|
BUTYLATED HYDROXYTOLUENE POWDER
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 38779006505
|
| Hospital Charge Code |
17041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$169.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UMR Bronson Commercial |
$125.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
BUTYLATED HYDROXYTOLUENE POWDER
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 38779006505
|
| Hospital Charge Code |
17041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.90 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UMR Bronson Commercial |
$148.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT
|
Facility
|
IP
|
$11,394.31
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
158850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,013.50 |
| Max. Negotiated Rate |
$10,254.88 |
| Rate for Payer: Aetna American Axle |
$7,406.30
|
| Rate for Payer: Aetna Commercial |
$9,685.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,406.30
|
| Rate for Payer: Cash Price |
$9,115.45
|
| Rate for Payer: Cofinity Commercial |
$7,976.02
|
| Rate for Payer: Cofinity Commercial |
$9,799.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,976.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,115.45
|
| Rate for Payer: Healthscope Commercial |
$10,254.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,976.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,545.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,685.16
|
| Rate for Payer: PHP Commercial |
$9,685.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,406.30
|
| Rate for Payer: Priority Health SBD |
$7,178.42
|
| Rate for Payer: UMR Bronson Commercial |
$5,013.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,545.73
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT
|
Facility
|
OP
|
$11,394.31
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
158850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$10,254.88 |
| Rate for Payer: Aetna American Axle |
$7,406.30
|
| Rate for Payer: Aetna Commercial |
$9,685.16
|
| Rate for Payer: Aetna Medicare |
$78.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,406.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.83
|
| Rate for Payer: BCBS Complete |
$42.69
|
| Rate for Payer: BCBS MAPPO |
$75.86
|
| Rate for Payer: BCN Medicare Advantage |
$75.86
|
| Rate for Payer: Cash Price |
$9,115.45
|
| Rate for Payer: Cash Price |
$9,115.45
|
| Rate for Payer: Cofinity Commercial |
$9,799.11
|
| Rate for Payer: Cofinity Commercial |
$7,976.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,976.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,115.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.86
|
| Rate for Payer: Healthscope Commercial |
$10,254.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,976.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,545.73
|
| Rate for Payer: Mclaren Medicaid |
$40.66
|
| Rate for Payer: Mclaren Medicare |
$75.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.65
|
| Rate for Payer: Meridian Medicaid |
$42.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,685.16
|
| Rate for Payer: PACE Medicare |
$72.07
|
| Rate for Payer: PACE SWMI |
$75.86
|
| Rate for Payer: PHP Commercial |
$9,685.16
|
| Rate for Payer: PHP Medicare Advantage |
$75.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,406.30
|
| Rate for Payer: Priority Health Medicare |
$75.86
|
| Rate for Payer: Priority Health SBD |
$7,178.42
|
| Rate for Payer: Railroad Medicare Medicare |
$75.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.86
|
| Rate for Payer: UHC Exchange |
$144.98
|
| Rate for Payer: UHC Medicare Advantage |
$75.86
|
| Rate for Payer: UHCCP Medicaid |
$40.66
|
| Rate for Payer: UMR Bronson Commercial |
$4,215.89
|
| Rate for Payer: VA VA |
$75.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,545.73
|
|
|
CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$64,470.71
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
105644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$121.82 |
| Max. Negotiated Rate |
$58,023.64 |
| Rate for Payer: Aetna American Axle |
$41,905.96
|
| Rate for Payer: Aetna Commercial |
$54,800.10
|
| Rate for Payer: Aetna Medicare |
$236.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41,905.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$284.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$284.10
|
| Rate for Payer: BCBS Complete |
$127.91
|
| Rate for Payer: BCBS MAPPO |
$227.28
|
| Rate for Payer: BCN Medicare Advantage |
$227.28
|
| Rate for Payer: Cash Price |
$51,576.57
|
| Rate for Payer: Cash Price |
$51,576.57
|
| Rate for Payer: Cofinity Commercial |
$55,444.81
|
| Rate for Payer: Cofinity Commercial |
$45,129.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$45,129.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51,576.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.28
|
| Rate for Payer: Healthscope Commercial |
$58,023.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45,129.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48,353.03
|
| Rate for Payer: Mclaren Medicaid |
$121.82
|
| Rate for Payer: Mclaren Medicare |
$227.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.64
|
| Rate for Payer: Meridian Medicaid |
$127.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54,800.10
|
| Rate for Payer: PACE Medicare |
$215.92
|
| Rate for Payer: PACE SWMI |
$227.28
|
| Rate for Payer: PHP Commercial |
$54,800.10
|
| Rate for Payer: PHP Medicare Advantage |
$227.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41,905.96
|
| Rate for Payer: Priority Health Medicare |
$227.28
|
| Rate for Payer: Priority Health SBD |
$40,616.55
|
| Rate for Payer: Railroad Medicare Medicare |
$227.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$639.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.28
|
| Rate for Payer: UHC Exchange |
$434.35
|
| Rate for Payer: UHC Medicare Advantage |
$227.28
|
| Rate for Payer: UHCCP Medicaid |
$121.82
|
| Rate for Payer: UMR Bronson Commercial |
$23,854.16
|
| Rate for Payer: VA VA |
$227.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48,353.03
|
|
|
CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$64,470.71
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
105644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28,367.11 |
| Max. Negotiated Rate |
$58,023.64 |
| Rate for Payer: Aetna American Axle |
$41,905.96
|
| Rate for Payer: Aetna Commercial |
$54,800.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41,905.96
|
| Rate for Payer: Cash Price |
$51,576.57
|
| Rate for Payer: Cofinity Commercial |
$45,129.50
|
| Rate for Payer: Cofinity Commercial |
$55,444.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$45,129.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51,576.57
|
| Rate for Payer: Healthscope Commercial |
$58,023.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45,129.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48,353.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54,800.10
|
| Rate for Payer: PHP Commercial |
$54,800.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41,905.96
|
| Rate for Payer: Priority Health SBD |
$40,616.55
|
| Rate for Payer: UMR Bronson Commercial |
$28,367.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48,353.03
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$447.35
|
|
|
Service Code
|
NDC 00093542088
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.83 |
| Max. Negotiated Rate |
$402.62 |
| Rate for Payer: Aetna American Axle |
$290.78
|
| Rate for Payer: Aetna Commercial |
$380.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.78
|
| Rate for Payer: Cash Price |
$357.88
|
| Rate for Payer: Cofinity Commercial |
$313.14
|
| Rate for Payer: Cofinity Commercial |
$384.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.88
|
| Rate for Payer: Healthscope Commercial |
$402.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.25
|
| Rate for Payer: PHP Commercial |
$380.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.78
|
| Rate for Payer: Priority Health SBD |
$281.83
|
| Rate for Payer: UMR Bronson Commercial |
$196.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.51
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
OP
|
$447.35
|
|
|
Service Code
|
NDC 00093542088
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.52 |
| Max. Negotiated Rate |
$402.62 |
| Rate for Payer: Aetna American Axle |
$290.78
|
| Rate for Payer: Aetna Commercial |
$380.25
|
| Rate for Payer: Aetna Medicare |
$223.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.78
|
| Rate for Payer: BCBS Complete |
$178.94
|
| Rate for Payer: Cash Price |
$357.88
|
| Rate for Payer: Cofinity Commercial |
$313.14
|
| Rate for Payer: Cofinity Commercial |
$384.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.88
|
| Rate for Payer: Healthscope Commercial |
$402.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.25
|
| Rate for Payer: PHP Commercial |
$380.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.78
|
| Rate for Payer: Priority Health SBD |
$281.83
|
| Rate for Payer: UMR Bronson Commercial |
$165.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.51
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
OP
|
$84.75
|
|
|
Service Code
|
NDC 50742011808
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$76.28 |
| Rate for Payer: Aetna American Axle |
$55.09
|
| Rate for Payer: Aetna Commercial |
$72.04
|
| Rate for Payer: Aetna Medicare |
$42.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.09
|
| Rate for Payer: BCBS Complete |
$33.90
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cofinity Commercial |
$59.33
|
| Rate for Payer: Cofinity Commercial |
$72.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.80
|
| Rate for Payer: Healthscope Commercial |
$76.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.04
|
| Rate for Payer: PHP Commercial |
$72.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.09
|
| Rate for Payer: Priority Health SBD |
$53.39
|
| Rate for Payer: UMR Bronson Commercial |
$31.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.56
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
NDC 59762100501
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna American Axle |
$104.65
|
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health SBD |
$101.43
|
| Rate for Payer: UMR Bronson Commercial |
$70.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.75
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
NDC 59762100501
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna American Axle |
$104.65
|
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna Medicare |
$80.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health SBD |
$101.43
|
| Rate for Payer: UMR Bronson Commercial |
$59.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.75
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$84.75
|
|
|
Service Code
|
NDC 50742011808
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$76.28 |
| Rate for Payer: Aetna American Axle |
$55.09
|
| Rate for Payer: Aetna Commercial |
$72.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.09
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cofinity Commercial |
$59.33
|
| Rate for Payer: Cofinity Commercial |
$72.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.80
|
| Rate for Payer: Healthscope Commercial |
$76.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.04
|
| Rate for Payer: PHP Commercial |
$72.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.09
|
| Rate for Payer: Priority Health SBD |
$53.39
|
| Rate for Payer: UMR Bronson Commercial |
$37.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.56
|
|
|
CABOTEGRAVIR ER 400 MG/2 ML-RILPIVIRINE ER 600 MG/2ML IM SUSPENSION,ER
|
Facility
|
IP
|
$11,768.05
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,177.94 |
| Max. Negotiated Rate |
$10,591.25 |
| Rate for Payer: Aetna American Axle |
$7,649.23
|
| Rate for Payer: Aetna Commercial |
$10,002.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,649.23
|
| Rate for Payer: Cash Price |
$9,414.44
|
| Rate for Payer: Cofinity Commercial |
$10,120.52
|
| Rate for Payer: Cofinity Commercial |
$8,237.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,237.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,414.44
|
| Rate for Payer: Healthscope Commercial |
$10,591.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,237.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,826.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,002.84
|
| Rate for Payer: PHP Commercial |
$10,002.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,649.23
|
| Rate for Payer: Priority Health SBD |
$7,413.87
|
| Rate for Payer: UMR Bronson Commercial |
$5,177.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,826.04
|
|
|
CABOTEGRAVIR ER 400 MG/2 ML-RILPIVIRINE ER 600 MG/2ML IM SUSPENSION,ER
|
Facility
|
OP
|
$11,768.05
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$10,591.25 |
| Rate for Payer: Aetna American Axle |
$7,649.23
|
| Rate for Payer: Aetna Commercial |
$10,002.84
|
| Rate for Payer: Aetna Medicare |
$24.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,649.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.56
|
| Rate for Payer: BCBS Complete |
$13.31
|
| Rate for Payer: BCBS MAPPO |
$23.65
|
| Rate for Payer: BCN Medicare Advantage |
$23.65
|
| Rate for Payer: Cash Price |
$9,414.44
|
| Rate for Payer: Cash Price |
$9,414.44
|
| Rate for Payer: Cofinity Commercial |
$10,120.52
|
| Rate for Payer: Cofinity Commercial |
$8,237.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,237.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,414.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.65
|
| Rate for Payer: Healthscope Commercial |
$10,591.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,237.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,826.04
|
| Rate for Payer: Mclaren Medicaid |
$12.68
|
| Rate for Payer: Mclaren Medicare |
$23.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.83
|
| Rate for Payer: Meridian Medicaid |
$13.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,002.84
|
| Rate for Payer: PACE Medicare |
$22.47
|
| Rate for Payer: PACE SWMI |
$23.65
|
| Rate for Payer: PHP Commercial |
$10,002.84
|
| Rate for Payer: PHP Medicare Advantage |
$23.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,649.23
|
| Rate for Payer: Priority Health Medicare |
$23.65
|
| Rate for Payer: Priority Health SBD |
$7,413.87
|
| Rate for Payer: Railroad Medicare Medicare |
$23.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.65
|
| Rate for Payer: UHC Exchange |
$45.20
|
| Rate for Payer: UHC Medicare Advantage |
$23.65
|
| Rate for Payer: UHCCP Medicaid |
$12.68
|
| Rate for Payer: UMR Bronson Commercial |
$4,354.18
|
| Rate for Payer: VA VA |
$23.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,826.04
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML (200 MG/ML) IM SUSPENSION,EXTENDED RELEASE
|
Facility
|
OP
|
$10,465.58
|
|
|
Service Code
|
HCPCS J0739
|
| Hospital Charge Code |
198975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$9,419.02 |
| Rate for Payer: Aetna American Axle |
$6,802.63
|
| Rate for Payer: Aetna Commercial |
$8,895.74
|
| Rate for Payer: Aetna Medicare |
$7.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,802.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.78
|
| Rate for Payer: BCBS Complete |
$3.95
|
| Rate for Payer: BCBS MAPPO |
$7.02
|
| Rate for Payer: BCN Medicare Advantage |
$7.02
|
| Rate for Payer: Cash Price |
$8,372.46
|
| Rate for Payer: Cash Price |
$8,372.46
|
| Rate for Payer: Cofinity Commercial |
$9,000.40
|
| Rate for Payer: Cofinity Commercial |
$7,325.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,325.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,372.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$9,419.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,325.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,849.19
|
| Rate for Payer: Mclaren Medicaid |
$3.76
|
| Rate for Payer: Mclaren Medicare |
$7.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.37
|
| Rate for Payer: Meridian Medicaid |
$3.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,895.74
|
| Rate for Payer: PACE Medicare |
$6.67
|
| Rate for Payer: PACE SWMI |
$7.02
|
| Rate for Payer: PHP Commercial |
$8,895.74
|
| Rate for Payer: PHP Medicare Advantage |
$7.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,802.63
|
| Rate for Payer: Priority Health Medicare |
$7.02
|
| Rate for Payer: Priority Health SBD |
$6,593.32
|
| Rate for Payer: Railroad Medicare Medicare |
$7.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.02
|
| Rate for Payer: UHC Exchange |
$13.42
|
| Rate for Payer: UHC Medicare Advantage |
$7.02
|
| Rate for Payer: UHCCP Medicaid |
$3.76
|
| Rate for Payer: UMR Bronson Commercial |
$3,872.26
|
| Rate for Payer: VA VA |
$7.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,849.19
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML (200 MG/ML) IM SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$10,465.58
|
|
|
Service Code
|
HCPCS J0739
|
| Hospital Charge Code |
198975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,604.86 |
| Max. Negotiated Rate |
$9,419.02 |
| Rate for Payer: Aetna American Axle |
$6,802.63
|
| Rate for Payer: Aetna Commercial |
$8,895.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,802.63
|
| Rate for Payer: Cash Price |
$8,372.46
|
| Rate for Payer: Cofinity Commercial |
$7,325.91
|
| Rate for Payer: Cofinity Commercial |
$9,000.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,325.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,372.46
|
| Rate for Payer: Healthscope Commercial |
$9,419.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,325.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,849.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,895.74
|
| Rate for Payer: PHP Commercial |
$8,895.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,802.63
|
| Rate for Payer: Priority Health SBD |
$6,593.32
|
| Rate for Payer: UMR Bronson Commercial |
$4,604.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,849.19
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER
|
Facility
|
IP
|
$17,652.08
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,766.92 |
| Max. Negotiated Rate |
$15,886.87 |
| Rate for Payer: Aetna American Axle |
$11,473.85
|
| Rate for Payer: Aetna Commercial |
$15,004.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,473.85
|
| Rate for Payer: Cash Price |
$14,121.66
|
| Rate for Payer: Cofinity Commercial |
$12,356.46
|
| Rate for Payer: Cofinity Commercial |
$15,180.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,356.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,121.66
|
| Rate for Payer: Healthscope Commercial |
$15,886.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,356.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,239.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,004.27
|
| Rate for Payer: PHP Commercial |
$15,004.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,473.85
|
| Rate for Payer: Priority Health SBD |
$11,120.81
|
| Rate for Payer: UMR Bronson Commercial |
$7,766.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,239.06
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER
|
Facility
|
OP
|
$17,652.08
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$15,886.87 |
| Rate for Payer: Aetna American Axle |
$11,473.85
|
| Rate for Payer: Aetna Commercial |
$15,004.27
|
| Rate for Payer: Aetna Medicare |
$24.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,473.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.56
|
| Rate for Payer: BCBS Complete |
$13.31
|
| Rate for Payer: BCBS MAPPO |
$23.65
|
| Rate for Payer: BCN Medicare Advantage |
$23.65
|
| Rate for Payer: Cash Price |
$14,121.66
|
| Rate for Payer: Cash Price |
$14,121.66
|
| Rate for Payer: Cofinity Commercial |
$15,180.79
|
| Rate for Payer: Cofinity Commercial |
$12,356.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,356.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,121.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.65
|
| Rate for Payer: Healthscope Commercial |
$15,886.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,356.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,239.06
|
| Rate for Payer: Mclaren Medicaid |
$12.68
|
| Rate for Payer: Mclaren Medicare |
$23.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.83
|
| Rate for Payer: Meridian Medicaid |
$13.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,004.27
|
| Rate for Payer: PACE Medicare |
$22.47
|
| Rate for Payer: PACE SWMI |
$23.65
|
| Rate for Payer: PHP Commercial |
$15,004.27
|
| Rate for Payer: PHP Medicare Advantage |
$23.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,473.85
|
| Rate for Payer: Priority Health Medicare |
$23.65
|
| Rate for Payer: Priority Health SBD |
$11,120.81
|
| Rate for Payer: Railroad Medicare Medicare |
$23.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.65
|
| Rate for Payer: UHC Exchange |
$45.20
|
| Rate for Payer: UHC Medicare Advantage |
$23.65
|
| Rate for Payer: UHCCP Medicaid |
$12.68
|
| Rate for Payer: UMR Bronson Commercial |
$6,531.27
|
| Rate for Payer: VA VA |
$23.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,239.06
|
|
|
CAFFEINE 200 MG TABLET
|
Facility
|
IP
|
$33.47
|
|
|
Service Code
|
NDC 09629596325
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$30.12 |
| Rate for Payer: Aetna American Axle |
$21.76
|
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.76
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$23.43
|
| Rate for Payer: Cofinity Commercial |
$28.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$30.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.45
|
| Rate for Payer: PHP Commercial |
$28.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.76
|
| Rate for Payer: Priority Health SBD |
$21.09
|
| Rate for Payer: UMR Bronson Commercial |
$14.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.10
|
|
|
CAFFEINE 200 MG TABLET
|
Facility
|
OP
|
$33.47
|
|
|
Service Code
|
NDC 09629596325
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$30.12 |
| Rate for Payer: Aetna American Axle |
$21.76
|
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Aetna Medicare |
$16.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.76
|
| Rate for Payer: BCBS Complete |
$13.39
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Cofinity Commercial |
$23.43
|
| Rate for Payer: Cofinity Commercial |
$28.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$30.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.45
|
| Rate for Payer: PHP Commercial |
$28.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.76
|
| Rate for Payer: Priority Health SBD |
$21.09
|
| Rate for Payer: UMR Bronson Commercial |
$12.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.10
|
|
|
CAFFEINE 200 MG TABLET
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
NDC 09900000881
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna American Axle |
$1.06
|
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.06
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cofinity Commercial |
$1.14
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.30
|
| Rate for Payer: Healthscope Commercial |
$1.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.06
|
| Rate for Payer: Priority Health SBD |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.22
|
|
|
CAFFEINE 200 MG TABLET
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
NDC 09900000881
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna American Axle |
$1.06
|
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna Medicare |
$0.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.06
|
| Rate for Payer: BCBS Complete |
$0.65
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cofinity Commercial |
$1.14
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.30
|
| Rate for Payer: Healthscope Commercial |
$1.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.06
|
| Rate for Payer: Priority Health SBD |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.22
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) BOLUS/LOAD IV SOLUTION CUSTOM
|
Facility
|
OP
|
$44.78
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
163560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna Medicare |
$22.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: BCBS Complete |
$17.91
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cofinity Commercial |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$38.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.82
|
| Rate for Payer: Healthscope Commercial |
$40.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.06
|
| Rate for Payer: PHP Commercial |
$38.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: Priority Health SBD |
$28.21
|
| Rate for Payer: UMR Bronson Commercial |
$16.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.59
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) BOLUS/LOAD IV SOLUTION CUSTOM
|
Facility
|
IP
|
$44.78
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
163560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cofinity Commercial |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$38.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.82
|
| Rate for Payer: Healthscope Commercial |
$40.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.06
|
| Rate for Payer: PHP Commercial |
$38.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.11
|
| Rate for Payer: Priority Health SBD |
$28.21
|
| Rate for Payer: UMR Bronson Commercial |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.59
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) BOLUS/LOAD ORAL SOLUTION CUSTOM
|
Facility
|
IP
|
$37.76
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
301512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Commercial |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.54
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: UMR Bronson Commercial |
$16.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
