|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$10.71
|
|
|
Service Code
|
NDC 00904743535
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: Aetna American Axle |
$6.96
|
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: Aetna Medicare |
$5.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.96
|
| Rate for Payer: BCBS Complete |
$4.28
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cofinity Advantage |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.57
|
| Rate for Payer: Healthscope Commercial |
$9.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.03
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: Priority Health SBD |
$6.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.96
|
| Rate for Payer: UHC Core |
$5.58
|
| Rate for Payer: UHC Exchange |
$4.21
|
| Rate for Payer: UMR Bronson Commercial |
$3.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.03
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
NDC 59390003613
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna American Axle |
$4.27
|
| Rate for Payer: Aetna Commercial |
$5.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.27
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cofinity Advantage |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$5.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$5.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.93
|
| Rate for Payer: PHP Commercial |
$5.58
|
| Rate for Payer: Priority Health SBD |
$4.14
|
| Rate for Payer: UMR Bronson Commercial |
$2.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.93
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$27.15
|
|
|
Service Code
|
NDC 41100081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$24.43 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Advantage |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.36
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.65
|
| Rate for Payer: UHC Core |
$14.15
|
| Rate for Payer: UHC Exchange |
$10.67
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$41.06
|
|
|
Service Code
|
NDC 41100081125
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$36.95 |
| Rate for Payer: Aetna American Axle |
$26.69
|
| Rate for Payer: Aetna Commercial |
$34.90
|
| Rate for Payer: Aetna Medicare |
$20.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.69
|
| Rate for Payer: BCBS Complete |
$16.42
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cofinity Advantage |
$28.74
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.85
|
| Rate for Payer: Healthscope Commercial |
$36.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.80
|
| Rate for Payer: PHP Commercial |
$34.90
|
| Rate for Payer: Priority Health SBD |
$25.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.69
|
| Rate for Payer: UHC Core |
$21.39
|
| Rate for Payer: UHC Exchange |
$16.14
|
| Rate for Payer: UMR Bronson Commercial |
$15.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.80
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$9.45
|
|
|
Service Code
|
NDC 00904676130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna Medicare |
$4.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Advantage |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.09
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.14
|
| Rate for Payer: UHC Core |
$4.92
|
| Rate for Payer: UHC Exchange |
$3.71
|
| Rate for Payer: UMR Bronson Commercial |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 00904676130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Advantage |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.09
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: UMR Bronson Commercial |
$4.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 70000000101
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna American Axle |
$6.67
|
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.67
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Advantage |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.67
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: UHC Exchange |
$4.03
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 23900001252
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Advantage |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.63
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.15
|
| Rate for Payer: UHC Core |
$12.94
|
| Rate for Payer: UHC Exchange |
$9.76
|
| Rate for Payer: UMR Bronson Commercial |
$9.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$27.15
|
|
|
Service Code
|
NDC 41100081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$24.43 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Advantage |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.36
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: UMR Bronson Commercial |
$11.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$41.06
|
|
|
Service Code
|
NDC 41100081125
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$36.95 |
| Rate for Payer: Aetna American Axle |
$26.69
|
| Rate for Payer: Aetna Commercial |
$34.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.69
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cofinity Advantage |
$28.74
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.85
|
| Rate for Payer: Healthscope Commercial |
$36.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.80
|
| Rate for Payer: PHP Commercial |
$34.90
|
| Rate for Payer: Priority Health SBD |
$25.87
|
| Rate for Payer: UMR Bronson Commercial |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.80
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 45802041059
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
OXYMORPHONE 10 MG TABLET
|
Facility
|
IP
|
$758.88
|
|
|
Service Code
|
NDC 31722093001
|
| Hospital Charge Code |
76676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.91 |
| Max. Negotiated Rate |
$682.99 |
| Rate for Payer: Aetna American Axle |
$493.27
|
| Rate for Payer: Aetna Commercial |
$645.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.27
|
| Rate for Payer: Cash Price |
$607.10
|
| Rate for Payer: Cofinity Advantage |
$531.22
|
| Rate for Payer: Cofinity Commercial |
$652.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.10
|
| Rate for Payer: Healthscope Commercial |
$682.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.16
|
| Rate for Payer: PHP Commercial |
$645.05
|
| Rate for Payer: Priority Health SBD |
$478.09
|
| Rate for Payer: UMR Bronson Commercial |
$333.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.16
|
|
|
OXYMORPHONE 10 MG TABLET
|
Facility
|
OP
|
$758.88
|
|
|
Service Code
|
NDC 31722093001
|
| Hospital Charge Code |
76676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.79 |
| Max. Negotiated Rate |
$682.99 |
| Rate for Payer: Aetna American Axle |
$493.27
|
| Rate for Payer: Aetna Commercial |
$645.05
|
| Rate for Payer: Aetna Medicare |
$379.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.27
|
| Rate for Payer: BCBS Complete |
$303.55
|
| Rate for Payer: Cash Price |
$607.10
|
| Rate for Payer: Cofinity Advantage |
$531.22
|
| Rate for Payer: Cofinity Commercial |
$652.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.10
|
| Rate for Payer: Healthscope Commercial |
$682.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$607.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$569.16
|
| Rate for Payer: PHP Commercial |
$645.05
|
| Rate for Payer: Priority Health SBD |
$478.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.27
|
| Rate for Payer: UHC Core |
$395.38
|
| Rate for Payer: UHC Exchange |
$298.24
|
| Rate for Payer: UMR Bronson Commercial |
$280.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.16
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.78
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$22.30 |
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$95.71
|
| Rate for Payer: Aetna American Axle |
$473.32
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: Aetna Commercial |
$618.96
|
| Rate for Payer: Aetna Commercial |
$125.16
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Aetna Medicare |
$73.62
|
| Rate for Payer: Aetna Medicare |
$364.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.32
|
| Rate for Payer: BCBS Complete |
$58.90
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS Complete |
$291.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.75
|
| Rate for Payer: BCBS Trust/PPO |
$6.75
|
| Rate for Payer: BCBS Trust/PPO |
$6.75
|
| Rate for Payer: BCN Commercial |
$6.75
|
| Rate for Payer: BCN Commercial |
$6.75
|
| Rate for Payer: BCN Commercial |
$6.75
|
| Rate for Payer: Cash Price |
$117.80
|
| Rate for Payer: Cash Price |
$117.80
|
| Rate for Payer: Cash Price |
$582.55
|
| Rate for Payer: Cash Price |
$582.55
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cofinity Advantage |
$509.73
|
| Rate for Payer: Cofinity Advantage |
$17.35
|
| Rate for Payer: Cofinity Advantage |
$103.08
|
| Rate for Payer: Cofinity Commercial |
$126.64
|
| Rate for Payer: Cofinity Commercial |
$21.31
|
| Rate for Payer: Cofinity Commercial |
$626.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Healthscope Commercial |
$132.53
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Healthscope Commercial |
$655.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$509.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$582.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.14
|
| Rate for Payer: PHP Commercial |
$21.06
|
| Rate for Payer: PHP Commercial |
$125.16
|
| Rate for Payer: PHP Commercial |
$618.96
|
| Rate for Payer: Priority Health SBD |
$92.77
|
| Rate for Payer: Priority Health SBD |
$458.76
|
| Rate for Payer: Priority Health SBD |
$15.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.44
|
| Rate for Payer: UHC Core |
$4.44
|
| Rate for Payer: UHC Core |
$4.44
|
| Rate for Payer: UHC Core |
$4.44
|
| Rate for Payer: UHC Exchange |
$4.44
|
| Rate for Payer: UHC Exchange |
$4.44
|
| Rate for Payer: UHC Exchange |
$4.44
|
| Rate for Payer: UMR Bronson Commercial |
$269.43
|
| Rate for Payer: UMR Bronson Commercial |
$54.48
|
| Rate for Payer: UMR Bronson Commercial |
$9.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.14
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.78
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$22.30 |
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$95.71
|
| Rate for Payer: Aetna American Axle |
$473.32
|
| Rate for Payer: Aetna Commercial |
$618.96
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: Aetna Commercial |
$125.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.32
|
| Rate for Payer: Cash Price |
$582.55
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$117.80
|
| Rate for Payer: Cofinity Advantage |
$509.73
|
| Rate for Payer: Cofinity Advantage |
$103.08
|
| Rate for Payer: Cofinity Advantage |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$626.24
|
| Rate for Payer: Cofinity Commercial |
$126.64
|
| Rate for Payer: Cofinity Commercial |
$21.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.80
|
| Rate for Payer: Healthscope Commercial |
$132.53
|
| Rate for Payer: Healthscope Commercial |
$655.37
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$509.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.59
|
| Rate for Payer: PHP Commercial |
$21.06
|
| Rate for Payer: PHP Commercial |
$125.16
|
| Rate for Payer: PHP Commercial |
$618.96
|
| Rate for Payer: Priority Health SBD |
$15.61
|
| Rate for Payer: Priority Health SBD |
$92.77
|
| Rate for Payer: Priority Health SBD |
$458.76
|
| Rate for Payer: UMR Bronson Commercial |
$64.79
|
| Rate for Payer: UMR Bronson Commercial |
$10.90
|
| Rate for Payer: UMR Bronson Commercial |
$320.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.44
|
|
|
OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
115673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
115673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.75
|
| Rate for Payer: BCN Commercial |
$6.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Advantage |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.39
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.44
|
| Rate for Payer: UHC Core |
$4.44
|
| Rate for Payer: UHC Exchange |
$4.44
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
IP
|
$245.39
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$220.85 |
| Rate for Payer: Aetna American Axle |
$159.50
|
| Rate for Payer: Aetna American Axle |
$231.52
|
| Rate for Payer: Aetna American Axle |
$250.18
|
| Rate for Payer: Aetna American Axle |
$333.70
|
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna American Axle |
$267.59
|
| Rate for Payer: Aetna American Axle |
$173.89
|
| Rate for Payer: Aetna Commercial |
$327.16
|
| Rate for Payer: Aetna Commercial |
$227.40
|
| Rate for Payer: Aetna Commercial |
$208.58
|
| Rate for Payer: Aetna Commercial |
$302.76
|
| Rate for Payer: Aetna Commercial |
$436.37
|
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.70
|
| Rate for Payer: Cash Price |
$196.31
|
| Rate for Payer: Cash Price |
$307.91
|
| Rate for Payer: Cash Price |
$284.95
|
| Rate for Payer: Cash Price |
$214.02
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cofinity Advantage |
$331.20
|
| Rate for Payer: Cofinity Advantage |
$171.77
|
| Rate for Payer: Cofinity Advantage |
$187.27
|
| Rate for Payer: Cofinity Advantage |
$269.42
|
| Rate for Payer: Cofinity Advantage |
$249.33
|
| Rate for Payer: Cofinity Advantage |
$288.18
|
| Rate for Payer: Cofinity Advantage |
$359.37
|
| Rate for Payer: Cofinity Commercial |
$306.32
|
| Rate for Payer: Cofinity Commercial |
$441.51
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$211.04
|
| Rate for Payer: Cofinity Commercial |
$230.08
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Cofinity Commercial |
$331.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.02
|
| Rate for Payer: Healthscope Commercial |
$462.04
|
| Rate for Payer: Healthscope Commercial |
$220.85
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$346.40
|
| Rate for Payer: Healthscope Commercial |
$240.78
|
| Rate for Payer: Healthscope Commercial |
$320.57
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$385.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.65
|
| Rate for Payer: PHP Commercial |
$227.40
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: PHP Commercial |
$327.16
|
| Rate for Payer: PHP Commercial |
$436.37
|
| Rate for Payer: PHP Commercial |
$302.76
|
| Rate for Payer: PHP Commercial |
$208.58
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: Priority Health SBD |
$154.60
|
| Rate for Payer: Priority Health SBD |
$242.48
|
| Rate for Payer: Priority Health SBD |
$259.36
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$323.43
|
| Rate for Payer: Priority Health SBD |
$168.54
|
| Rate for Payer: Priority Health SBD |
$224.40
|
| Rate for Payer: UMR Bronson Commercial |
$225.89
|
| Rate for Payer: UMR Bronson Commercial |
$107.97
|
| Rate for Payer: UMR Bronson Commercial |
$169.35
|
| Rate for Payer: UMR Bronson Commercial |
$117.71
|
| Rate for Payer: UMR Bronson Commercial |
$181.14
|
| Rate for Payer: UMR Bronson Commercial |
$208.18
|
| Rate for Payer: UMR Bronson Commercial |
$156.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.04
|
|
|
PACLITAXEL 6 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$245.39
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
10843
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$220.85 |
| Rate for Payer: Aetna American Axle |
$159.50
|
| Rate for Payer: Aetna American Axle |
$231.52
|
| Rate for Payer: Aetna American Axle |
$250.18
|
| Rate for Payer: Aetna American Axle |
$204.21
|
| Rate for Payer: Aetna American Axle |
$267.59
|
| Rate for Payer: Aetna American Axle |
$173.89
|
| Rate for Payer: Aetna American Axle |
$304.84
|
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna American Axle |
$723.01
|
| Rate for Payer: Aetna American Axle |
$333.70
|
| Rate for Payer: Aetna American Axle |
$173.13
|
| Rate for Payer: Aetna Commercial |
$945.47
|
| Rate for Payer: Aetna Commercial |
$436.37
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Commercial |
$208.58
|
| Rate for Payer: Aetna Commercial |
$398.63
|
| Rate for Payer: Aetna Commercial |
$227.40
|
| Rate for Payer: Aetna Commercial |
$226.40
|
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna Commercial |
$267.04
|
| Rate for Payer: Aetna Commercial |
$302.76
|
| Rate for Payer: Aetna Commercial |
$327.16
|
| Rate for Payer: Aetna Medicare |
$256.69
|
| Rate for Payer: Aetna Medicare |
$133.18
|
| Rate for Payer: Aetna Medicare |
$556.16
|
| Rate for Payer: Aetna Medicare |
$133.76
|
| Rate for Payer: Aetna Medicare |
$122.69
|
| Rate for Payer: Aetna Medicare |
$234.49
|
| Rate for Payer: Aetna Medicare |
$236.57
|
| Rate for Payer: Aetna Medicare |
$205.84
|
| Rate for Payer: Aetna Medicare |
$178.09
|
| Rate for Payer: Aetna Medicare |
$192.44
|
| Rate for Payer: Aetna Medicare |
$157.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.70
|
| Rate for Payer: BCBS Complete |
$142.48
|
| Rate for Payer: BCBS Complete |
$107.01
|
| Rate for Payer: BCBS Complete |
$444.93
|
| Rate for Payer: BCBS Complete |
$164.67
|
| Rate for Payer: BCBS Complete |
$205.35
|
| Rate for Payer: BCBS Complete |
$153.96
|
| Rate for Payer: BCBS Complete |
$125.67
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: BCBS Complete |
$98.16
|
| Rate for Payer: BCBS Complete |
$187.59
|
| Rate for Payer: BCBS Complete |
$106.54
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$889.86
|
| Rate for Payer: Cash Price |
$213.08
|
| Rate for Payer: Cash Price |
$213.08
|
| Rate for Payer: Cash Price |
$196.31
|
| Rate for Payer: Cash Price |
$196.31
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$307.91
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$375.18
|
| Rate for Payer: Cash Price |
$375.18
|
| Rate for Payer: Cash Price |
$214.02
|
| Rate for Payer: Cash Price |
$214.02
|
| Rate for Payer: Cash Price |
$284.95
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cash Price |
$284.95
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cash Price |
$251.34
|
| Rate for Payer: Cash Price |
$251.34
|
| Rate for Payer: Cash Price |
$307.91
|
| Rate for Payer: Cash Price |
$889.86
|
| Rate for Payer: Cofinity Advantage |
$328.29
|
| Rate for Payer: Cofinity Advantage |
$171.77
|
| Rate for Payer: Cofinity Advantage |
$219.92
|
| Rate for Payer: Cofinity Advantage |
$187.27
|
| Rate for Payer: Cofinity Advantage |
$186.44
|
| Rate for Payer: Cofinity Advantage |
$249.33
|
| Rate for Payer: Cofinity Advantage |
$269.42
|
| Rate for Payer: Cofinity Advantage |
$778.62
|
| Rate for Payer: Cofinity Advantage |
$288.18
|
| Rate for Payer: Cofinity Advantage |
$359.37
|
| Rate for Payer: Cofinity Advantage |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$956.60
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Cofinity Commercial |
$331.01
|
| Rate for Payer: Cofinity Commercial |
$403.32
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$270.19
|
| Rate for Payer: Cofinity Commercial |
$306.32
|
| Rate for Payer: Cofinity Commercial |
$441.51
|
| Rate for Payer: Cofinity Commercial |
$229.06
|
| Rate for Payer: Cofinity Commercial |
$230.08
|
| Rate for Payer: Cofinity Commercial |
$211.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$220.85
|
| Rate for Payer: Healthscope Commercial |
$1,001.09
|
| Rate for Payer: Healthscope Commercial |
$239.72
|
| Rate for Payer: Healthscope Commercial |
$240.78
|
| Rate for Payer: Healthscope Commercial |
$282.75
|
| Rate for Payer: Healthscope Commercial |
$320.57
|
| Rate for Payer: Healthscope Commercial |
$346.40
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Healthscope Commercial |
$422.08
|
| Rate for Payer: Healthscope Commercial |
$462.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$778.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$834.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$889.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$307.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$375.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$288.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$385.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$834.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.76
|
| Rate for Payer: PHP Commercial |
$302.76
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: PHP Commercial |
$327.16
|
| Rate for Payer: PHP Commercial |
$227.40
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: PHP Commercial |
$208.58
|
| Rate for Payer: PHP Commercial |
$398.63
|
| Rate for Payer: PHP Commercial |
$436.37
|
| Rate for Payer: PHP Commercial |
$267.04
|
| Rate for Payer: PHP Commercial |
$945.47
|
| Rate for Payer: PHP Commercial |
$226.40
|
| Rate for Payer: Priority Health SBD |
$154.60
|
| Rate for Payer: Priority Health SBD |
$295.46
|
| Rate for Payer: Priority Health SBD |
$700.76
|
| Rate for Payer: Priority Health SBD |
$224.40
|
| Rate for Payer: Priority Health SBD |
$168.54
|
| Rate for Payer: Priority Health SBD |
$259.36
|
| Rate for Payer: Priority Health SBD |
$323.43
|
| Rate for Payer: Priority Health SBD |
$167.80
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$242.48
|
| Rate for Payer: Priority Health SBD |
$197.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UMR Bronson Commercial |
$411.56
|
| Rate for Payer: UMR Bronson Commercial |
$173.52
|
| Rate for Payer: UMR Bronson Commercial |
$189.95
|
| Rate for Payer: UMR Bronson Commercial |
$142.41
|
| Rate for Payer: UMR Bronson Commercial |
$175.06
|
| Rate for Payer: UMR Bronson Commercial |
$98.55
|
| Rate for Payer: UMR Bronson Commercial |
$152.32
|
| Rate for Payer: UMR Bronson Commercial |
$116.24
|
| Rate for Payer: UMR Bronson Commercial |
$98.99
|
| Rate for Payer: UMR Bronson Commercial |
$131.79
|
| Rate for Payer: UMR Bronson Commercial |
$90.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$834.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.63
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$5,160.33
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
40475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$4,644.30 |
| Rate for Payer: Aetna American Axle |
$3,354.21
|
| Rate for Payer: Aetna Commercial |
$4,386.28
|
| Rate for Payer: Aetna Medicare |
$6.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,354.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.53
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$26.03
|
| Rate for Payer: BCN Commercial |
$26.03
|
| Rate for Payer: BCN Medicare Advantage |
$6.02
|
| Rate for Payer: Cash Price |
$4,128.26
|
| Rate for Payer: Cash Price |
$4,128.26
|
| Rate for Payer: Cofinity Advantage |
$3,612.23
|
| Rate for Payer: Cofinity Commercial |
$4,437.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,128.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.02
|
| Rate for Payer: Healthscope Commercial |
$4,644.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,612.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,870.25
|
| Rate for Payer: Mclaren Medicaid |
$6.02
|
| Rate for Payer: Mclaren Medicare |
$6.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.32
|
| Rate for Payer: Meridian Medicaid |
$6.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,386.28
|
| Rate for Payer: Nomi Health Commercial |
$18.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,870.25
|
| Rate for Payer: PACE Medicare |
$5.72
|
| Rate for Payer: PACE SWMI |
$6.02
|
| Rate for Payer: PHP Commercial |
$4,386.28
|
| Rate for Payer: PHP Medicare Advantage |
$6.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.24
|
| Rate for Payer: Priority Health Medicare |
$6.02
|
| Rate for Payer: Priority Health SBD |
$3,251.01
|
| Rate for Payer: Priority Health Tiered Network |
$26.59
|
| Rate for Payer: Railroad Medicare Medicare |
$6.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.50
|
| Rate for Payer: UHC Core |
$13.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.02
|
| Rate for Payer: UHC Exchange |
$13.50
|
| Rate for Payer: UHC Medicaid |
$3.15
|
| Rate for Payer: UHCCP Medicaid |
$3.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,909.32
|
| Rate for Payer: VA VA |
$6.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,870.25
|
|
|
PACLITAXEL PROTEIN-BOUND 100 MG INTRAVENOUS SUSPENSION
|
Facility
|
IP
|
$5,160.33
|
|
|
Service Code
|
HCPCS J9264
|
| Hospital Charge Code |
40475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,270.55 |
| Max. Negotiated Rate |
$4,644.30 |
| Rate for Payer: Aetna American Axle |
$3,354.21
|
| Rate for Payer: Aetna Commercial |
$4,386.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,354.21
|
| Rate for Payer: Cash Price |
$4,128.26
|
| Rate for Payer: Cofinity Advantage |
$3,612.23
|
| Rate for Payer: Cofinity Commercial |
$4,437.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,128.26
|
| Rate for Payer: Healthscope Commercial |
$4,644.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,612.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,870.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,386.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,870.25
|
| Rate for Payer: PHP Commercial |
$4,386.28
|
| Rate for Payer: Priority Health SBD |
$3,251.01
|
| Rate for Payer: UMR Bronson Commercial |
$2,270.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,870.25
|
|
|
PALATOPLASTY FOR CLEFT PALATE; ATTACHMENT PHARYNGEAL FLAP
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 42225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,835.44
|
| Rate for Payer: BCN Commercial |
$3,835.44
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
PALATOPLASTY FOR CLEFT PALATE, SOFT AND/OR HARD PALATE ONLY
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 42200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,474.67
|
| Rate for Payer: BCN Commercial |
$4,474.67
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLAR RIDGE; WITH BONE GRAFT TO ALVEOLAR RIDGE (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 42210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,474.67
|
| Rate for Payer: BCN Commercial |
$4,474.67
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2,523.92
|
|
|
Service Code
|
NDC 00378397893
|
| Hospital Charge Code |
100011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$933.85 |
| Max. Negotiated Rate |
$2,271.53 |
| Rate for Payer: Aetna American Axle |
$1,640.55
|
| Rate for Payer: Aetna Commercial |
$2,145.33
|
| Rate for Payer: Aetna Medicare |
$1,261.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,640.55
|
| Rate for Payer: BCBS Complete |
$1,009.57
|
| Rate for Payer: Cash Price |
$2,019.14
|
| Rate for Payer: Cofinity Advantage |
$1,766.74
|
| Rate for Payer: Cofinity Commercial |
$2,170.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,019.14
|
| Rate for Payer: Healthscope Commercial |
$2,271.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,766.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,892.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,019.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,145.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,892.94
|
| Rate for Payer: PHP Commercial |
$2,145.33
|
| Rate for Payer: Priority Health SBD |
$1,590.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,640.55
|
| Rate for Payer: UHC Core |
$1,314.96
|
| Rate for Payer: UHC Exchange |
$991.90
|
| Rate for Payer: UMR Bronson Commercial |
$933.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,892.94
|
|
