna Commercial |
$126.22
|
| Rate for Payer: Aetna Commercial |
$308.69
|
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Medicare |
$181.59
|
| Rate for Payer: Aetna Medicare |
$73.87
|
| Rate for Payer: Aetna Medicare |
$233.65
|
| Rate for Payer: Aetna Medicare |
$74.25
|
| Rate for Payer: Aetna Medicare |
$70.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.06
|
| Rate for Payer: BCBS Complete |
$186.92
|
| Rate for Payer: BCBS Complete |
$56.20
|
| Rate for Payer: BCBS Complete |
$145.27
|
| Rate for Payer: BCBS Complete |
$59.40
|
| Rate for Payer: BCBS Complete |
$59.10
|
| Rate for Payer: Cash Price |
$373.83
|
| Rate for Payer: Cash Price |
$112.39
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cash Price |
$290.54
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cofinity Commercial |
$327.10
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Cofinity Commercial |
$312.33
|
| Rate for Payer: Cofinity Commercial |
$120.82
|
| Rate for Payer: Cofinity Commercial |
$127.71
|
| Rate for Payer: Cofinity Commercial |
$103.95
|
| Rate for Payer: Cofinity Commercial |
$254.22
|
| Rate for Payer: Cofinity Commercial |
$98.34
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Cofinity Commercial |
$401.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$254.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.80
|
| Rate for Payer: Healthscope Commercial |
$126.44
|
| Rate for Payer: Healthscope Commercial |
$133.65
|
| Rate for Payer: Healthscope Commercial |
$420.56
|
| Rate for Payer: Healthscope Commercial |
$326.85
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.20
|
| Rate for Payer: PHP Commercial |
$308.69
|
| Rate for Payer: PHP Commercial |
$126.22
|
| Rate for Payer: PHP Commercial |
$119.42
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: PHP Commercial |
$397.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.03
|
| Rate for Payer: Priority Health SBD |
$93.08
|
| Rate for Payer: Priority Health SBD |
$88.51
|
| Rate for Payer: Priority Health SBD |
$93.56
|
| Rate for Payer: Priority Health SBD |
$228.80
|
| Rate for Payer: Priority Health SBD |
$294.39
|
| Rate for Payer: UMR Bronson Commercial |
$172.90
|
| Rate for Payer: UMR Bronson Commercial |
$134.37
|
| Rate for Payer: UMR Bronson Commercial |
$54.66
|
| Rate for Payer: UMR Bronson Commercial |
$51.98
|
| Rate for Payer: UMR Bronson Commercial |
$54.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.38
|
|
|
NAFCILLIN 1 GRAM IVPB (INTRA-OP)
|
Facility
|
OP
|
$5.70
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna American Axle |
$3.71
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.71
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.71
|
| Rate for Payer: Priority Health SBD |
$3.59
|
| Rate for Payer: UMR Bronson Commercial |
$2.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.28
|
|
|
NAFCILLIN 1 GRAM IVPB (INTRA-OP)
|
Facility
|
IP
|
$5.70
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna American Axle |
$3.71
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.71
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.71
|
| Rate for Payer: Priority Health SBD |
$3.59
|
| Rate for Payer: UMR Bronson Commercial |
$2.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.28
|
|
|
NAFCILLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$129.29
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
27285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.89 |
| Max. Negotiated Rate |
$116.36 |
| Rate for Payer: Aetna American Axle |
$84.04
|
| Rate for Payer: Aetna Commercial |
$109.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.04
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Cofinity Commercial |
$111.19
|
| Rate for Payer: Cofinity Commercial |
$90.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.43
|
| Rate for Payer: Healthscope Commercial |
$116.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.90
|
| Rate for Payer: PHP Commercial |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.04
|
| Rate for Payer: Priority Health SBD |
$81.45
|
| Rate for Payer: UMR Bronson Commercial |
$56.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.97
|
|
|
NAFCILLIN 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$129.29
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
27285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$116.36 |
| Rate for Payer: Aetna American Axle |
$84.04
|
| Rate for Payer: Aetna Commercial |
$109.90
|
| Rate for Payer: Aetna Medicare |
$64.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.04
|
| Rate for Payer: BCBS Complete |
$51.72
|
| Rate for Payer: Cash Price |
$103.43
|
| Rate for Payer: Cofinity Commercial |
$111.19
|
| Rate for Payer: Cofinity Commercial |
$90.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.43
|
| Rate for Payer: Healthscope Commercial |
$116.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.90
|
| Rate for Payer: PHP Commercial |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.04
|
| Rate for Payer: Priority Health SBD |
$81.45
|
| Rate for Payer: UMR Bronson Commercial |
$47.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.97
|
|
|
NAFCILLIN 2 GRAM IVPB (INTRA-OP)
|
Facility
|
OP
|
$21.20
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna American Axle |
$13.78
|
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: BCBS Complete |
$8.48
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| Rate for Payer: Priority Health SBD |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.90
|
|
|
NAFCILLIN 2 GRAM IVPB (INTRA-OP)
|
Facility
|
IP
|
$21.20
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
168911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna American Axle |
$13.78
|
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.78
|
| Rate for Payer: Cash Price |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.02
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.78
|
| Rate for Payer: Priority Health SBD |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.90
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$89.81
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$80.83 |
| Rate for Payer: Aetna American Axle |
$58.38
|
| Rate for Payer: Aetna American Axle |
$61.35
|
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna American Axle |
$60.53
|
| Rate for Payer: Aetna Commercial |
$80.23
|
| Rate for Payer: Aetna Commercial |
$76.34
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna Medicare |
$47.20
|
| Rate for Payer: Aetna Medicare |
$44.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Complete |
$37.76
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: BCBS Complete |
$35.92
|
| Rate for Payer: Cash Price |
$71.85
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$75.51
|
| Rate for Payer: Cofinity Commercial |
$77.24
|
| Rate for Payer: Cofinity Commercial |
$81.18
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$62.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.85
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$80.83
|
| Rate for Payer: Healthscope Commercial |
$84.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$76.34
|
| Rate for Payer: PHP Commercial |
$80.23
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: Priority Health SBD |
$59.47
|
| Rate for Payer: Priority Health SBD |
$56.58
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: UMR Bronson Commercial |
$34.45
|
| Rate for Payer: UMR Bronson Commercial |
$33.23
|
| Rate for Payer: UMR Bronson Commercial |
$34.92
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.36
|
|
|
NAFCILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
5335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.97 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna American Axle |
$60.53
|
| Rate for Payer: Aetna American Axle |
$58.38
|
| Rate for Payer: Aetna American Axle |
$15.66
|
| Rate for Payer: Aetna American Axle |
$61.35
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Commercial |
$80.23
|
| Rate for Payer: Aetna Commercial |
$76.34
|
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Cash Price |
$71.85
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$75.51
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$81.18
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$62.87
|
| Rate for Payer: Cofinity Commercial |
$77.24
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.85
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Healthscope Commercial |
$80.83
|
| Rate for Payer: Healthscope Commercial |
$84.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$80.23
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$76.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health SBD |
$59.47
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: Priority Health SBD |
$56.58
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: UMR Bronson Commercial |
$40.97
|
| Rate for Payer: UMR Bronson Commercial |
$41.53
|
| Rate for Payer: UMR Bronson Commercial |
$39.52
|
| Rate for Payer: UMR Bronson Commercial |
$10.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.45 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna American Axle |
$60.53
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna Medicare |
$46.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: BCBS Complete |
$37.25
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: UMR Bronson Commercial |
$34.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
|
|
NAFCILLIN 2 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$93.12
|
|
|
Service Code
|
HCPCS J2290
|
| Hospital Charge Code |
301716
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.97 |
| Max. Negotiated Rate |
$83.81 |
| Rate for Payer: Aetna American Axle |
$60.53
|
| Rate for Payer: Aetna Commercial |
$79.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.53
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$80.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.50
|
| Rate for Payer: Healthscope Commercial |
$83.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.15
|
| Rate for Payer: PHP Commercial |
$79.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.53
|
| Rate for Payer: Priority Health SBD |
$58.67
|
| Rate for Payer: UMR Bronson Commercial |
$40.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.84
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
5339
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
NALBUPHINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
5339
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
