|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$81.55
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.88 |
| Max. Negotiated Rate |
$73.40 |
| Rate for Payer: Aetna American Axle |
$53.01
|
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.01
|
| Rate for Payer: Cash Price |
$65.24
|
| Rate for Payer: Cofinity Commercial |
$57.08
|
| Rate for Payer: Cofinity Commercial |
$70.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.24
|
| Rate for Payer: Healthscope Commercial |
$73.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.32
|
| Rate for Payer: PHP Commercial |
$69.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: Priority Health SBD |
$51.38
|
| Rate for Payer: UMR Bronson Commercial |
$35.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.16
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,172.82
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$516.04 |
| Max. Negotiated Rate |
$1,055.54 |
| Rate for Payer: Aetna American Axle |
$762.33
|
| Rate for Payer: Aetna Commercial |
$996.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.33
|
| Rate for Payer: Cash Price |
$938.26
|
| Rate for Payer: Cofinity Commercial |
$1,008.63
|
| Rate for Payer: Cofinity Commercial |
$820.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$938.26
|
| Rate for Payer: Healthscope Commercial |
$1,055.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$820.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$879.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$996.90
|
| Rate for Payer: PHP Commercial |
$996.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.97
|
| Rate for Payer: Priority Health SBD |
$738.88
|
| Rate for Payer: UMR Bronson Commercial |
$516.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$879.62
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,172.82
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$1,055.54 |
| Rate for Payer: Aetna American Axle |
$762.33
|
| Rate for Payer: Aetna Commercial |
$996.90
|
| Rate for Payer: Aetna Medicare |
$8.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.78
|
| Rate for Payer: BCBS Complete |
$4.49
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$24.49
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$938.26
|
| Rate for Payer: Cash Price |
$938.26
|
| Rate for Payer: Cofinity Commercial |
$1,008.63
|
| Rate for Payer: Cofinity Commercial |
$820.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$938.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$1,055.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$820.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$879.62
|
| Rate for Payer: Mclaren Medicaid |
$4.28
|
| Rate for Payer: Mclaren Medicare |
$7.82
|
| Rate for Payer: Meridian Medicaid |
$4.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$996.90
|
| Rate for Payer: PACE Medicare |
$7.43
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$996.90
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$820.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.30
|
| Rate for Payer: Priority Health Medicare |
$7.82
|
| Rate for Payer: Priority Health Narrow Network |
$17.04
|
| Rate for Payer: Priority Health SBD |
$738.88
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.82
|
| Rate for Payer: UHC Medicare Advantage |
$8.06
|
| Rate for Payer: UMR Bronson Commercial |
$433.94
|
| Rate for Payer: VA VA |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$879.62
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$163.10
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$146.79 |
| Rate for Payer: Aetna American Axle |
$106.02
|
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.02
|
| Rate for Payer: Cash Price |
$130.48
|
| Rate for Payer: Cofinity Commercial |
$114.17
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.48
|
| Rate for Payer: Healthscope Commercial |
$146.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.64
|
| Rate for Payer: PHP Commercial |
$138.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.17
|
| Rate for Payer: Priority Health SBD |
$102.75
|
| Rate for Payer: UMR Bronson Commercial |
$71.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.32
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$163.10
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$146.79 |
| Rate for Payer: Aetna American Axle |
$106.02
|
| Rate for Payer: Aetna Commercial |
$138.64
|
| Rate for Payer: Aetna Medicare |
$8.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.78
|
| Rate for Payer: BCBS Complete |
$4.49
|
| Rate for Payer: BCBS MAPPO |
$7.82
|
| Rate for Payer: BCBS Trust/PPO |
$24.49
|
| Rate for Payer: BCN Medicare Advantage |
$7.82
|
| Rate for Payer: Cash Price |
$130.48
|
| Rate for Payer: Cash Price |
$130.48
|
| Rate for Payer: Cofinity Commercial |
$114.17
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.82
|
| Rate for Payer: Healthscope Commercial |
$146.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.32
|
| Rate for Payer: Mclaren Medicaid |
$4.28
|
| Rate for Payer: Mclaren Medicare |
$7.82
|
| Rate for Payer: Meridian Medicaid |
$4.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.64
|
| Rate for Payer: PACE Medicare |
$7.43
|
| Rate for Payer: PACE SWMI |
$7.82
|
| Rate for Payer: PHP Commercial |
$138.64
|
| Rate for Payer: PHP Medicare Advantage |
$7.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.30
|
| Rate for Payer: Priority Health Medicare |
$7.82
|
| Rate for Payer: Priority Health Narrow Network |
$17.04
|
| Rate for Payer: Priority Health SBD |
$102.75
|
| Rate for Payer: Railroad Medicare Medicare |
$7.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.82
|
| Rate for Payer: UHC Medicare Advantage |
$8.06
|
| Rate for Payer: UMR Bronson Commercial |
$60.35
|
| Rate for Payer: VA VA |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.32
|
|
|
EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$130.85
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
162203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.57 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna American Axle |
$85.05
|
| Rate for Payer: Aetna American Axle |
$81.44
|
| Rate for Payer: Aetna Commercial |
$106.50
|
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.05
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cash Price |
$100.24
|
| Rate for Payer: Cofinity Commercial |
$87.71
|
| Rate for Payer: Cofinity Commercial |
$91.60
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Cofinity Commercial |
$107.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.24
|
| Rate for Payer: Healthscope Commercial |
$117.76
|
| Rate for Payer: Healthscope Commercial |
$112.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.50
|
| Rate for Payer: PHP Commercial |
$111.22
|
| Rate for Payer: PHP Commercial |
$106.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.60
|
| Rate for Payer: Priority Health SBD |
$78.94
|
| Rate for Payer: Priority Health SBD |
$82.44
|
| Rate for Payer: UMR Bronson Commercial |
$57.57
|
| Rate for Payer: UMR Bronson Commercial |
$55.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.14
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$200.22
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
155384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.10 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Aetna American Axle |
$130.14
|
| Rate for Payer: Aetna Commercial |
$170.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.14
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$140.15
|
| Rate for Payer: Cofinity Commercial |
$172.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Healthscope Commercial |
$180.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.19
|
| Rate for Payer: PHP Commercial |
$170.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.15
|
| Rate for Payer: Priority Health SBD |
$126.14
|
| Rate for Payer: UMR Bronson Commercial |
$88.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.16
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$126.72
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
15897
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.76 |
| Max. Negotiated Rate |
$114.05 |
| Rate for Payer: Aetna American Axle |
$82.37
|
| Rate for Payer: Aetna Commercial |
$107.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.37
|
| Rate for Payer: Cash Price |
$101.38
|
| Rate for Payer: Cofinity Commercial |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$88.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.38
|
| Rate for Payer: Healthscope Commercial |
$114.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.71
|
| Rate for Payer: PHP Commercial |
$107.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.70
|
| Rate for Payer: Priority Health SBD |
$79.83
|
| Rate for Payer: UMR Bronson Commercial |
$55.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.04
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,948.33
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$857.27 |
| Max. Negotiated Rate |
$1,753.50 |
| Rate for Payer: Aetna American Axle |
$1,266.41
|
| Rate for Payer: Aetna American Axle |
$694.57
|
| Rate for Payer: Aetna American Axle |
$1,247.74
|
| Rate for Payer: Aetna American Axle |
$187.90
|
| Rate for Payer: Aetna American Axle |
$174.02
|
| Rate for Payer: Aetna American Axle |
$165.58
|
| Rate for Payer: Aetna American Axle |
$1,095.38
|
| Rate for Payer: Aetna Commercial |
$1,432.42
|
| Rate for Payer: Aetna Commercial |
$227.57
|
| Rate for Payer: Aetna Commercial |
$216.53
|
| Rate for Payer: Aetna Commercial |
$1,631.66
|
| Rate for Payer: Aetna Commercial |
$1,656.08
|
| Rate for Payer: Aetna Commercial |
$908.28
|
| Rate for Payer: Aetna Commercial |
$245.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$694.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.74
|
| Rate for Payer: Cash Price |
$203.79
|
| Rate for Payer: Cash Price |
$854.86
|
| Rate for Payer: Cash Price |
$1,348.16
|
| Rate for Payer: Cash Price |
$1,535.68
|
| Rate for Payer: Cash Price |
$1,558.66
|
| Rate for Payer: Cash Price |
$214.18
|
| Rate for Payer: Cash Price |
$231.26
|
| Rate for Payer: Cofinity Commercial |
$1,179.64
|
| Rate for Payer: Cofinity Commercial |
$748.00
|
| Rate for Payer: Cofinity Commercial |
$918.97
|
| Rate for Payer: Cofinity Commercial |
$230.25
|
| Rate for Payer: Cofinity Commercial |
$219.08
|
| Rate for Payer: Cofinity Commercial |
$248.61
|
| Rate for Payer: Cofinity Commercial |
$1,449.27
|
| Rate for Payer: Cofinity Commercial |
$1,675.56
|
| Rate for Payer: Cofinity Commercial |
$1,343.72
|
| Rate for Payer: Cofinity Commercial |
$1,650.86
|
| Rate for Payer: Cofinity Commercial |
$178.32
|
| Rate for Payer: Cofinity Commercial |
$1,363.83
|
| Rate for Payer: Cofinity Commercial |
$202.36
|
| Rate for Payer: Cofinity Commercial |
$187.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,558.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$854.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,535.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,348.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.26
|
| Rate for Payer: Healthscope Commercial |
$240.96
|
| Rate for Payer: Healthscope Commercial |
$229.27
|
| Rate for Payer: Healthscope Commercial |
$1,727.64
|
| Rate for Payer: Healthscope Commercial |
$1,516.68
|
| Rate for Payer: Healthscope Commercial |
$961.71
|
| Rate for Payer: Healthscope Commercial |
$260.17
|
| Rate for Payer: Healthscope Commercial |
$1,753.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,343.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,363.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$748.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,179.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,461.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,439.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$801.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,631.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$245.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,656.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,432.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$908.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.57
|
| Rate for Payer: PHP Commercial |
$1,432.42
|
| Rate for Payer: PHP Commercial |
$1,656.08
|
| Rate for Payer: PHP Commercial |
$245.72
|
| Rate for Payer: PHP Commercial |
$1,631.66
|
| Rate for Payer: PHP Commercial |
$227.57
|
| Rate for Payer: PHP Commercial |
$216.53
|
| Rate for Payer: PHP Commercial |
$908.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.72
|
| Rate for Payer: Priority Health SBD |
$1,209.35
|
| Rate for Payer: Priority Health SBD |
$1,061.68
|
| Rate for Payer: Priority Health SBD |
$1,227.45
|
| Rate for Payer: Priority Health SBD |
$673.20
|
| Rate for Payer: Priority Health SBD |
$160.49
|
| Rate for Payer: Priority Health SBD |
$168.67
|
| Rate for Payer: Priority Health SBD |
$182.12
|
| Rate for Payer: UMR Bronson Commercial |
$857.27
|
| Rate for Payer: UMR Bronson Commercial |
$117.80
|
| Rate for Payer: UMR Bronson Commercial |
$470.17
|
| Rate for Payer: UMR Bronson Commercial |
$844.62
|
| Rate for Payer: UMR Bronson Commercial |
$741.49
|
| Rate for Payer: UMR Bronson Commercial |
$127.20
|
| Rate for Payer: UMR Bronson Commercial |
$112.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,439.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,461.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$801.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.81
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$330.15
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$297.14 |
| Rate for Payer: Aetna American Axle |
$214.60
|
| Rate for Payer: Aetna American Axle |
$55.77
|
| Rate for Payer: Aetna American Axle |
$55.91
|
| Rate for Payer: Aetna American Axle |
$54.03
|
| Rate for Payer: Aetna American Axle |
$369.57
|
| Rate for Payer: Aetna Commercial |
$73.12
|
| Rate for Payer: Aetna Commercial |
$280.63
|
| Rate for Payer: Aetna Commercial |
$72.93
|
| Rate for Payer: Aetna Commercial |
$70.66
|
| Rate for Payer: Aetna Commercial |
$483.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.77
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cash Price |
$264.12
|
| Rate for Payer: Cash Price |
$454.86
|
| Rate for Payer: Cash Price |
$68.64
|
| Rate for Payer: Cofinity Commercial |
$60.21
|
| Rate for Payer: Cofinity Commercial |
$488.97
|
| Rate for Payer: Cofinity Commercial |
$73.79
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Cofinity Commercial |
$58.19
|
| Rate for Payer: Cofinity Commercial |
$71.49
|
| Rate for Payer: Cofinity Commercial |
$398.00
|
| Rate for Payer: Cofinity Commercial |
$283.93
|
| Rate for Payer: Cofinity Commercial |
$60.06
|
| Rate for Payer: Cofinity Commercial |
$231.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$74.82
|
| Rate for Payer: Healthscope Commercial |
$511.71
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Healthscope Commercial |
$297.14
|
| Rate for Payer: Healthscope Commercial |
$77.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.12
|
| Rate for Payer: PHP Commercial |
$73.12
|
| Rate for Payer: PHP Commercial |
$280.63
|
| Rate for Payer: PHP Commercial |
$483.28
|
| Rate for Payer: PHP Commercial |
$70.66
|
| Rate for Payer: PHP Commercial |
$72.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.19
|
| Rate for Payer: Priority Health SBD |
$207.99
|
| Rate for Payer: Priority Health SBD |
$52.37
|
| Rate for Payer: Priority Health SBD |
$54.05
|
| Rate for Payer: Priority Health SBD |
$54.19
|
| Rate for Payer: Priority Health SBD |
$358.20
|
| Rate for Payer: UMR Bronson Commercial |
$36.58
|
| Rate for Payer: UMR Bronson Commercial |
$250.17
|
| Rate for Payer: UMR Bronson Commercial |
$145.27
|
| Rate for Payer: UMR Bronson Commercial |
$37.85
|
| Rate for Payer: UMR Bronson Commercial |
$37.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.43
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,656.74
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$5,091.07 |
| Rate for Payer: Aetna American Axle |
$3,676.88
|
| Rate for Payer: Aetna Commercial |
$4,808.23
|
| Rate for Payer: Aetna Medicare |
$18.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,676.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.57
|
| Rate for Payer: BCBS Complete |
$10.37
|
| Rate for Payer: BCBS MAPPO |
$18.06
|
| Rate for Payer: BCBS Trust/PPO |
$58.33
|
| Rate for Payer: BCN Medicare Advantage |
$18.06
|
| Rate for Payer: Cash Price |
$4,525.39
|
| Rate for Payer: Cash Price |
$4,525.39
|
| Rate for Payer: Cofinity Commercial |
$4,864.80
|
| Rate for Payer: Cofinity Commercial |
$3,959.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,525.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$5,091.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,959.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,242.56
|
| Rate for Payer: Mclaren Medicaid |
$9.88
|
| Rate for Payer: Mclaren Medicare |
$18.06
|
| Rate for Payer: Meridian Medicaid |
$10.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,808.23
|
| Rate for Payer: PACE Medicare |
$17.16
|
| Rate for Payer: PACE SWMI |
$18.06
|
| Rate for Payer: PHP Commercial |
$4,808.23
|
| Rate for Payer: PHP Medicare Advantage |
$18.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,959.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.20
|
| Rate for Payer: Priority Health Medicare |
$18.06
|
| Rate for Payer: Priority Health Narrow Network |
$40.96
|
| Rate for Payer: Priority Health SBD |
$3,563.75
|
| Rate for Payer: Railroad Medicare Medicare |
$18.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.06
|
| Rate for Payer: UHC Medicare Advantage |
$18.60
|
| Rate for Payer: UMR Bronson Commercial |
$2,092.99
|
| Rate for Payer: VA VA |
$18.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,242.56
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,656.74
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,488.97 |
| Max. Negotiated Rate |
$5,091.07 |
| Rate for Payer: Aetna American Axle |
$3,676.88
|
| Rate for Payer: Aetna Commercial |
$4,808.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,676.88
|
| Rate for Payer: Cash Price |
$4,525.39
|
| Rate for Payer: Cofinity Commercial |
$3,959.72
|
| Rate for Payer: Cofinity Commercial |
$4,864.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,525.39
|
| Rate for Payer: Healthscope Commercial |
$5,091.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,959.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,242.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,808.23
|
| Rate for Payer: PHP Commercial |
$4,808.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,959.72
|
| Rate for Payer: Priority Health SBD |
$3,563.75
|
| Rate for Payer: UMR Bronson Commercial |
$2,488.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,242.56
|
|
|
ERAVACYCLINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$390.49
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
195057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.82 |
| Max. Negotiated Rate |
$351.44 |
| Rate for Payer: Aetna American Axle |
$253.82
|
| Rate for Payer: Aetna Commercial |
$331.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.82
|
| Rate for Payer: Cash Price |
$312.39
|
| Rate for Payer: Cofinity Commercial |
$273.34
|
| Rate for Payer: Cofinity Commercial |
$335.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.39
|
| Rate for Payer: Healthscope Commercial |
$351.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.92
|
| Rate for Payer: PHP Commercial |
$331.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.34
|
| Rate for Payer: Priority Health SBD |
$246.01
|
| Rate for Payer: UMR Bronson Commercial |
$171.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.87
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 64380-737-06
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna American Axle |
$168.02
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.02
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Cofinity Commercial |
$180.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.72
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.95
|
| Rate for Payer: Priority Health SBD |
$162.86
|
| Rate for Payer: UMR Bronson Commercial |
$113.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$260.49
|
|
|
Service Code
|
NDC 7583401060
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$234.44 |
| Rate for Payer: Aetna American Axle |
$169.32
|
| Rate for Payer: Aetna Commercial |
$221.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.32
|
| Rate for Payer: Cash Price |
$208.39
|
| Rate for Payer: Cofinity Commercial |
$182.34
|
| Rate for Payer: Cofinity Commercial |
$224.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.39
|
| Rate for Payer: Healthscope Commercial |
$234.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.42
|
| Rate for Payer: PHP Commercial |
$221.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.34
|
| Rate for Payer: Priority Health SBD |
$164.11
|
| Rate for Payer: UMR Bronson Commercial |
$114.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.37
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$277.59
|
|
|
Service Code
|
NDC 4778164726
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.14 |
| Max. Negotiated Rate |
$249.83 |
| Rate for Payer: Aetna American Axle |
$180.43
|
| Rate for Payer: Aetna Commercial |
$235.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.43
|
| Rate for Payer: Cash Price |
$222.07
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Cofinity Commercial |
$238.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.07
|
| Rate for Payer: Healthscope Commercial |
$249.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.95
|
| Rate for Payer: PHP Commercial |
$235.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.31
|
| Rate for Payer: Priority Health SBD |
$174.88
|
| Rate for Payer: UMR Bronson Commercial |
$122.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.19
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 9900-0019-65
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.20
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.17
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.18
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$255.46
|
|
|
Service Code
|
NDC 3932835760
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$229.91 |
| Rate for Payer: Aetna American Axle |
$166.05
|
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.05
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cofinity Commercial |
$178.82
|
| Rate for Payer: Cofinity Commercial |
$219.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.37
|
| Rate for Payer: Healthscope Commercial |
$229.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.14
|
| Rate for Payer: PHP Commercial |
$217.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.82
|
| Rate for Payer: Priority Health SBD |
$160.94
|
| Rate for Payer: UMR Bronson Commercial |
$112.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.60
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$266.19
|
|
|
Service Code
|
NDC 6936728302
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$239.57 |
| Rate for Payer: Aetna American Axle |
$173.02
|
| Rate for Payer: Aetna Commercial |
$226.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.02
|
| Rate for Payer: Cash Price |
$212.95
|
| Rate for Payer: Cofinity Commercial |
$186.33
|
| Rate for Payer: Cofinity Commercial |
$228.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.95
|
| Rate for Payer: Healthscope Commercial |
$239.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$226.26
|
| Rate for Payer: PHP Commercial |
$226.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.33
|
| Rate for Payer: Priority Health SBD |
$167.70
|
| Rate for Payer: UMR Bronson Commercial |
$117.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.64
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,142.32
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
106773
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.31 |
| Max. Negotiated Rate |
$5,528.09 |
| Rate for Payer: Aetna American Axle |
$3,992.51
|
| Rate for Payer: Aetna Commercial |
$5,220.97
|
| Rate for Payer: Aetna Medicare |
$139.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,992.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.52
|
| Rate for Payer: BCBS Complete |
$76.98
|
| Rate for Payer: BCBS MAPPO |
$134.02
|
| Rate for Payer: BCBS Trust/PPO |
$433.06
|
| Rate for Payer: BCN Medicare Advantage |
$134.02
|
| Rate for Payer: Cash Price |
$4,913.86
|
| Rate for Payer: Cash Price |
$4,913.86
|
| Rate for Payer: Cofinity Commercial |
$5,282.40
|
| Rate for Payer: Cofinity Commercial |
$4,299.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,913.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.02
|
| Rate for Payer: Healthscope Commercial |
$5,528.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,299.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,606.74
|
| Rate for Payer: Mclaren Medicaid |
$73.31
|
| Rate for Payer: Mclaren Medicare |
$134.02
|
| Rate for Payer: Meridian Medicaid |
$76.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,220.97
|
| Rate for Payer: PACE Medicare |
$127.32
|
| Rate for Payer: PACE SWMI |
$134.02
|
| Rate for Payer: PHP Commercial |
$5,220.97
|
| Rate for Payer: PHP Medicare Advantage |
$134.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,299.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$384.35
|
| Rate for Payer: Priority Health Medicare |
$134.02
|
| Rate for Payer: Priority Health Narrow Network |
$307.48
|
| Rate for Payer: Priority Health SBD |
$3,869.66
|
| Rate for Payer: Railroad Medicare Medicare |
$134.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.02
|
| Rate for Payer: UHC Medicare Advantage |
$138.04
|
| Rate for Payer: UMR Bronson Commercial |
$2,272.66
|
| Rate for Payer: VA VA |
$134.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,606.74
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$218.33
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.07 |
| Max. Negotiated Rate |
$196.50 |
| Rate for Payer: Aetna American Axle |
$141.91
|
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$185.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Cash Price |
$174.66
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$152.83
|
| Rate for Payer: Cofinity Commercial |
$187.76
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$196.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.40
|
| Rate for Payer: PHP Commercial |
$185.58
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.80
|
| Rate for Payer: Priority Health SBD |
$137.55
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: UMR Bronson Commercial |
$186.56
|
| Rate for Payer: UMR Bronson Commercial |
$96.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna American Axle |
$69.24
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Trust/PPO |
$41.87
|
| Rate for Payer: BCBS Trust/PPO |
$41.87
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.57
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: UMR Bronson Commercial |
$39.42
|
| Rate for Payer: UMR Bronson Commercial |
$156.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$101.40
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.62 |
| Max. Negotiated Rate |
$91.26 |
| Rate for Payer: Aetna American Axle |
$65.91
|
| Rate for Payer: Aetna American Axle |
$84.16
|
| Rate for Payer: Aetna American Axle |
$69.24
|
| Rate for Payer: Aetna American Axle |
$141.91
|
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$185.58
|
| Rate for Payer: Aetna Commercial |
$110.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$103.58
|
| Rate for Payer: Cash Price |
$174.66
|
| Rate for Payer: Cofinity Commercial |
$90.63
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$152.83
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$111.34
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$187.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.66
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$116.52
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$196.50
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.05
|
| Rate for Payer: PHP Commercial |
$185.58
|
| Rate for Payer: PHP Commercial |
$110.05
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.80
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$81.57
|
| Rate for Payer: Priority Health SBD |
$137.55
|
| Rate for Payer: UMR Bronson Commercial |
$46.87
|
| Rate for Payer: UMR Bronson Commercial |
$96.07
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
| Rate for Payer: UMR Bronson Commercial |
$56.97
|
| Rate for Payer: UMR Bronson Commercial |
$186.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.10
|
|
|
ERTAPENEM IVPB (INTRA-OP)
|
Facility
|
IP
|
$4,550.67
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
167002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,002.29 |
| Max. Negotiated Rate |
$4,095.60 |
| Rate for Payer: Aetna American Axle |
$2,957.94
|
| Rate for Payer: Aetna Commercial |
$3,868.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,957.94
|
| Rate for Payer: Cash Price |
$3,640.54
|
| Rate for Payer: Cofinity Commercial |
$3,185.47
|
| Rate for Payer: Cofinity Commercial |
$3,913.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,640.54
|
| Rate for Payer: Healthscope Commercial |
$4,095.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,185.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,413.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,868.07
|
| Rate for Payer: PHP Commercial |
$3,868.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,185.47
|
| Rate for Payer: Priority Health SBD |
$2,866.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,002.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,413.00
|
|
|
ERYTHROMYCIN 250 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$514.93
|
|
|
Service Code
|
NDC 52536-180-03
|
| Hospital Charge Code |
108619
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.57 |
| Max. Negotiated Rate |
$463.44 |
| Rate for Payer: Aetna American Axle |
$334.70
|
| Rate for Payer: Aetna Commercial |
$437.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.70
|
| Rate for Payer: Cash Price |
$411.94
|
| Rate for Payer: Cofinity Commercial |
$360.45
|
| Rate for Payer: Cofinity Commercial |
$442.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.94
|
| Rate for Payer: Healthscope Commercial |
$463.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$360.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$386.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$437.69
|
| Rate for Payer: PHP Commercial |
$437.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.45
|
| Rate for Payer: Priority Health SBD |
$324.41
|
| Rate for Payer: UMR Bronson Commercial |
$226.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$386.20
|
|
