|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$18.80
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$16.92 |
| Rate for Payer: Aetna Commercial |
$15.98
|
| Rate for Payer: Aetna Medicare |
$4.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.88
|
| Rate for Payer: BCBS Complete |
$3.48
|
| Rate for Payer: BCBS MAPPO |
$4.70
|
| Rate for Payer: BCBS Trust/PPO |
$15.46
|
| Rate for Payer: BCN Commercial |
$15.46
|
| Rate for Payer: BCN Medicare Advantage |
$4.70
|
| Rate for Payer: Cash Price |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$16.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.10
|
| Rate for Payer: Mclaren Medicaid |
$3.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.93
|
| Rate for Payer: Meridian Medicaid |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.98
|
| Rate for Payer: Nomi Health Commercial |
$15.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.10
|
| Rate for Payer: PACE Senior Care Partners |
$4.46
|
| Rate for Payer: PACE SWMI |
$4.70
|
| Rate for Payer: PHP Commercial |
$15.98
|
| Rate for Payer: PHP Medicare Advantage |
$4.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.36
|
| Rate for Payer: Priority Health Medicare |
$4.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.08
|
| Rate for Payer: Railroad Medicare Medicare |
$4.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.54
|
| Rate for Payer: UHC Core |
$15.70
|
| Rate for Payer: UHC Exchange |
$4.70
|
| Rate for Payer: UHC Medicaid |
$3.31
|
| Rate for Payer: UHC Medicare Advantage |
$4.70
|
| Rate for Payer: UHCCP Medicaid |
$3.31
|
| Rate for Payer: VA VA |
$4.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.10
|
|
|
ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$1,946.29
|
|
|
Service Code
|
HCPCS J1744
|
| Hospital Charge Code |
153436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$343.13 |
| Max. Negotiated Rate |
$1,751.66 |
| Rate for Payer: Aetna Commercial |
$1,654.35
|
| Rate for Payer: Aetna Commercial |
$3,541.44
|
| Rate for Payer: Aetna Commercial |
$6,528.90
|
| Rate for Payer: Aetna Commercial |
$1,824.08
|
| Rate for Payer: Aetna Medicare |
$557.95
|
| Rate for Payer: Aetna Medicare |
$506.04
|
| Rate for Payer: Aetna Medicare |
$1,083.26
|
| Rate for Payer: Aetna Medicare |
$1,997.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$608.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,302.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$670.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,400.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$670.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,400.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,302.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$608.22
|
| Rate for Payer: BCBS Complete |
$1,421.76
|
| Rate for Payer: BCBS Complete |
$397.22
|
| Rate for Payer: BCBS Complete |
$360.26
|
| Rate for Payer: BCBS Complete |
$771.20
|
| Rate for Payer: BCBS MAPPO |
$486.57
|
| Rate for Payer: BCBS MAPPO |
$536.50
|
| Rate for Payer: BCBS MAPPO |
$1,920.27
|
| Rate for Payer: BCBS MAPPO |
$1,041.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,425.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,600.05
|
| Rate for Payer: BCBS Trust/PPO |
$6,314.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,764.21
|
| Rate for Payer: BCN Commercial |
$3,425.20
|
| Rate for Payer: BCN Commercial |
$6,314.60
|
| Rate for Payer: BCN Commercial |
$1,764.21
|
| Rate for Payer: BCN Commercial |
$1,600.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,041.60
|
| Rate for Payer: BCN Medicare Advantage |
$536.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,920.27
|
| Rate for Payer: BCN Medicare Advantage |
$486.57
|
| Rate for Payer: Cash Price |
$6,144.85
|
| Rate for Payer: Cash Price |
$3,333.12
|
| Rate for Payer: Cash Price |
$1,557.03
|
| Rate for Payer: Cash Price |
$1,716.78
|
| Rate for Payer: Cofinity Commercial |
$1,845.54
|
| Rate for Payer: Cofinity Commercial |
$1,673.81
|
| Rate for Payer: Cofinity Commercial |
$3,583.10
|
| Rate for Payer: Cofinity Commercial |
$6,605.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,557.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,144.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,333.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,716.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,920.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$536.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,041.60
|
| Rate for Payer: Healthscope Commercial |
$1,751.66
|
| Rate for Payer: Healthscope Commercial |
$6,912.95
|
| Rate for Payer: Healthscope Commercial |
$3,749.76
|
| Rate for Payer: Healthscope Commercial |
$1,931.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,760.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,124.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,609.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,459.72
|
| Rate for Payer: Mclaren Medicaid |
$734.54
|
| Rate for Payer: Mclaren Medicaid |
$378.34
|
| Rate for Payer: Mclaren Medicaid |
$343.13
|
| Rate for Payer: Mclaren Medicaid |
$1,354.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,016.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$563.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,093.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$510.90
|
| Rate for Payer: Meridian Medicaid |
$360.26
|
| Rate for Payer: Meridian Medicaid |
$771.20
|
| Rate for Payer: Meridian Medicaid |
$1,421.76
|
| Rate for Payer: Meridian Medicaid |
$397.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$559.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,197.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,208.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$616.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$590.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$535.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,145.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,112.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,541.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,654.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,528.90
|
| Rate for Payer: Nomi Health Commercial |
$3,416.45
|
| Rate for Payer: Nomi Health Commercial |
$1,595.96
|
| Rate for Payer: Nomi Health Commercial |
$1,759.70
|
| Rate for Payer: Nomi Health Commercial |
$6,298.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,760.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,124.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,609.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,459.72
|
| Rate for Payer: PACE Senior Care Partners |
$989.52
|
| Rate for Payer: PACE Senior Care Partners |
$1,824.25
|
| Rate for Payer: PACE Senior Care Partners |
$462.24
|
| Rate for Payer: PACE Senior Care Partners |
$509.67
|
| Rate for Payer: PACE SWMI |
$486.57
|
| Rate for Payer: PACE SWMI |
$1,920.27
|
| Rate for Payer: PACE SWMI |
$536.50
|
| Rate for Payer: PACE SWMI |
$1,041.60
|
| Rate for Payer: PHP Commercial |
$1,654.35
|
| Rate for Payer: PHP Commercial |
$1,824.08
|
| Rate for Payer: PHP Commercial |
$3,541.44
|
| Rate for Payer: PHP Commercial |
$6,528.90
|
| Rate for Payer: PHP Medicare Advantage |
$486.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,920.27
|
| Rate for Payer: PHP Medicare Advantage |
$536.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,041.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$378.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,354.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$734.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,624.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,682.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,867.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,693.27
|
| Rate for Payer: Priority Health Medicare |
$541.86
|
| Rate for Payer: Priority Health Medicare |
$491.44
|
| Rate for Payer: Priority Health Medicare |
$1,052.02
|
| Rate for Payer: Priority Health Medicare |
$1,939.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,346.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,493.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,899.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,354.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,041.60
|
| Rate for Payer: Railroad Medicare Medicare |
$486.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,920.27
|
| Rate for Payer: Railroad Medicare Medicare |
$536.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,666.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,888.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,712.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,759.33
|
| Rate for Payer: UHC Core |
$1,625.15
|
| Rate for Payer: UHC Core |
$3,478.94
|
| Rate for Payer: UHC Core |
$1,791.89
|
| Rate for Payer: UHC Core |
$6,413.69
|
| Rate for Payer: UHC Exchange |
$1,041.60
|
| Rate for Payer: UHC Exchange |
$536.50
|
| Rate for Payer: UHC Exchange |
$1,920.27
|
| Rate for Payer: UHC Exchange |
$486.57
|
| Rate for Payer: UHC Medicaid |
$343.13
|
| Rate for Payer: UHC Medicaid |
$378.34
|
| Rate for Payer: UHC Medicaid |
$734.54
|
| Rate for Payer: UHC Medicaid |
$1,354.17
|
| Rate for Payer: UHC Medicare Advantage |
$536.50
|
| Rate for Payer: UHC Medicare Advantage |
$486.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,920.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,041.60
|
| Rate for Payer: UHCCP Medicaid |
$734.54
|
| Rate for Payer: UHCCP Medicaid |
$1,354.17
|
| Rate for Payer: UHCCP Medicaid |
$378.34
|
| Rate for Payer: UHCCP Medicaid |
$343.13
|
| Rate for Payer: VA VA |
$486.57
|
| Rate for Payer: VA VA |
$1,920.27
|
| Rate for Payer: VA VA |
$1,041.60
|
| Rate for Payer: VA VA |
$536.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,124.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,459.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,609.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,760.80
|
|
|
ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,166.40
|
|
|
Service Code
|
HCPCS J1744
|
| Hospital Charge Code |
153436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,899.81 |
| Max. Negotiated Rate |
$3,749.76 |
| Rate for Payer: Aetna Commercial |
$3,541.44
|
| Rate for Payer: Aetna Commercial |
$1,824.08
|
| Rate for Payer: Aetna Commercial |
$1,654.35
|
| Rate for Payer: Aetna Commercial |
$6,528.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,441.03
|
| Rate for Payer: BCBS Trust/PPO |
$6,343.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,772.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,607.44
|
| Rate for Payer: BCN Commercial |
$3,441.03
|
| Rate for Payer: BCN Commercial |
$1,607.44
|
| Rate for Payer: BCN Commercial |
$6,343.79
|
| Rate for Payer: BCN Commercial |
$1,772.36
|
| Rate for Payer: Cash Price |
$1,716.78
|
| Rate for Payer: Cash Price |
$3,333.12
|
| Rate for Payer: Cash Price |
$6,144.85
|
| Rate for Payer: Cash Price |
$1,557.03
|
| Rate for Payer: Cofinity Commercial |
$1,673.81
|
| Rate for Payer: Cofinity Commercial |
$6,605.71
|
| Rate for Payer: Cofinity Commercial |
$3,583.10
|
| Rate for Payer: Cofinity Commercial |
$1,845.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,557.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,333.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,716.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,144.85
|
| Rate for Payer: Healthscope Commercial |
$6,912.95
|
| Rate for Payer: Healthscope Commercial |
$1,931.38
|
| Rate for Payer: Healthscope Commercial |
$3,749.76
|
| Rate for Payer: Healthscope Commercial |
$1,751.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,760.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,609.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,124.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,459.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,541.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,654.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,528.90
|
| Rate for Payer: Nomi Health Commercial |
$1,595.96
|
| Rate for Payer: Nomi Health Commercial |
$1,759.70
|
| Rate for Payer: Nomi Health Commercial |
$6,298.47
|
| Rate for Payer: Nomi Health Commercial |
$3,416.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,609.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,459.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,124.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,760.80
|
| Rate for Payer: PHP Commercial |
$6,528.90
|
| Rate for Payer: PHP Commercial |
$1,654.35
|
| Rate for Payer: PHP Commercial |
$1,824.08
|
| Rate for Payer: PHP Commercial |
$3,541.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,624.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,682.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,693.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,867.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,899.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,346.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,493.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,354.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,759.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,712.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,888.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,666.43
|
| Rate for Payer: UHC Core |
$3,478.94
|
| Rate for Payer: UHC Core |
$6,413.69
|
| Rate for Payer: UHC Core |
$1,791.89
|
| Rate for Payer: UHC Core |
$1,625.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,760.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,459.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,609.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,124.80
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,283.61
|
|
|
Service Code
|
NDC 00597019705
|
| Hospital Charge Code |
176112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6,461.39 |
| Max. Negotiated Rate |
$8,355.25 |
| Rate for Payer: Aetna Commercial |
$7,891.07
|
| Rate for Payer: BCBS Trust/PPO |
$7,667.33
|
| Rate for Payer: BCN Commercial |
$7,667.33
|
| Rate for Payer: Cash Price |
$7,426.89
|
| Rate for Payer: Cofinity Commercial |
$7,983.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,426.89
|
| Rate for Payer: Healthscope Commercial |
$8,355.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,962.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,891.07
|
| Rate for Payer: Nomi Health Commercial |
$7,612.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,962.71
|
| Rate for Payer: PHP Commercial |
$7,891.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,076.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,461.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,169.58
|
| Rate for Payer: UHC Core |
$7,751.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,962.71
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,283.61
|
|
|
Service Code
|
NDC 00597019705
|
| Hospital Charge Code |
176112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,636.70 |
| Max. Negotiated Rate |
$8,355.25 |
| Rate for Payer: Aetna Commercial |
$7,891.07
|
| Rate for Payer: Aetna Medicare |
$2,413.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,901.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,901.13
|
| Rate for Payer: BCBS Complete |
$1,718.40
|
| Rate for Payer: BCBS MAPPO |
$2,320.90
|
| Rate for Payer: BCBS Trust/PPO |
$7,632.06
|
| Rate for Payer: BCN Commercial |
$7,632.06
|
| Rate for Payer: BCN Medicare Advantage |
$2,320.90
|
| Rate for Payer: Cash Price |
$7,426.89
|
| Rate for Payer: Cofinity Commercial |
$7,983.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,426.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,320.90
|
| Rate for Payer: Healthscope Commercial |
$8,355.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,962.71
|
| Rate for Payer: Mclaren Medicaid |
$1,636.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,436.95
|
| Rate for Payer: Meridian Medicaid |
$1,718.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,669.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,552.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,891.07
|
| Rate for Payer: Nomi Health Commercial |
$7,612.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,962.71
|
| Rate for Payer: PACE Senior Care Partners |
$2,204.86
|
| Rate for Payer: PACE SWMI |
$2,320.90
|
| Rate for Payer: PHP Commercial |
$7,891.07
|
| Rate for Payer: PHP Medicare Advantage |
$2,320.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,636.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,076.74
|
| Rate for Payer: Priority Health Medicare |
$2,344.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,461.39
|
| Rate for Payer: Railroad Medicare Medicare |
$2,320.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,169.58
|
| Rate for Payer: UHC Core |
$7,751.81
|
| Rate for Payer: UHC Exchange |
$2,320.90
|
| Rate for Payer: UHC Medicaid |
$1,636.70
|
| Rate for Payer: UHC Medicare Advantage |
$2,320.90
|
| Rate for Payer: UHCCP Medicaid |
$1,636.70
|
| Rate for Payer: VA VA |
$2,320.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,962.71
|
|
|
IMPACT PEPTIDE 1.5 INTERMITTENT FEED
|
Facility
|
OP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: Aetna Medicare |
$17.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.81
|
| Rate for Payer: BCBS Complete |
$12.33
|
| Rate for Payer: BCBS MAPPO |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$54.75
|
| Rate for Payer: BCN Commercial |
$54.75
|
| Rate for Payer: BCN Medicare Advantage |
$16.65
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: Mclaren Medicaid |
$11.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.48
|
| Rate for Payer: Meridian Medicaid |
$12.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Nomi Health Commercial |
$54.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PACE Senior Care Partners |
$15.82
|
| Rate for Payer: PACE SWMI |
$16.65
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: PHP Medicare Advantage |
$16.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.94
|
| Rate for Payer: Priority Health Medicare |
$16.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$16.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.61
|
| Rate for Payer: UHC Core |
$55.61
|
| Rate for Payer: UHC Exchange |
$16.65
|
| Rate for Payer: UHC Medicaid |
$11.74
|
| Rate for Payer: UHC Medicare Advantage |
$16.65
|
| Rate for Payer: UHCCP Medicaid |
$11.74
|
| Rate for Payer: VA VA |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPACT PEPTIDE 1.5 INTERMITTENT FEED
|
Facility
|
IP
|
$66.60
|
|
|
Service Code
|
NDC 43900097370
|
| Hospital Charge Code |
200090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.35 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Aetna Commercial |
$56.61
|
| Rate for Payer: BCBS Trust/PPO |
$55.00
|
| Rate for Payer: BCN Commercial |
$55.00
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.61
|
| Rate for Payer: Nomi Health Commercial |
$54.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.95
|
| Rate for Payer: PHP Commercial |
$56.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.61
|
| Rate for Payer: UHC Core |
$55.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.95
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$159,358.97
|
|
|
Service Code
|
APR-DRG 1614
|
| Min. Negotiated Rate |
$151,770.44 |
| Max. Negotiated Rate |
$159,358.97 |
| Rate for Payer: BCBS Complete |
$159,358.97
|
| Rate for Payer: Mclaren Medicaid |
$151,770.44
|
| Rate for Payer: Meridian Medicaid |
$159,358.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$151,770.44
|
| Rate for Payer: UHC Medicaid |
$151,770.44
|
| Rate for Payer: UHCCP Medicaid |
$151,770.44
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$78,375.40
|
|
|
Service Code
|
APR-DRG 1612
|
| Min. Negotiated Rate |
$74,643.24 |
| Max. Negotiated Rate |
$78,375.40 |
| Rate for Payer: BCBS Complete |
$78,375.40
|
| Rate for Payer: Mclaren Medicaid |
$74,643.24
|
| Rate for Payer: Meridian Medicaid |
$78,375.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$74,643.24
|
| Rate for Payer: UHC Medicaid |
$74,643.24
|
| Rate for Payer: UHCCP Medicaid |
$74,643.24
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$66,054.44
|
|
|
Service Code
|
APR-DRG 1611
|
| Min. Negotiated Rate |
$62,908.99 |
| Max. Negotiated Rate |
$66,054.44 |
| Rate for Payer: BCBS Complete |
$66,054.44
|
| Rate for Payer: Mclaren Medicaid |
$62,908.99
|
| Rate for Payer: Meridian Medicaid |
$66,054.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$62,908.99
|
| Rate for Payer: UHC Medicaid |
$62,908.99
|
| Rate for Payer: UHCCP Medicaid |
$62,908.99
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$86,295.60
|
|
|
Service Code
|
APR-DRG 1613
|
| Min. Negotiated Rate |
$82,186.29 |
| Max. Negotiated Rate |
$86,295.60 |
| Rate for Payer: BCBS Complete |
$86,295.60
|
| Rate for Payer: Mclaren Medicaid |
$82,186.29
|
| Rate for Payer: Meridian Medicaid |
$86,295.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$82,186.29
|
| Rate for Payer: UHC Medicaid |
$82,186.29
|
| Rate for Payer: UHCCP Medicaid |
$82,186.29
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$7,119.35
|
|
|
Service Code
|
APR-DRG 4232
|
| Min. Negotiated Rate |
$6,780.33 |
| Max. Negotiated Rate |
$7,119.35 |
| Rate for Payer: BCBS Complete |
$7,119.35
|
| Rate for Payer: Mclaren Medicaid |
$6,780.33
|
| Rate for Payer: Meridian Medicaid |
$7,119.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,780.33
|
| Rate for Payer: UHC Medicaid |
$6,780.33
|
| Rate for Payer: UHCCP Medicaid |
$6,780.33
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$26,221.54
|
|
|
Service Code
|
APR-DRG 4234
|
| Min. Negotiated Rate |
$24,972.89 |
| Max. Negotiated Rate |
$26,221.54 |
| Rate for Payer: BCBS Complete |
$26,221.54
|
| Rate for Payer: Mclaren Medicaid |
$24,972.89
|
| Rate for Payer: Meridian Medicaid |
$26,221.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,972.89
|
| Rate for Payer: UHC Medicaid |
$24,972.89
|
| Rate for Payer: UHCCP Medicaid |
$24,972.89
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$10,031.45
|
|
|
Service Code
|
APR-DRG 4233
|
| Min. Negotiated Rate |
$9,553.76 |
| Max. Negotiated Rate |
$10,031.45 |
| Rate for Payer: BCBS Complete |
$10,031.45
|
| Rate for Payer: Mclaren Medicaid |
$9,553.76
|
| Rate for Payer: Meridian Medicaid |
$10,031.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,553.76
|
| Rate for Payer: UHC Medicaid |
$9,553.76
|
| Rate for Payer: UHCCP Medicaid |
$9,553.76
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$3,080.37
|
|
|
Service Code
|
APR-DRG 4231
|
| Min. Negotiated Rate |
$2,933.69 |
| Max. Negotiated Rate |
$3,080.37 |
| Rate for Payer: BCBS Complete |
$3,080.37
|
| Rate for Payer: Mclaren Medicaid |
$2,933.69
|
| Rate for Payer: Meridian Medicaid |
$3,080.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,933.69
|
| Rate for Payer: UHC Medicaid |
$2,933.69
|
| Rate for Payer: UHCCP Medicaid |
$2,933.69
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION CUSTOM WRAPPER
|
Facility
|
IP
|
$475.17
|
|
|
Service Code
|
HCPCS J9220
|
| Hospital Charge Code |
301555
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$330.72 |
| Max. Negotiated Rate |
$427.65 |
| Rate for Payer: Aetna Commercial |
$403.89
|
| Rate for Payer: Aetna Commercial |
$440.62
|
| Rate for Payer: BCBS Trust/PPO |
$392.44
|
| Rate for Payer: BCBS Trust/PPO |
$428.13
|
| Rate for Payer: BCN Commercial |
$392.44
|
| Rate for Payer: BCN Commercial |
$428.13
|
| Rate for Payer: Cash Price |
$380.14
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cofinity Commercial |
$445.81
|
| Rate for Payer: Cofinity Commercial |
$408.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.14
|
| Rate for Payer: Healthscope Commercial |
$427.65
|
| Rate for Payer: Healthscope Commercial |
$466.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.62
|
| Rate for Payer: Nomi Health Commercial |
$389.64
|
| Rate for Payer: Nomi Health Commercial |
$425.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.79
|
| Rate for Payer: PHP Commercial |
$440.62
|
| Rate for Payer: PHP Commercial |
$403.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$450.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$413.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.17
|
| Rate for Payer: UHC Core |
$396.77
|
| Rate for Payer: UHC Core |
$432.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.79
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION CUSTOM WRAPPER
|
Facility
|
OP
|
$475.17
|
|
|
Service Code
|
HCPCS J9220
|
| Hospital Charge Code |
301555
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.77 |
| Max. Negotiated Rate |
$427.65 |
| Rate for Payer: Aetna Commercial |
$403.89
|
| Rate for Payer: Aetna Commercial |
$440.62
|
| Rate for Payer: Aetna Medicare |
$134.78
|
| Rate for Payer: Aetna Medicare |
$123.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.99
|
| Rate for Payer: BCBS Complete |
$87.95
|
| Rate for Payer: BCBS Complete |
$95.95
|
| Rate for Payer: BCBS MAPPO |
$118.79
|
| Rate for Payer: BCBS MAPPO |
$129.59
|
| Rate for Payer: BCBS Trust/PPO |
$390.64
|
| Rate for Payer: BCBS Trust/PPO |
$426.16
|
| Rate for Payer: BCN Commercial |
$426.16
|
| Rate for Payer: BCN Commercial |
$390.64
|
| Rate for Payer: BCN Medicare Advantage |
$129.59
|
| Rate for Payer: BCN Medicare Advantage |
$118.79
|
| Rate for Payer: Cash Price |
$380.14
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cofinity Commercial |
$408.65
|
| Rate for Payer: Cofinity Commercial |
$445.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.79
|
| Rate for Payer: Healthscope Commercial |
$427.65
|
| Rate for Payer: Healthscope Commercial |
$466.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.79
|
| Rate for Payer: Mclaren Medicaid |
$91.39
|
| Rate for Payer: Mclaren Medicaid |
$83.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.73
|
| Rate for Payer: Meridian Medicaid |
$87.95
|
| Rate for Payer: Meridian Medicaid |
$95.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$142.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.89
|
| Rate for Payer: Nomi Health Commercial |
$425.07
|
| Rate for Payer: Nomi Health Commercial |
$389.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.79
|
| Rate for Payer: PACE Senior Care Partners |
$123.12
|
| Rate for Payer: PACE Senior Care Partners |
$112.85
|
| Rate for Payer: PACE SWMI |
$129.59
|
| Rate for Payer: PACE SWMI |
$118.79
|
| Rate for Payer: PHP Commercial |
$403.89
|
| Rate for Payer: PHP Commercial |
$440.62
|
| Rate for Payer: PHP Medicare Advantage |
$118.79
|
| Rate for Payer: PHP Medicare Advantage |
$129.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$450.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$413.40
|
| Rate for Payer: Priority Health Medicare |
$130.89
|
| Rate for Payer: Priority Health Medicare |
$119.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.79
|
| Rate for Payer: Railroad Medicare Medicare |
$118.79
|
| Rate for Payer: Railroad Medicare Medicare |
$129.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.17
|
| Rate for Payer: UHC Core |
$432.85
|
| Rate for Payer: UHC Core |
$396.77
|
| Rate for Payer: UHC Exchange |
$129.59
|
| Rate for Payer: UHC Exchange |
$118.79
|
| Rate for Payer: UHC Medicaid |
$91.39
|
| Rate for Payer: UHC Medicaid |
$83.77
|
| Rate for Payer: UHC Medicare Advantage |
$118.79
|
| Rate for Payer: UHC Medicare Advantage |
$129.59
|
| Rate for Payer: UHCCP Medicaid |
$83.77
|
| Rate for Payer: UHCCP Medicaid |
$91.39
|
| Rate for Payer: VA VA |
$118.79
|
| Rate for Payer: VA VA |
$129.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.38
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION
|
Facility
|
OP
|
$475.17
|
|
|
Service Code
|
HCPCS J9220
|
| Hospital Charge Code |
108702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.77 |
| Max. Negotiated Rate |
$427.65 |
| Rate for Payer: Aetna Commercial |
$403.89
|
| Rate for Payer: Aetna Commercial |
$440.62
|
| Rate for Payer: Aetna Medicare |
$134.78
|
| Rate for Payer: Aetna Medicare |
$123.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.99
|
| Rate for Payer: BCBS Complete |
$87.95
|
| Rate for Payer: BCBS Complete |
$95.95
|
| Rate for Payer: BCBS MAPPO |
$118.79
|
| Rate for Payer: BCBS MAPPO |
$129.59
|
| Rate for Payer: BCBS Trust/PPO |
$390.64
|
| Rate for Payer: BCBS Trust/PPO |
$426.16
|
| Rate for Payer: BCN Commercial |
$426.16
|
| Rate for Payer: BCN Commercial |
$390.64
|
| Rate for Payer: BCN Medicare Advantage |
$129.59
|
| Rate for Payer: BCN Medicare Advantage |
$118.79
|
| Rate for Payer: Cash Price |
$380.14
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cofinity Commercial |
$408.65
|
| Rate for Payer: Cofinity Commercial |
$445.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.79
|
| Rate for Payer: Healthscope Commercial |
$427.65
|
| Rate for Payer: Healthscope Commercial |
$466.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.79
|
| Rate for Payer: Mclaren Medicaid |
$91.39
|
| Rate for Payer: Mclaren Medicaid |
$83.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.73
|
| Rate for Payer: Meridian Medicaid |
$87.95
|
| Rate for Payer: Meridian Medicaid |
$95.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$142.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.89
|
| Rate for Payer: Nomi Health Commercial |
$425.07
|
| Rate for Payer: Nomi Health Commercial |
$389.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.79
|
| Rate for Payer: PACE Senior Care Partners |
$123.12
|
| Rate for Payer: PACE Senior Care Partners |
$112.85
|
| Rate for Payer: PACE SWMI |
$129.59
|
| Rate for Payer: PACE SWMI |
$118.79
|
| Rate for Payer: PHP Commercial |
$403.89
|
| Rate for Payer: PHP Commercial |
$440.62
|
| Rate for Payer: PHP Medicare Advantage |
$118.79
|
| Rate for Payer: PHP Medicare Advantage |
$129.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$450.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$413.40
|
| Rate for Payer: Priority Health Medicare |
$130.89
|
| Rate for Payer: Priority Health Medicare |
$119.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.79
|
| Rate for Payer: Railroad Medicare Medicare |
$118.79
|
| Rate for Payer: Railroad Medicare Medicare |
$129.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.17
|
| Rate for Payer: UHC Core |
$432.85
|
| Rate for Payer: UHC Core |
$396.77
|
| Rate for Payer: UHC Exchange |
$129.59
|
| Rate for Payer: UHC Exchange |
$118.79
|
| Rate for Payer: UHC Medicaid |
$91.39
|
| Rate for Payer: UHC Medicaid |
$83.77
|
| Rate for Payer: UHC Medicare Advantage |
$118.79
|
| Rate for Payer: UHC Medicare Advantage |
$129.59
|
| Rate for Payer: UHCCP Medicaid |
$83.77
|
| Rate for Payer: UHCCP Medicaid |
$91.39
|
| Rate for Payer: VA VA |
$118.79
|
| Rate for Payer: VA VA |
$129.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.38
|
|
|
INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJECTION SOLUTION
|
Facility
|
IP
|
$475.17
|
|
|
Service Code
|
HCPCS J9220
|
| Hospital Charge Code |
108702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$330.72 |
| Max. Negotiated Rate |
$427.65 |
| Rate for Payer: Aetna Commercial |
$403.89
|
| Rate for Payer: Aetna Commercial |
$440.62
|
| Rate for Payer: BCBS Trust/PPO |
$392.44
|
| Rate for Payer: BCBS Trust/PPO |
$428.13
|
| Rate for Payer: BCN Commercial |
$392.44
|
| Rate for Payer: BCN Commercial |
$428.13
|
| Rate for Payer: Cash Price |
$380.14
|
| Rate for Payer: Cash Price |
$414.70
|
| Rate for Payer: Cofinity Commercial |
$445.81
|
| Rate for Payer: Cofinity Commercial |
$408.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.14
|
| Rate for Payer: Healthscope Commercial |
$427.65
|
| Rate for Payer: Healthscope Commercial |
$466.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.62
|
| Rate for Payer: Nomi Health Commercial |
$389.64
|
| Rate for Payer: Nomi Health Commercial |
$425.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.79
|
| Rate for Payer: PHP Commercial |
$440.62
|
| Rate for Payer: PHP Commercial |
$403.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$450.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$413.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$360.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.17
|
| Rate for Payer: UHC Core |
$396.77
|
| Rate for Payer: UHC Core |
$432.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.79
|
|
|
INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$681.21
|
|
|
Service Code
|
NDC 70100072501
|
| Hospital Charge Code |
10266
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.10 |
| Max. Negotiated Rate |
$613.09 |
| Rate for Payer: Aetna Commercial |
$579.03
|
| Rate for Payer: Aetna Medicare |
$177.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.88
|
| Rate for Payer: BCBS Complete |
$126.09
|
| Rate for Payer: BCBS MAPPO |
$170.30
|
| Rate for Payer: BCBS Trust/PPO |
$560.02
|
| Rate for Payer: BCN Commercial |
$560.02
|
| Rate for Payer: BCN Medicare Advantage |
$170.30
|
| Rate for Payer: Cash Price |
$544.97
|
| Rate for Payer: Cofinity Commercial |
$585.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$613.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.91
|
| Rate for Payer: Mclaren Medicaid |
$120.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.82
|
| Rate for Payer: Meridian Medicaid |
$126.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$187.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.03
|
| Rate for Payer: Nomi Health Commercial |
$558.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.91
|
| Rate for Payer: PACE Senior Care Partners |
$161.79
|
| Rate for Payer: PACE SWMI |
$170.30
|
| Rate for Payer: PHP Commercial |
$579.03
|
| Rate for Payer: PHP Medicare Advantage |
$170.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$592.65
|
| Rate for Payer: Priority Health Medicare |
$172.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$474.12
|
| Rate for Payer: Railroad Medicare Medicare |
$170.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$599.46
|
| Rate for Payer: UHC Core |
$568.81
|
| Rate for Payer: UHC Exchange |
$170.30
|
| Rate for Payer: UHC Medicaid |
$120.10
|
| Rate for Payer: UHC Medicare Advantage |
$170.30
|
| Rate for Payer: UHCCP Medicaid |
$120.10
|
| Rate for Payer: VA VA |
$170.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.91
|
|
|
INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$681.21
|
|
|
Service Code
|
NDC 70100082502
|
| Hospital Charge Code |
10266
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.10 |
| Max. Negotiated Rate |
$613.09 |
| Rate for Payer: Aetna Commercial |
$579.03
|
| Rate for Payer: Aetna Medicare |
$177.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.88
|
| Rate for Payer: BCBS Complete |
$126.09
|
| Rate for Payer: BCBS MAPPO |
$170.30
|
| Rate for Payer: BCBS Trust/PPO |
$560.02
|
| Rate for Payer: BCN Commercial |
$560.02
|
| Rate for Payer: BCN Medicare Advantage |
$170.30
|
| Rate for Payer: Cash Price |
$544.97
|
| Rate for Payer: Cofinity Commercial |
$585.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$613.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.91
|
| Rate for Payer: Mclaren Medicaid |
$120.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.82
|
| Rate for Payer: Meridian Medicaid |
$126.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$187.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.03
|
| Rate for Payer: Nomi Health Commercial |
$558.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.91
|
| Rate for Payer: PACE Senior Care Partners |
$161.79
|
| Rate for Payer: PACE SWMI |
$170.30
|
| Rate for Payer: PHP Commercial |
$579.03
|
| Rate for Payer: PHP Medicare Advantage |
$170.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$592.65
|
| Rate for Payer: Priority Health Medicare |
$172.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$474.12
|
| Rate for Payer: Railroad Medicare Medicare |
$170.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$599.46
|
| Rate for Payer: UHC Core |
$568.81
|
| Rate for Payer: UHC Exchange |
$170.30
|
| Rate for Payer: UHC Medicaid |
$120.10
|
| Rate for Payer: UHC Medicare Advantage |
$170.30
|
| Rate for Payer: UHCCP Medicaid |
$120.10
|
| Rate for Payer: VA VA |
$170.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.91
|
|
|
INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$681.21
|
|
|
Service Code
|
NDC 70100082502
|
| Hospital Charge Code |
10266
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$474.12 |
| Max. Negotiated Rate |
$613.09 |
| Rate for Payer: Aetna Commercial |
$579.03
|
| Rate for Payer: BCBS Trust/PPO |
$562.61
|
| Rate for Payer: BCN Commercial |
$562.61
|
| Rate for Payer: Cash Price |
$544.97
|
| Rate for Payer: Cofinity Commercial |
$585.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.97
|
| Rate for Payer: Healthscope Commercial |
$613.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.03
|
| Rate for Payer: Nomi Health Commercial |
$558.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.91
|
| Rate for Payer: PHP Commercial |
$579.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$592.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$474.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$599.46
|
| Rate for Payer: UHC Core |
$568.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.91
|
|
|
INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$681.21
|
|
|
Service Code
|
NDC 70100072501
|
| Hospital Charge Code |
10266
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$474.12 |
| Max. Negotiated Rate |
$613.09 |
| Rate for Payer: Aetna Commercial |
$579.03
|
| Rate for Payer: BCBS Trust/PPO |
$562.61
|
| Rate for Payer: BCN Commercial |
$562.61
|
| Rate for Payer: Cash Price |
$544.97
|
| Rate for Payer: Cofinity Commercial |
$585.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.97
|
| Rate for Payer: Healthscope Commercial |
$613.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$579.03
|
| Rate for Payer: Nomi Health Commercial |
$558.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$510.91
|
| Rate for Payer: PHP Commercial |
$579.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$592.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$474.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$599.46
|
| Rate for Payer: UHC Core |
$568.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.91
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
IP
|
$128.73
|
|
|
Service Code
|
NDC 50268043015
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$115.86 |
| Rate for Payer: Aetna Commercial |
$109.42
|
| Rate for Payer: BCBS Trust/PPO |
$106.32
|
| Rate for Payer: BCN Commercial |
$106.32
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Cofinity Commercial |
$110.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.98
|
| Rate for Payer: Healthscope Commercial |
$115.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.42
|
| Rate for Payer: Nomi Health Commercial |
$105.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.55
|
| Rate for Payer: PHP Commercial |
$109.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$112.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.28
|
| Rate for Payer: UHC Core |
$107.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.55
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
OP
|
$128.73
|
|
|
Service Code
|
NDC 50268043015
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$115.86 |
| Rate for Payer: Aetna Commercial |
$109.42
|
| Rate for Payer: Aetna Medicare |
$33.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.23
|
| Rate for Payer: BCBS Complete |
$23.83
|
| Rate for Payer: BCBS MAPPO |
$32.18
|
| Rate for Payer: BCBS Trust/PPO |
$105.83
|
| Rate for Payer: BCN Commercial |
$105.83
|
| Rate for Payer: BCN Medicare Advantage |
$32.18
|
| Rate for Payer: Cash Price |
$102.98
|
| Rate for Payer: Cofinity Commercial |
$110.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.18
|
| Rate for Payer: Healthscope Commercial |
$115.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.55
|
| Rate for Payer: Mclaren Medicaid |
$22.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.79
|
| Rate for Payer: Meridian Medicaid |
$23.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.42
|
| Rate for Payer: Nomi Health Commercial |
$105.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.55
|
| Rate for Payer: PACE Senior Care Partners |
$30.57
|
| Rate for Payer: PACE SWMI |
$32.18
|
| Rate for Payer: PHP Commercial |
$109.42
|
| Rate for Payer: PHP Medicare Advantage |
$32.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$112.00
|
| Rate for Payer: Priority Health Medicare |
$32.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.60
|
| Rate for Payer: Railroad Medicare Medicare |
$32.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.28
|
| Rate for Payer: UHC Core |
$107.49
|
| Rate for Payer: UHC Exchange |
$32.18
|
| Rate for Payer: UHC Medicaid |
$22.70
|
| Rate for Payer: UHC Medicare Advantage |
$32.18
|
| Rate for Payer: UHCCP Medicaid |
$22.70
|
| Rate for Payer: VA VA |
$32.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.55
|
|
