|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
IP
|
$366.60
|
|
|
Service Code
|
NDC 00904666761
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.15 |
| Max. Negotiated Rate |
$329.94 |
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: BCBS Trust/PPO |
$302.77
|
| Rate for Payer: BCN Commercial |
$302.77
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Healthscope Commercial |
$329.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: Nomi Health Commercial |
$300.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.95
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$318.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.61
|
| Rate for Payer: UHC Core |
$306.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.95
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 63739090410
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.62 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna Medicare |
$77.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.27
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS MAPPO |
$74.61
|
| Rate for Payer: BCBS Trust/PPO |
$245.36
|
| Rate for Payer: BCN Commercial |
$245.36
|
| Rate for Payer: BCN Medicare Advantage |
$74.61
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.61
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Mclaren Medicaid |
$52.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.34
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: PACE Senior Care Partners |
$70.88
|
| Rate for Payer: PACE SWMI |
$74.61
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: PHP Medicare Advantage |
$74.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$259.65
|
| Rate for Payer: Priority Health Medicare |
$75.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.72
|
| Rate for Payer: Railroad Medicare Medicare |
$74.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.64
|
| Rate for Payer: UHC Core |
$249.21
|
| Rate for Payer: UHC Exchange |
$74.61
|
| Rate for Payer: UHC Medicaid |
$52.62
|
| Rate for Payer: UHC Medicare Advantage |
$74.61
|
| Rate for Payer: UHCCP Medicaid |
$52.62
|
| Rate for Payer: VA VA |
$74.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 63739090410
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.72 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: BCBS Trust/PPO |
$246.49
|
| Rate for Payer: BCN Commercial |
$246.49
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$259.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.64
|
| Rate for Payer: UHC Core |
$249.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
OP
|
$150.40
|
|
|
Service Code
|
NDC 67877022401
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna Medicare |
$39.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.00
|
| Rate for Payer: BCBS Complete |
$27.84
|
| Rate for Payer: BCBS MAPPO |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$123.64
|
| Rate for Payer: BCN Commercial |
$123.64
|
| Rate for Payer: BCN Medicare Advantage |
$37.60
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.80
|
| Rate for Payer: Mclaren Medicaid |
$26.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.48
|
| Rate for Payer: Meridian Medicaid |
$27.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Nomi Health Commercial |
$123.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.80
|
| Rate for Payer: PACE Senior Care Partners |
$35.72
|
| Rate for Payer: PACE SWMI |
$37.60
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: PHP Medicare Advantage |
$37.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.85
|
| Rate for Payer: Priority Health Medicare |
$37.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.68
|
| Rate for Payer: Railroad Medicare Medicare |
$37.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.35
|
| Rate for Payer: UHC Core |
$125.58
|
| Rate for Payer: UHC Exchange |
$37.60
|
| Rate for Payer: UHC Medicaid |
$26.52
|
| Rate for Payer: UHC Medicare Advantage |
$37.60
|
| Rate for Payer: UHCCP Medicaid |
$26.52
|
| Rate for Payer: VA VA |
$37.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
NDC 63739098410
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.83 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: BCBS Trust/PPO |
$197.97
|
| Rate for Payer: BCN Commercial |
$197.97
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Nomi Health Commercial |
$196.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$208.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.94
|
| Rate for Payer: UHC Core |
$200.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
NDC 63739098410
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.75
|
| Rate for Payer: Aetna Medicare |
$62.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.91
|
| Rate for Payer: BCBS Complete |
$44.37
|
| Rate for Payer: BCBS MAPPO |
$59.92
|
| Rate for Payer: BCBS Trust/PPO |
$197.06
|
| Rate for Payer: BCN Commercial |
$197.06
|
| Rate for Payer: BCN Medicare Advantage |
$59.92
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.92
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Mclaren Medicaid |
$42.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.92
|
| Rate for Payer: Meridian Medicaid |
$44.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.75
|
| Rate for Payer: Nomi Health Commercial |
$196.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.78
|
| Rate for Payer: PACE Senior Care Partners |
$56.93
|
| Rate for Payer: PACE SWMI |
$59.92
|
| Rate for Payer: PHP Commercial |
$203.75
|
| Rate for Payer: PHP Medicare Advantage |
$59.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$208.54
|
| Rate for Payer: Priority Health Medicare |
$60.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.83
|
| Rate for Payer: Railroad Medicare Medicare |
$59.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.94
|
| Rate for Payer: UHC Core |
$200.15
|
| Rate for Payer: UHC Exchange |
$59.92
|
| Rate for Payer: UHC Medicaid |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$59.92
|
| Rate for Payer: UHCCP Medicaid |
$42.26
|
| Rate for Payer: VA VA |
$59.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
GABAPENTIN 400 MG CAPSULE
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 67877022401
|
| Hospital Charge Code |
18307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.68 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: BCBS Trust/PPO |
$124.22
|
| Rate for Payer: BCN Commercial |
$124.22
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Nomi Health Commercial |
$123.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.80
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.35
|
| Rate for Payer: UHC Core |
$125.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$128.40
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$115.56 |
| Rate for Payer: Aetna Commercial |
$109.14
|
| Rate for Payer: Aetna Commercial |
$81.86
|
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna Medicare |
$25.04
|
| Rate for Payer: Aetna Medicare |
$33.38
|
| Rate for Payer: Aetna Medicare |
$8.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.09
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Complete |
$23.77
|
| Rate for Payer: BCBS Complete |
$17.83
|
| Rate for Payer: BCBS MAPPO |
$24.07
|
| Rate for Payer: BCBS MAPPO |
$32.10
|
| Rate for Payer: BCBS MAPPO |
$8.03
|
| Rate for Payer: BCBS Trust/PPO |
$105.56
|
| Rate for Payer: BCBS Trust/PPO |
$26.39
|
| Rate for Payer: BCBS Trust/PPO |
$79.17
|
| Rate for Payer: BCN Commercial |
$26.39
|
| Rate for Payer: BCN Commercial |
$79.17
|
| Rate for Payer: BCN Commercial |
$105.56
|
| Rate for Payer: BCN Medicare Advantage |
$24.07
|
| Rate for Payer: BCN Medicare Advantage |
$8.03
|
| Rate for Payer: BCN Medicare Advantage |
$32.10
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Cofinity Commercial |
$82.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.10
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Healthscope Commercial |
$115.56
|
| Rate for Payer: Healthscope Commercial |
$86.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.07
|
| Rate for Payer: Mclaren Medicaid |
$22.64
|
| Rate for Payer: Mclaren Medicaid |
$16.98
|
| Rate for Payer: Mclaren Medicaid |
$5.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.28
|
| Rate for Payer: Meridian Medicaid |
$17.83
|
| Rate for Payer: Meridian Medicaid |
$23.77
|
| Rate for Payer: Meridian Medicaid |
$5.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Nomi Health Commercial |
$78.97
|
| Rate for Payer: Nomi Health Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$105.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.30
|
| Rate for Payer: PACE Senior Care Partners |
$7.62
|
| Rate for Payer: PACE Senior Care Partners |
$30.50
|
| Rate for Payer: PACE Senior Care Partners |
$22.87
|
| Rate for Payer: PACE SWMI |
$24.07
|
| Rate for Payer: PACE SWMI |
$8.03
|
| Rate for Payer: PACE SWMI |
$32.10
|
| Rate for Payer: PHP Commercial |
$109.14
|
| Rate for Payer: PHP Commercial |
$81.86
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: PHP Medicare Advantage |
$8.03
|
| Rate for Payer: PHP Medicare Advantage |
$32.10
|
| Rate for Payer: PHP Medicare Advantage |
$24.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$111.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.78
|
| Rate for Payer: Priority Health Medicare |
$24.32
|
| Rate for Payer: Priority Health Medicare |
$8.11
|
| Rate for Payer: Priority Health Medicare |
$32.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.37
|
| Rate for Payer: Railroad Medicare Medicare |
$8.03
|
| Rate for Payer: Railroad Medicare Medicare |
$24.07
|
| Rate for Payer: Railroad Medicare Medicare |
$32.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.99
|
| Rate for Payer: UHC Core |
$107.21
|
| Rate for Payer: UHC Core |
$80.41
|
| Rate for Payer: UHC Core |
$26.80
|
| Rate for Payer: UHC Exchange |
$24.07
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Exchange |
$32.10
|
| Rate for Payer: UHC Medicaid |
$22.64
|
| Rate for Payer: UHC Medicaid |
$16.98
|
| Rate for Payer: UHC Medicaid |
$5.66
|
| Rate for Payer: UHC Medicare Advantage |
$8.03
|
| Rate for Payer: UHC Medicare Advantage |
$32.10
|
| Rate for Payer: UHC Medicare Advantage |
$24.07
|
| Rate for Payer: UHCCP Medicaid |
$5.66
|
| Rate for Payer: UHCCP Medicaid |
$22.64
|
| Rate for Payer: UHCCP Medicaid |
$16.98
|
| Rate for Payer: VA VA |
$32.10
|
| Rate for Payer: VA VA |
$24.07
|
| Rate for Payer: VA VA |
$8.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.22
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$128.40
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.37 |
| Max. Negotiated Rate |
$115.56 |
| Rate for Payer: Aetna Commercial |
$109.14
|
| Rate for Payer: Aetna Commercial |
$27.29
|
| Rate for Payer: Aetna Commercial |
$81.86
|
| Rate for Payer: BCBS Trust/PPO |
$26.51
|
| Rate for Payer: BCBS Trust/PPO |
$106.05
|
| Rate for Payer: BCBS Trust/PPO |
$79.53
|
| Rate for Payer: BCN Commercial |
$26.51
|
| Rate for Payer: BCN Commercial |
$106.05
|
| Rate for Payer: BCN Commercial |
$79.53
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Commercial |
$82.82
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.04
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Healthscope Commercial |
$115.56
|
| Rate for Payer: Healthscope Commercial |
$86.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.86
|
| Rate for Payer: Nomi Health Commercial |
$105.29
|
| Rate for Payer: Nomi Health Commercial |
$26.32
|
| Rate for Payer: Nomi Health Commercial |
$78.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.22
|
| Rate for Payer: PHP Commercial |
$109.14
|
| Rate for Payer: PHP Commercial |
$81.86
|
| Rate for Payer: PHP Commercial |
$27.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$111.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.99
|
| Rate for Payer: UHC Core |
$107.21
|
| Rate for Payer: UHC Core |
$80.41
|
| Rate for Payer: UHC Core |
$26.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.07
|
|
|
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML(469.01 MG/ML) INTRAVENOUS SOLN
|
Facility
|
IP
|
$77.62
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
118272
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$69.86 |
| Rate for Payer: Aetna Commercial |
$65.98
|
| Rate for Payer: BCBS Trust/PPO |
$64.11
|
| Rate for Payer: BCN Commercial |
$64.11
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cofinity Commercial |
$66.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.10
|
| Rate for Payer: Healthscope Commercial |
$69.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.98
|
| Rate for Payer: Nomi Health Commercial |
$63.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.22
|
| Rate for Payer: PHP Commercial |
$65.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.31
|
| Rate for Payer: UHC Core |
$64.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.22
|
|
|
GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML(469.01 MG/ML) INTRAVENOUS SOLN
|
Facility
|
OP
|
$77.62
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
118272
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$69.86 |
| Rate for Payer: Aetna Commercial |
$65.98
|
| Rate for Payer: Aetna Medicare |
$20.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.26
|
| Rate for Payer: BCBS Complete |
$14.37
|
| Rate for Payer: BCBS MAPPO |
$19.41
|
| Rate for Payer: BCBS Trust/PPO |
$63.81
|
| Rate for Payer: BCN Commercial |
$63.81
|
| Rate for Payer: BCN Medicare Advantage |
$19.41
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cofinity Commercial |
$66.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.41
|
| Rate for Payer: Healthscope Commercial |
$69.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.22
|
| Rate for Payer: Mclaren Medicaid |
$13.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.38
|
| Rate for Payer: Meridian Medicaid |
$14.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.98
|
| Rate for Payer: Nomi Health Commercial |
$63.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.22
|
| Rate for Payer: PACE Senior Care Partners |
$18.43
|
| Rate for Payer: PACE SWMI |
$19.41
|
| Rate for Payer: PHP Commercial |
$65.98
|
| Rate for Payer: PHP Medicare Advantage |
$19.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.53
|
| Rate for Payer: Priority Health Medicare |
$19.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.02
|
| Rate for Payer: Railroad Medicare Medicare |
$19.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.31
|
| Rate for Payer: UHC Core |
$64.81
|
| Rate for Payer: UHC Exchange |
$19.41
|
| Rate for Payer: UHC Medicaid |
$13.68
|
| Rate for Payer: UHC Medicare Advantage |
$19.41
|
| Rate for Payer: UHCCP Medicaid |
$13.68
|
| Rate for Payer: VA VA |
$19.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.22
|
|
|
GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$631.68
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
93574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.37 |
| Max. Negotiated Rate |
$568.51 |
| Rate for Payer: Aetna Commercial |
$536.93
|
| Rate for Payer: Aetna Medicare |
$164.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$197.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$197.40
|
| Rate for Payer: BCBS Complete |
$116.92
|
| Rate for Payer: BCBS MAPPO |
$157.92
|
| Rate for Payer: BCBS Trust/PPO |
$519.30
|
| Rate for Payer: BCN Commercial |
$519.30
|
| Rate for Payer: BCN Medicare Advantage |
$157.92
|
| Rate for Payer: Cash Price |
$505.34
|
| Rate for Payer: Cofinity Commercial |
$543.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.92
|
| Rate for Payer: Healthscope Commercial |
$568.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.76
|
| Rate for Payer: Mclaren Medicaid |
$111.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.82
|
| Rate for Payer: Meridian Medicaid |
$116.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$173.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.93
|
| Rate for Payer: Nomi Health Commercial |
$517.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.76
|
| Rate for Payer: PACE Senior Care Partners |
$150.02
|
| Rate for Payer: PACE SWMI |
$157.92
|
| Rate for Payer: PHP Commercial |
$536.93
|
| Rate for Payer: PHP Medicare Advantage |
$157.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$549.56
|
| Rate for Payer: Priority Health Medicare |
$159.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$439.65
|
| Rate for Payer: Railroad Medicare Medicare |
$157.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.88
|
| Rate for Payer: UHC Core |
$527.45
|
| Rate for Payer: UHC Exchange |
$157.92
|
| Rate for Payer: UHC Medicaid |
$111.37
|
| Rate for Payer: UHC Medicare Advantage |
$157.92
|
| Rate for Payer: UHCCP Medicaid |
$111.37
|
| Rate for Payer: VA VA |
$157.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.76
|
|
|
GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$631.68
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
93574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$439.65 |
| Max. Negotiated Rate |
$568.51 |
| Rate for Payer: Aetna Commercial |
$536.93
|
| Rate for Payer: BCBS Trust/PPO |
$521.70
|
| Rate for Payer: BCN Commercial |
$521.70
|
| Rate for Payer: Cash Price |
$505.34
|
| Rate for Payer: Cofinity Commercial |
$543.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.34
|
| Rate for Payer: Healthscope Commercial |
$568.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.93
|
| Rate for Payer: Nomi Health Commercial |
$517.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.76
|
| Rate for Payer: PHP Commercial |
$536.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$549.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$439.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.88
|
| Rate for Payer: UHC Core |
$527.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.76
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
OP
|
$455.99
|
|
|
Service Code
|
NDC 68084072921
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.39 |
| Max. Negotiated Rate |
$410.39 |
| Rate for Payer: Aetna Commercial |
$387.59
|
| Rate for Payer: Aetna Medicare |
$118.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.50
|
| Rate for Payer: BCBS Complete |
$84.40
|
| Rate for Payer: BCBS MAPPO |
$114.00
|
| Rate for Payer: BCBS Trust/PPO |
$374.87
|
| Rate for Payer: BCN Commercial |
$374.87
|
| Rate for Payer: BCN Medicare Advantage |
$114.00
|
| Rate for Payer: Cash Price |
$364.79
|
| Rate for Payer: Cofinity Commercial |
$392.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.00
|
| Rate for Payer: Healthscope Commercial |
$410.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.99
|
| Rate for Payer: Mclaren Medicaid |
$80.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.70
|
| Rate for Payer: Meridian Medicaid |
$84.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$125.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.59
|
| Rate for Payer: Nomi Health Commercial |
$373.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$341.99
|
| Rate for Payer: PACE Senior Care Partners |
$108.30
|
| Rate for Payer: PACE SWMI |
$114.00
|
| Rate for Payer: PHP Commercial |
$387.59
|
| Rate for Payer: PHP Medicare Advantage |
$114.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$396.71
|
| Rate for Payer: Priority Health Medicare |
$115.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.37
|
| Rate for Payer: Railroad Medicare Medicare |
$114.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.27
|
| Rate for Payer: UHC Core |
$380.75
|
| Rate for Payer: UHC Exchange |
$114.00
|
| Rate for Payer: UHC Medicaid |
$80.39
|
| Rate for Payer: UHC Medicare Advantage |
$114.00
|
| Rate for Payer: UHCCP Medicaid |
$80.39
|
| Rate for Payer: VA VA |
$114.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.99
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
IP
|
$15.20
|
|
|
Service Code
|
NDC 68084072911
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna Commercial |
$12.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.55
|
| Rate for Payer: BCN Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$12.16
|
| Rate for Payer: Cofinity Commercial |
$13.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$13.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.92
|
| Rate for Payer: Nomi Health Commercial |
$12.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.40
|
| Rate for Payer: PHP Commercial |
$12.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.38
|
| Rate for Payer: UHC Core |
$12.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.40
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
OP
|
$15.20
|
|
|
Service Code
|
NDC 68084072911
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna Commercial |
$12.92
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.75
|
| Rate for Payer: BCBS Complete |
$2.81
|
| Rate for Payer: BCBS MAPPO |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.50
|
| Rate for Payer: BCN Commercial |
$12.50
|
| Rate for Payer: BCN Medicare Advantage |
$3.80
|
| Rate for Payer: Cash Price |
$12.16
|
| Rate for Payer: Cofinity Commercial |
$13.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$13.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.40
|
| Rate for Payer: Mclaren Medicaid |
$2.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.99
|
| Rate for Payer: Meridian Medicaid |
$2.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.92
|
| Rate for Payer: Nomi Health Commercial |
$12.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.40
|
| Rate for Payer: PACE Senior Care Partners |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.80
|
| Rate for Payer: PHP Commercial |
$12.92
|
| Rate for Payer: PHP Medicare Advantage |
$3.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.22
|
| Rate for Payer: Priority Health Medicare |
$3.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.58
|
| Rate for Payer: Railroad Medicare Medicare |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.38
|
| Rate for Payer: UHC Core |
$12.69
|
| Rate for Payer: UHC Exchange |
$3.80
|
| Rate for Payer: UHC Medicaid |
$2.68
|
| Rate for Payer: UHC Medicare Advantage |
$3.80
|
| Rate for Payer: UHCCP Medicaid |
$2.68
|
| Rate for Payer: VA VA |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.40
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
IP
|
$455.99
|
|
|
Service Code
|
NDC 68084072921
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$317.37 |
| Max. Negotiated Rate |
$410.39 |
| Rate for Payer: Aetna Commercial |
$387.59
|
| Rate for Payer: BCBS Trust/PPO |
$376.60
|
| Rate for Payer: BCN Commercial |
$376.60
|
| Rate for Payer: Cash Price |
$364.79
|
| Rate for Payer: Cofinity Commercial |
$392.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.79
|
| Rate for Payer: Healthscope Commercial |
$410.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$387.59
|
| Rate for Payer: Nomi Health Commercial |
$373.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$341.99
|
| Rate for Payer: PHP Commercial |
$387.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$396.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$317.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.27
|
| Rate for Payer: UHC Core |
$380.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.99
|
|
|
GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$199.77
|
|
|
Service Code
|
HCPCS J1570
|
| Hospital Charge Code |
10101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$179.79 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: Aetna Medicare |
$51.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.43
|
| Rate for Payer: BCBS Complete |
$36.98
|
| Rate for Payer: BCBS MAPPO |
$49.94
|
| Rate for Payer: BCBS Trust/PPO |
$164.23
|
| Rate for Payer: BCN Commercial |
$164.23
|
| Rate for Payer: BCN Medicare Advantage |
$49.94
|
| Rate for Payer: Cash Price |
$159.82
|
| Rate for Payer: Cofinity Commercial |
$171.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$179.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.83
|
| Rate for Payer: Mclaren Medicaid |
$35.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.44
|
| Rate for Payer: Meridian Medicaid |
$36.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: Nomi Health Commercial |
$163.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.83
|
| Rate for Payer: PACE Senior Care Partners |
$47.45
|
| Rate for Payer: PACE SWMI |
$49.94
|
| Rate for Payer: PHP Commercial |
$169.80
|
| Rate for Payer: PHP Medicare Advantage |
$49.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.80
|
| Rate for Payer: Priority Health Medicare |
$50.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.04
|
| Rate for Payer: Railroad Medicare Medicare |
$49.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.80
|
| Rate for Payer: UHC Core |
$166.81
|
| Rate for Payer: UHC Exchange |
$49.94
|
| Rate for Payer: UHC Medicaid |
$35.22
|
| Rate for Payer: UHC Medicare Advantage |
$49.94
|
| Rate for Payer: UHCCP Medicaid |
$35.22
|
| Rate for Payer: VA VA |
$49.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.83
|
|
|
GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$199.77
|
|
|
Service Code
|
HCPCS J1570
|
| Hospital Charge Code |
10101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.04 |
| Max. Negotiated Rate |
$179.79 |
| Rate for Payer: Aetna Commercial |
$169.80
|
| Rate for Payer: BCBS Trust/PPO |
$164.99
|
| Rate for Payer: BCN Commercial |
$164.99
|
| Rate for Payer: Cash Price |
$159.82
|
| Rate for Payer: Cofinity Commercial |
$171.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.82
|
| Rate for Payer: Healthscope Commercial |
$179.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.80
|
| Rate for Payer: Nomi Health Commercial |
$163.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.83
|
| Rate for Payer: PHP Commercial |
$169.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.80
|
| Rate for Payer: UHC Core |
$166.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.83
|
|
|
GANCICLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$148.68
|
|
|
Service Code
|
NDC 25021018510
|
| Hospital Charge Code |
186410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.48 |
| Max. Negotiated Rate |
$133.81 |
| Rate for Payer: Aetna Commercial |
$126.38
|
| Rate for Payer: BCBS Trust/PPO |
$122.79
|
| Rate for Payer: BCN Commercial |
$122.79
|
| Rate for Payer: Cash Price |
$118.94
|
| Rate for Payer: Cofinity Commercial |
$127.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.94
|
| Rate for Payer: Healthscope Commercial |
$133.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.38
|
| Rate for Payer: Nomi Health Commercial |
$121.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.51
|
| Rate for Payer: PHP Commercial |
$126.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$129.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.84
|
| Rate for Payer: UHC Core |
$124.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.51
|
|
|
GANCICLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$148.68
|
|
|
Service Code
|
NDC 25021018510
|
| Hospital Charge Code |
186410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$133.81 |
| Rate for Payer: Aetna Commercial |
$126.38
|
| Rate for Payer: Aetna Medicare |
$38.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.46
|
| Rate for Payer: BCBS Complete |
$27.52
|
| Rate for Payer: BCBS MAPPO |
$37.17
|
| Rate for Payer: BCBS Trust/PPO |
$122.23
|
| Rate for Payer: BCN Commercial |
$122.23
|
| Rate for Payer: BCN Medicare Advantage |
$37.17
|
| Rate for Payer: Cash Price |
$118.94
|
| Rate for Payer: Cofinity Commercial |
$127.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.17
|
| Rate for Payer: Healthscope Commercial |
$133.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.51
|
| Rate for Payer: Mclaren Medicaid |
$26.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.03
|
| Rate for Payer: Meridian Medicaid |
$27.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.38
|
| Rate for Payer: Nomi Health Commercial |
$121.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.51
|
| Rate for Payer: PACE Senior Care Partners |
$35.31
|
| Rate for Payer: PACE SWMI |
$37.17
|
| Rate for Payer: PHP Commercial |
$126.38
|
| Rate for Payer: PHP Medicare Advantage |
$37.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$129.35
|
| Rate for Payer: Priority Health Medicare |
$37.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.48
|
| Rate for Payer: Railroad Medicare Medicare |
$37.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.84
|
| Rate for Payer: UHC Core |
$124.15
|
| Rate for Payer: UHC Exchange |
$37.17
|
| Rate for Payer: UHC Medicaid |
$26.21
|
| Rate for Payer: UHC Medicare Advantage |
$37.17
|
| Rate for Payer: UHCCP Medicaid |
$26.21
|
| Rate for Payer: VA VA |
$37.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.51
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$14,512.66
|
|
|
Service Code
|
APR-DRG 2464
|
| Min. Negotiated Rate |
$13,821.58 |
| Max. Negotiated Rate |
$14,512.66 |
| Rate for Payer: BCBS Complete |
$14,512.66
|
| Rate for Payer: Mclaren Medicaid |
$13,821.58
|
| Rate for Payer: Meridian Medicaid |
$14,512.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,821.58
|
| Rate for Payer: UHC Medicaid |
$13,821.58
|
| Rate for Payer: UHCCP Medicaid |
$13,821.58
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$3,891.74
|
|
|
Service Code
|
APR-DRG 2461
|
| Min. Negotiated Rate |
$3,706.42 |
| Max. Negotiated Rate |
$3,891.74 |
| Rate for Payer: BCBS Complete |
$3,891.74
|
| Rate for Payer: Mclaren Medicaid |
$3,706.42
|
| Rate for Payer: Meridian Medicaid |
$3,891.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,706.42
|
| Rate for Payer: UHC Medicaid |
$3,706.42
|
| Rate for Payer: UHCCP Medicaid |
$3,706.42
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$7,663.59
|
|
|
Service Code
|
APR-DRG 2463
|
| Min. Negotiated Rate |
$7,298.66 |
| Max. Negotiated Rate |
$7,663.59 |
| Rate for Payer: BCBS Complete |
$7,663.59
|
| Rate for Payer: Mclaren Medicaid |
$7,298.66
|
| Rate for Payer: Meridian Medicaid |
$7,663.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,298.66
|
| Rate for Payer: UHC Medicaid |
$7,298.66
|
| Rate for Payer: UHCCP Medicaid |
$7,298.66
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$5,248.41
|
|
|
Service Code
|
APR-DRG 2462
|
| Min. Negotiated Rate |
$4,998.48 |
| Max. Negotiated Rate |
$5,248.41 |
| Rate for Payer: BCBS Complete |
$5,248.41
|
| Rate for Payer: Mclaren Medicaid |
$4,998.48
|
| Rate for Payer: Meridian Medicaid |
$5,248.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,998.48
|
| Rate for Payer: UHC Medicaid |
$4,998.48
|
| Rate for Payer: UHCCP Medicaid |
$4,998.48
|
|
