|
OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION; PROXIMAL PHALANX, FIRST TOE (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 28310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$350.66 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.73
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$350.66
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS;
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 28304
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$593.50 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,192.68
|
| Rate for Payer: BCN Commercial |
$4,192.68
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$652.85
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$593.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OSTEOTOMY; TIBIA
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$725.78 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$798.36
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$725.78
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OSTEOTOMY; ULNA
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 25360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$637.72 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$701.49
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$637.72
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; FIRST METATARSAL
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 28306
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$393.13 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$3,015.99
|
| Rate for Payer: BCN Commercial |
$3,015.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.44
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$393.13
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; FIRST METATARSAL WITH AUTOGRAFT (OTHER THAN FIRST TOE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 28307
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$501.45 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.78
|
| Rate for Payer: BCN Commercial |
$2,214.78
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$551.60
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$501.45
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; OTHER THAN FIRST METATARSAL, EACH
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$373.11 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,461.52
|
| Rate for Payer: BCN Commercial |
$3,461.52
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.42
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$373.11
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
OTOLARYNGOLOGIC EXAMINATION UNDER GENERAL ANESTHESIA
|
Facility
|
OP
|
$1,568.21
|
|
|
Service Code
|
CPT 92502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$90.27 |
| Max. Negotiated Rate |
$1,568.21 |
| Rate for Payer: BCN Commercial |
$413.40
|
| Rate for Payer: Aetna Medicare |
$518.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.69
|
| Rate for Payer: BCBS Complete |
$280.81
|
| Rate for Payer: BCBS MAPPO |
$498.95
|
| Rate for Payer: BCBS Trust/PPO |
$413.40
|
| Rate for Payer: BCN Medicare Advantage |
$498.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.95
|
| Rate for Payer: Mclaren Medicaid |
$267.44
|
| Rate for Payer: Mclaren Medicare |
$498.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.90
|
| Rate for Payer: Meridian Medicaid |
$280.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.79
|
| Rate for Payer: Nomi Health Commercial |
$1,047.80
|
| Rate for Payer: PACE Medicare |
$474.00
|
| Rate for Payer: PACE SWMI |
$498.95
|
| Rate for Payer: PHP Medicare Advantage |
$498.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,568.21
|
| Rate for Payer: Priority Health Medicare |
$498.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,254.57
|
| Rate for Payer: Railroad Medicare Medicare |
$498.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.30
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.95
|
| Rate for Payer: UHC Exchange |
$90.27
|
| Rate for Payer: UHC Medicare Advantage |
$498.95
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: VA VA |
$498.95
|
|
|
OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE REDUCTION
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 69300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$451.01 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.82
|
| Rate for Payer: BCN Commercial |
$1,708.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.11
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$451.01
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL
|
Facility
|
OP
|
$15,201.47
|
|
|
Service Code
|
CPT 58925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$747.07 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,559.29
|
| Rate for Payer: BCN Commercial |
$3,559.29
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.78
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$747.07
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$281.26
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
99612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$253.13 |
| Rate for Payer: Aetna American Axle |
$182.82
|
| Rate for Payer: Aetna American Axle |
$179.76
|
| Rate for Payer: Aetna American Axle |
$182.02
|
| Rate for Payer: Aetna American Axle |
$159.58
|
| Rate for Payer: Aetna American Axle |
$278.90
|
| Rate for Payer: Aetna American Axle |
$586.22
|
| Rate for Payer: Aetna American Axle |
$110.06
|
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna American Axle |
$150.57
|
| Rate for Payer: Aetna American Axle |
$169.76
|
| Rate for Payer: Aetna Commercial |
$221.99
|
| Rate for Payer: Aetna Commercial |
$766.60
|
| Rate for Payer: Aetna Commercial |
$235.07
|
| Rate for Payer: Aetna Commercial |
$208.68
|
| Rate for Payer: Aetna Commercial |
$238.03
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Commercial |
$239.07
|
| Rate for Payer: Aetna Commercial |
$143.93
|
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Commercial |
$364.71
|
| Rate for Payer: Aetna Medicare |
$115.82
|
| Rate for Payer: Aetna Medicare |
$140.02
|
| Rate for Payer: Aetna Medicare |
$130.58
|
| Rate for Payer: Aetna Medicare |
$138.28
|
| Rate for Payer: Aetna Medicare |
$84.66
|
| Rate for Payer: Aetna Medicare |
$450.94
|
| Rate for Payer: Aetna Medicare |
$114.00
|
| Rate for Payer: Aetna Medicare |
$214.54
|
| Rate for Payer: Aetna Medicare |
$122.75
|
| Rate for Payer: Aetna Medicare |
$140.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.02
|
| Rate for Payer: BCBS Complete |
$67.73
|
| Rate for Payer: BCBS Complete |
$92.66
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS Complete |
$360.75
|
| Rate for Payer: BCBS Complete |
$98.20
|
| Rate for Payer: BCBS Complete |
$171.63
|
| Rate for Payer: BCBS Complete |
$112.01
|
| Rate for Payer: BCBS Complete |
$104.47
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS Complete |
$110.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$225.01
|
| Rate for Payer: Cash Price |
$225.01
|
| Rate for Payer: Cash Price |
$343.26
|
| Rate for Payer: Cash Price |
$343.26
|
| Rate for Payer: Cash Price |
$196.40
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cash Price |
$224.02
|
| Rate for Payer: Cash Price |
$208.94
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cash Price |
$221.24
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$221.24
|
| Rate for Payer: Cash Price |
$208.94
|
| Rate for Payer: Cash Price |
$196.40
|
| Rate for Payer: Cash Price |
$224.02
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Cofinity Commercial |
$118.53
|
| Rate for Payer: Cofinity Commercial |
$145.62
|
| Rate for Payer: Cofinity Commercial |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$162.16
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Cofinity Commercial |
$171.85
|
| Rate for Payer: Cofinity Commercial |
$211.13
|
| Rate for Payer: Cofinity Commercial |
$182.82
|
| Rate for Payer: Cofinity Commercial |
$224.61
|
| Rate for Payer: Cofinity Commercial |
$193.58
|
| Rate for Payer: Cofinity Commercial |
$237.83
|
| Rate for Payer: Cofinity Commercial |
$196.02
|
| Rate for Payer: Cofinity Commercial |
$240.83
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Cofinity Commercial |
$300.35
|
| Rate for Payer: Cofinity Commercial |
$369.00
|
| Rate for Payer: Cofinity Commercial |
$631.32
|
| Rate for Payer: Cofinity Commercial |
$775.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$631.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$208.48
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$220.95
|
| Rate for Payer: Healthscope Commercial |
$152.40
|
| Rate for Payer: Healthscope Commercial |
$235.05
|
| Rate for Payer: Healthscope Commercial |
$248.90
|
| Rate for Payer: Healthscope Commercial |
$386.16
|
| Rate for Payer: Healthscope Commercial |
$811.69
|
| Rate for Payer: Healthscope Commercial |
$253.13
|
| Rate for Payer: Healthscope Commercial |
$252.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$631.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$676.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.99
|
| Rate for Payer: PHP Commercial |
$238.03
|
| Rate for Payer: PHP Commercial |
$208.68
|
| Rate for Payer: PHP Commercial |
$364.71
|
| Rate for Payer: PHP Commercial |
$221.99
|
| Rate for Payer: PHP Commercial |
$235.07
|
| Rate for Payer: PHP Commercial |
$239.07
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: PHP Commercial |
$143.93
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: PHP Commercial |
$766.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health SBD |
$270.31
|
| Rate for Payer: Priority Health SBD |
$177.19
|
| Rate for Payer: Priority Health SBD |
$164.54
|
| Rate for Payer: Priority Health SBD |
$143.64
|
| Rate for Payer: Priority Health SBD |
$145.94
|
| Rate for Payer: Priority Health SBD |
$106.68
|
| Rate for Payer: Priority Health SBD |
$568.18
|
| Rate for Payer: Priority Health SBD |
$176.42
|
| Rate for Payer: Priority Health SBD |
$174.23
|
| Rate for Payer: Priority Health SBD |
$154.66
|
| Rate for Payer: UMR Bronson Commercial |
$62.65
|
| Rate for Payer: UMR Bronson Commercial |
$104.07
|
| Rate for Payer: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: UMR Bronson Commercial |
$158.76
|
| Rate for Payer: UMR Bronson Commercial |
$333.70
|
| Rate for Payer: UMR Bronson Commercial |
$85.71
|
| Rate for Payer: UMR Bronson Commercial |
$103.61
|
| Rate for Payer: UMR Bronson Commercial |
$102.32
|
| Rate for Payer: UMR Bronson Commercial |
$84.36
|
| Rate for Payer: UMR Bronson Commercial |
$96.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$676.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$280.03
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
99612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.21 |
| Max. Negotiated Rate |
$252.03 |
| Rate for Payer: Aetna American Axle |
$182.02
|
| Rate for Payer: Aetna American Axle |
$150.57
|
| Rate for Payer: Aetna American Axle |
$148.20
|
| Rate for Payer: Aetna American Axle |
$182.82
|
| Rate for Payer: Aetna Commercial |
$238.03
|
| Rate for Payer: Aetna Commercial |
$239.07
|
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.02
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cash Price |
$224.02
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$225.01
|
| Rate for Payer: Cofinity Commercial |
$159.60
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Cofinity Commercial |
$196.02
|
| Rate for Payer: Cofinity Commercial |
$162.16
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Cofinity Commercial |
$240.83
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$252.03
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$208.48
|
| Rate for Payer: Healthscope Commercial |
$253.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.03
|
| Rate for Payer: PHP Commercial |
$238.03
|
| Rate for Payer: PHP Commercial |
$239.07
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health SBD |
$177.19
|
| Rate for Payer: Priority Health SBD |
$143.64
|
| Rate for Payer: Priority Health SBD |
$145.94
|
| Rate for Payer: Priority Health SBD |
$176.42
|
| Rate for Payer: UMR Bronson Commercial |
$123.21
|
| Rate for Payer: UMR Bronson Commercial |
$123.75
|
| Rate for Payer: UMR Bronson Commercial |
$101.93
|
| Rate for Payer: UMR Bronson Commercial |
$100.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.02
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$186.76
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
41598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$168.08 |
| Rate for Payer: Aetna American Axle |
$121.39
|
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.39
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cofinity Commercial |
$130.73
|
| Rate for Payer: Cofinity Commercial |
$160.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.41
|
| Rate for Payer: Healthscope Commercial |
$168.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.75
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.39
|
| Rate for Payer: Priority Health SBD |
$117.66
|
| Rate for Payer: UMR Bronson Commercial |
$82.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.07
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$119.31
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
41598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$107.38 |
| Rate for Payer: Aetna American Axle |
$77.55
|
| Rate for Payer: Aetna American Axle |
$136.32
|
| Rate for Payer: Aetna American Axle |
$89.18
|
| Rate for Payer: Aetna American Axle |
$173.49
|
| Rate for Payer: Aetna American Axle |
$121.39
|
| Rate for Payer: Aetna American Axle |
$89.81
|
| Rate for Payer: Aetna American Axle |
$88.61
|
| Rate for Payer: Aetna Commercial |
$101.41
|
| Rate for Payer: Aetna Commercial |
$116.62
|
| Rate for Payer: Aetna Commercial |
$117.44
|
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna Commercial |
$178.26
|
| Rate for Payer: Aetna Commercial |
$226.87
|
| Rate for Payer: Aetna Commercial |
$115.88
|
| Rate for Payer: Aetna Medicare |
$68.60
|
| Rate for Payer: Aetna Medicare |
$68.16
|
| Rate for Payer: Aetna Medicare |
$59.66
|
| Rate for Payer: Aetna Medicare |
$133.46
|
| Rate for Payer: Aetna Medicare |
$104.86
|
| Rate for Payer: Aetna Medicare |
$93.38
|
| Rate for Payer: Aetna Medicare |
$69.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.18
|
| Rate for Payer: BCBS Complete |
$55.27
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS Complete |
$83.89
|
| Rate for Payer: BCBS Complete |
$54.88
|
| Rate for Payer: BCBS Complete |
$106.76
|
| Rate for Payer: BCBS Complete |
$47.72
|
| Rate for Payer: BCBS Complete |
$54.53
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.16
|
| Rate for Payer: Cash Price |
$109.06
|
| Rate for Payer: Cash Price |
$109.76
|
| Rate for Payer: Cash Price |
$95.45
|
| Rate for Payer: Cash Price |
$95.45
|
| Rate for Payer: Cash Price |
$109.06
|
| Rate for Payer: Cash Price |
$109.76
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cash Price |
$167.78
|
| Rate for Payer: Cash Price |
$167.78
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cofinity Commercial |
$160.61
|
| Rate for Payer: Cofinity Commercial |
$83.52
|
| Rate for Payer: Cofinity Commercial |
$180.36
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$96.72
|
| Rate for Payer: Cofinity Commercial |
$146.80
|
| Rate for Payer: Cofinity Commercial |
$95.43
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Cofinity Commercial |
$117.24
|
| Rate for Payer: Cofinity Commercial |
$96.04
|
| Rate for Payer: Cofinity Commercial |
$102.61
|
| Rate for Payer: Cofinity Commercial |
$186.84
|
| Rate for Payer: Cofinity Commercial |
$117.99
|
| Rate for Payer: Cofinity Commercial |
$130.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.41
|
| Rate for Payer: Healthscope Commercial |
$168.08
|
| Rate for Payer: Healthscope Commercial |
$124.35
|
| Rate for Payer: Healthscope Commercial |
$188.75
|
| Rate for Payer: Healthscope Commercial |
$107.38
|
| Rate for Payer: Healthscope Commercial |
$122.70
|
| Rate for Payer: Healthscope Commercial |
$240.22
|
| Rate for Payer: Healthscope Commercial |
$123.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.26
|
| Rate for Payer: PHP Commercial |
$178.26
|
| Rate for Payer: PHP Commercial |
$101.41
|
| Rate for Payer: PHP Commercial |
$226.87
|
| Rate for Payer: PHP Commercial |
$115.88
|
| Rate for Payer: PHP Commercial |
$116.62
|
| Rate for Payer: PHP Commercial |
$117.44
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.32
|
| Rate for Payer: Priority Health SBD |
$168.15
|
| Rate for Payer: Priority Health SBD |
$117.66
|
| Rate for Payer: Priority Health SBD |
$75.17
|
| Rate for Payer: Priority Health SBD |
$132.12
|
| Rate for Payer: Priority Health SBD |
$86.44
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: Priority Health SBD |
$85.89
|
| Rate for Payer: UMR Bronson Commercial |
$77.60
|
| Rate for Payer: UMR Bronson Commercial |
$50.44
|
| Rate for Payer: UMR Bronson Commercial |
$98.76
|
| Rate for Payer: UMR Bronson Commercial |
$69.10
|
| Rate for Payer: UMR Bronson Commercial |
$50.76
|
| Rate for Payer: UMR Bronson Commercial |
$44.14
|
| Rate for Payer: UMR Bronson Commercial |
$51.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.90
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$9.04
|
|
|
Service Code
|
NDC 62584081311
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: Aetna American Axle |
$5.88
|
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.88
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cofinity Commercial |
$6.33
|
| Rate for Payer: Cofinity Commercial |
$7.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.23
|
| Rate for Payer: Healthscope Commercial |
$8.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.68
|
| Rate for Payer: PHP Commercial |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.88
|
| Rate for Payer: Priority Health SBD |
$5.70
|
| Rate for Payer: UMR Bronson Commercial |
$3.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.78
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$903.17
|
|
|
Service Code
|
NDC 62584081301
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$397.39 |
| Max. Negotiated Rate |
$812.85 |
| Rate for Payer: Aetna American Axle |
$587.06
|
| Rate for Payer: Aetna Commercial |
$767.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.06
|
| Rate for Payer: Cash Price |
$722.54
|
| Rate for Payer: Cofinity Commercial |
$632.22
|
| Rate for Payer: Cofinity Commercial |
$776.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$632.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.54
|
| Rate for Payer: Healthscope Commercial |
$812.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$632.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$677.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.69
|
| Rate for Payer: PHP Commercial |
$767.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.06
|
| Rate for Payer: Priority Health SBD |
$569.00
|
| Rate for Payer: UMR Bronson Commercial |
$397.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$677.38
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$903.17
|
|
|
Service Code
|
NDC 62584081301
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$334.17 |
| Max. Negotiated Rate |
$812.85 |
| Rate for Payer: Aetna American Axle |
$587.06
|
| Rate for Payer: Aetna Commercial |
$767.69
|
| Rate for Payer: Aetna Medicare |
$451.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.06
|
| Rate for Payer: BCBS Complete |
$361.27
|
| Rate for Payer: Cash Price |
$722.54
|
| Rate for Payer: Cofinity Commercial |
$632.22
|
| Rate for Payer: Cofinity Commercial |
$776.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$632.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.54
|
| Rate for Payer: Healthscope Commercial |
$812.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$632.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$677.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.69
|
| Rate for Payer: PHP Commercial |
$767.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.06
|
| Rate for Payer: Priority Health SBD |
$569.00
|
| Rate for Payer: UMR Bronson Commercial |
$334.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$677.38
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$342.24
|
|
|
Service Code
|
NDC 00228206910
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.59 |
| Max. Negotiated Rate |
$308.02 |
| Rate for Payer: Aetna American Axle |
$222.46
|
| Rate for Payer: Aetna Commercial |
$290.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.46
|
| Rate for Payer: Cash Price |
$273.79
|
| Rate for Payer: Cofinity Commercial |
$239.57
|
| Rate for Payer: Cofinity Commercial |
$294.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.79
|
| Rate for Payer: Healthscope Commercial |
$308.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.90
|
| Rate for Payer: PHP Commercial |
$290.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.46
|
| Rate for Payer: Priority Health SBD |
$215.61
|
| Rate for Payer: UMR Bronson Commercial |
$150.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.68
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$9.04
|
|
|
Service Code
|
NDC 62584081311
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: Aetna American Axle |
$5.88
|
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.88
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cofinity Commercial |
$6.33
|
| Rate for Payer: Cofinity Commercial |
$7.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.23
|
| Rate for Payer: Healthscope Commercial |
$8.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.68
|
| Rate for Payer: PHP Commercial |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.88
|
| Rate for Payer: Priority Health SBD |
$5.70
|
| Rate for Payer: UMR Bronson Commercial |
$3.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.78
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$342.24
|
|
|
Service Code
|
NDC 00228206910
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.63 |
| Max. Negotiated Rate |
$308.02 |
| Rate for Payer: Cofinity Commercial |
$239.57
|
| Rate for Payer: Aetna American Axle |
$222.46
|
| Rate for Payer: Aetna Commercial |
$290.90
|
| Rate for Payer: Aetna Medicare |
$171.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.46
|
| Rate for Payer: BCBS Complete |
$136.90
|
| Rate for Payer: Cash Price |
$273.79
|
| Rate for Payer: Cofinity Commercial |
$294.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.79
|
| Rate for Payer: Healthscope Commercial |
$308.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.90
|
| Rate for Payer: PHP Commercial |
$290.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.46
|
| Rate for Payer: Priority Health SBD |
$215.61
|
| Rate for Payer: UMR Bronson Commercial |
$126.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.68
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$270.75
|
|
|
Service Code
|
NDC 68462013701
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$243.68 |
| Rate for Payer: Aetna American Axle |
$175.99
|
| Rate for Payer: Aetna Commercial |
$230.14
|
| Rate for Payer: Aetna Medicare |
$135.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.99
|
| Rate for Payer: BCBS Complete |
$108.30
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cofinity Commercial |
$189.52
|
| Rate for Payer: Cofinity Commercial |
$232.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.60
|
| Rate for Payer: Healthscope Commercial |
$243.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.14
|
| Rate for Payer: PHP Commercial |
$230.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.99
|
| Rate for Payer: Priority Health SBD |
$170.57
|
| Rate for Payer: UMR Bronson Commercial |
$100.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.06
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 50268067915
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$209.48 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$162.92
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.29
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UMR Bronson Commercial |
$102.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 50268067911
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna American Axle |
$3.03
|
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.03
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Commercial |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.03
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$270.75
|
|
|
Service Code
|
NDC 68462013701
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$243.68 |
| Rate for Payer: Cofinity Medicare Advantage |
$189.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.60
|
| Rate for Payer: Healthscope Commercial |
$243.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.14
|
| Rate for Payer: PHP Commercial |
$230.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.99
|
| Rate for Payer: Priority Health SBD |
$170.57
|
| Rate for Payer: UMR Bronson Commercial |
$119.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.06
|
| Rate for Payer: Aetna American Axle |
$175.99
|
| Rate for Payer: Aetna Commercial |
$230.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.99
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cofinity Commercial |
$189.52
|
| Rate for Payer: Cofinity Commercial |
$232.84
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 51991029201
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.86 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UMR Bronson Commercial |
$147.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
