|
FENTANYL 50 MCG/ML 2ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$22.04
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
180136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$19.84 |
| Rate for Payer: Aetna American Axle |
$14.33
|
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.33
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cofinity Commercial |
$15.43
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.73
|
| Rate for Payer: PHP Commercial |
$18.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.43
|
| Rate for Payer: Priority Health SBD |
$13.89
|
| Rate for Payer: UMR Bronson Commercial |
$9.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.53
|
|
|
FENTANYL 50 MCG/ML INHALATION
|
Facility
|
IP
|
$22.72
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
300141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna American Axle |
$14.77
|
| Rate for Payer: Aetna American Axle |
$15.28
|
| Rate for Payer: Aetna American Axle |
$22.56
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna Commercial |
$29.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: Cash Price |
$27.77
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.77
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Healthscope Commercial |
$31.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.50
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Commercial |
$29.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health SBD |
$14.31
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: Priority Health SBD |
$21.87
|
| Rate for Payer: UMR Bronson Commercial |
$15.27
|
| Rate for Payer: UMR Bronson Commercial |
$10.34
|
| Rate for Payer: UMR Bronson Commercial |
$10.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$125.16
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
30807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.07 |
| Max. Negotiated Rate |
$112.64 |
| Rate for Payer: Aetna American Axle |
$81.35
|
| Rate for Payer: Aetna Commercial |
$106.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.35
|
| Rate for Payer: Cash Price |
$100.13
|
| Rate for Payer: Cofinity Commercial |
$107.64
|
| Rate for Payer: Cofinity Commercial |
$87.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.13
|
| Rate for Payer: Healthscope Commercial |
$112.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.39
|
| Rate for Payer: PHP Commercial |
$106.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.61
|
| Rate for Payer: Priority Health SBD |
$78.85
|
| Rate for Payer: UMR Bronson Commercial |
$55.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.87
|
|
|
FENTANYL (PF) 2 MCG/ML-BUPIVACAINE 0.1 %-NACL INJECTION SOLUTION
|
Facility
|
IP
|
$86.78
|
|
|
Service Code
|
NDC 9900-0010-23
|
| Hospital Charge Code |
30863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.18 |
| Max. Negotiated Rate |
$78.10 |
| Rate for Payer: Aetna American Axle |
$56.41
|
| Rate for Payer: Aetna Commercial |
$73.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.41
|
| Rate for Payer: Cash Price |
$69.42
|
| Rate for Payer: Cofinity Commercial |
$60.75
|
| Rate for Payer: Cofinity Commercial |
$74.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.42
|
| Rate for Payer: Healthscope Commercial |
$78.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.76
|
| Rate for Payer: PHP Commercial |
$73.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.75
|
| Rate for Payer: Priority Health SBD |
$54.67
|
| Rate for Payer: UMR Bronson Commercial |
$38.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.08
|
|
|
FENTANYL (PF) 4 MCG/ML SD (NICU)
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
165999
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.18
|
| Rate for Payer: Priority Health SBD |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.19
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
IP
|
$11.10
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$9.99 |
| Rate for Payer: Aetna American Axle |
$7.22
|
| Rate for Payer: Aetna American Axle |
$27.38
|
| Rate for Payer: Aetna American Axle |
$16.07
|
| Rate for Payer: Aetna American Axle |
$22.56
|
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna American Axle |
$45.02
|
| Rate for Payer: Aetna American Axle |
$26.59
|
| Rate for Payer: Aetna American Axle |
$87.40
|
| Rate for Payer: Aetna Commercial |
$29.50
|
| Rate for Payer: Aetna Commercial |
$9.44
|
| Rate for Payer: Aetna Commercial |
$58.87
|
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: Aetna Commercial |
$114.29
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Commercial |
$34.77
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.59
|
| Rate for Payer: Cash Price |
$27.77
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$33.70
|
| Rate for Payer: Cash Price |
$107.57
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$32.73
|
| Rate for Payer: Cash Price |
$8.88
|
| Rate for Payer: Cash Price |
$55.41
|
| Rate for Payer: Cofinity Commercial |
$7.77
|
| Rate for Payer: Cofinity Commercial |
$9.55
|
| Rate for Payer: Cofinity Commercial |
$115.64
|
| Rate for Payer: Cofinity Commercial |
$94.12
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$17.30
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Cofinity Commercial |
$28.64
|
| Rate for Payer: Cofinity Commercial |
$35.18
|
| Rate for Payer: Cofinity Commercial |
$29.48
|
| Rate for Payer: Cofinity Commercial |
$36.22
|
| Rate for Payer: Cofinity Commercial |
$48.48
|
| Rate for Payer: Cofinity Commercial |
$59.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.70
|
| Rate for Payer: Healthscope Commercial |
$37.91
|
| Rate for Payer: Healthscope Commercial |
$36.82
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$9.99
|
| Rate for Payer: Healthscope Commercial |
$121.01
|
| Rate for Payer: Healthscope Commercial |
$62.33
|
| Rate for Payer: Healthscope Commercial |
$31.24
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.50
|
| Rate for Payer: PHP Commercial |
$9.44
|
| Rate for Payer: PHP Commercial |
$29.50
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$114.29
|
| Rate for Payer: PHP Commercial |
$58.87
|
| Rate for Payer: PHP Commercial |
$34.77
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$35.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.48
|
| Rate for Payer: Priority Health SBD |
$6.99
|
| Rate for Payer: Priority Health SBD |
$84.71
|
| Rate for Payer: Priority Health SBD |
$15.57
|
| Rate for Payer: Priority Health SBD |
$21.87
|
| Rate for Payer: Priority Health SBD |
$25.77
|
| Rate for Payer: Priority Health SBD |
$26.54
|
| Rate for Payer: Priority Health SBD |
$43.63
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$10.88
|
| Rate for Payer: UMR Bronson Commercial |
$4.88
|
| Rate for Payer: UMR Bronson Commercial |
$18.53
|
| Rate for Payer: UMR Bronson Commercial |
$18.00
|
| Rate for Payer: UMR Bronson Commercial |
$15.27
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: UMR Bronson Commercial |
$30.47
|
| Rate for Payer: UMR Bronson Commercial |
$59.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.54
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.14
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Aetna American Axle |
$6.59
|
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna American Axle |
$6.38
|
| Rate for Payer: Aetna American Axle |
$51.02
|
| Rate for Payer: Aetna American Axle |
$47.45
|
| Rate for Payer: Aetna American Axle |
$28.92
|
| Rate for Payer: Aetna American Axle |
$25.22
|
| Rate for Payer: Aetna American Axle |
$22.56
|
| Rate for Payer: Aetna American Axle |
$8.69
|
| Rate for Payer: Aetna American Axle |
$12.06
|
| Rate for Payer: Aetna American Axle |
$20.92
|
| Rate for Payer: Aetna American Axle |
$15.28
|
| Rate for Payer: Aetna American Axle |
$15.11
|
| Rate for Payer: Aetna American Axle |
$14.77
|
| Rate for Payer: Aetna American Axle |
$12.51
|
| Rate for Payer: Aetna American Axle |
$12.15
|
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna Commercial |
$11.36
|
| Rate for Payer: Aetna Commercial |
$15.77
|
| Rate for Payer: Aetna Commercial |
$8.34
|
| Rate for Payer: Aetna Commercial |
$8.62
|
| Rate for Payer: Aetna Commercial |
$66.72
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Commercial |
$37.82
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$32.98
|
| Rate for Payer: Aetna Commercial |
$19.75
|
| Rate for Payer: Aetna Commercial |
$29.50
|
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Commercial |
$27.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.38
|
| Rate for Payer: Cash Price |
$25.75
|
| Rate for Payer: Cash Price |
$8.11
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Cash Price |
$14.84
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cash Price |
$18.59
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cash Price |
$27.77
|
| Rate for Payer: Cash Price |
$31.04
|
| Rate for Payer: Cash Price |
$7.85
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Cofinity Commercial |
$8.44
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Cofinity Commercial |
$16.07
|
| Rate for Payer: Cofinity Commercial |
$67.51
|
| Rate for Payer: Cofinity Commercial |
$54.95
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$8.72
|
| Rate for Payer: Cofinity Commercial |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$15.95
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Cofinity Commercial |
$51.10
|
| Rate for Payer: Cofinity Commercial |
$16.27
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$9.36
|
| Rate for Payer: Cofinity Commercial |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$31.15
|
| Rate for Payer: Cofinity Commercial |
$22.53
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$33.37
|
| Rate for Payer: Cofinity Commercial |
$27.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.60
|
| Rate for Payer: Healthscope Commercial |
$12.03
|
| Rate for Payer: Healthscope Commercial |
$28.97
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$20.92
|
| Rate for Payer: Healthscope Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$9.13
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Healthscope Commercial |
$31.24
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Healthscope Commercial |
$34.92
|
| Rate for Payer: Healthscope Commercial |
$70.65
|
| Rate for Payer: Healthscope Commercial |
$8.83
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.34
|
| Rate for Payer: PHP Commercial |
$15.77
|
| Rate for Payer: PHP Commercial |
$19.75
|
| Rate for Payer: PHP Commercial |
$37.82
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$32.98
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: PHP Commercial |
$8.34
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Commercial |
$11.36
|
| Rate for Payer: PHP Commercial |
$66.72
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: PHP Commercial |
$27.36
|
| Rate for Payer: PHP Commercial |
$8.62
|
| Rate for Payer: PHP Commercial |
$29.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.10
|
| Rate for Payer: Priority Health SBD |
$6.18
|
| Rate for Payer: Priority Health SBD |
$21.87
|
| Rate for Payer: Priority Health SBD |
$8.42
|
| Rate for Payer: Priority Health SBD |
$24.44
|
| Rate for Payer: Priority Health SBD |
$14.31
|
| Rate for Payer: Priority Health SBD |
$11.77
|
| Rate for Payer: Priority Health SBD |
$12.12
|
| Rate for Payer: Priority Health SBD |
$6.39
|
| Rate for Payer: Priority Health SBD |
$14.64
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$20.28
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: Priority Health SBD |
$49.46
|
| Rate for Payer: Priority Health SBD |
$28.04
|
| Rate for Payer: Priority Health SBD |
$45.99
|
| Rate for Payer: Priority Health SBD |
$11.69
|
| Rate for Payer: UMR Bronson Commercial |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$4.46
|
| Rate for Payer: UMR Bronson Commercial |
$14.16
|
| Rate for Payer: UMR Bronson Commercial |
$17.07
|
| Rate for Payer: UMR Bronson Commercial |
$10.34
|
| Rate for Payer: UMR Bronson Commercial |
$10.23
|
| Rate for Payer: UMR Bronson Commercial |
$15.27
|
| Rate for Payer: UMR Bronson Commercial |
$19.58
|
| Rate for Payer: UMR Bronson Commercial |
$10.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: UMR Bronson Commercial |
$8.22
|
| Rate for Payer: UMR Bronson Commercial |
$34.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.16
|
| Rate for Payer: UMR Bronson Commercial |
$5.88
|
| Rate for Payer: UMR Bronson Commercial |
$4.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.88
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$33.38
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
112217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Aetna American Axle |
$21.70
|
| Rate for Payer: Aetna Commercial |
$28.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$28.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.70
|
| Rate for Payer: Healthscope Commercial |
$30.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.37
|
| Rate for Payer: PHP Commercial |
$28.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.37
|
| Rate for Payer: Priority Health SBD |
$21.03
|
| Rate for Payer: UMR Bronson Commercial |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.04
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,978.84
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2,680.96 |
| Rate for Payer: Aetna American Axle |
$1,936.25
|
| Rate for Payer: Aetna Commercial |
$2,532.01
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,936.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.43
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$2,383.07
|
| Rate for Payer: Cash Price |
$2,383.07
|
| Rate for Payer: Cofinity Commercial |
$2,085.19
|
| Rate for Payer: Cofinity Commercial |
$2,561.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$2,680.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,085.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,234.13
|
| Rate for Payer: Mclaren Medicaid |
$0.63
|
| Rate for Payer: Mclaren Medicare |
$1.15
|
| Rate for Payer: Meridian Medicaid |
$0.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,532.01
|
| Rate for Payer: PACE Medicare |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$2,532.01
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,085.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.31
|
| Rate for Payer: Priority Health Medicare |
$1.15
|
| Rate for Payer: Priority Health Narrow Network |
$2.65
|
| Rate for Payer: Priority Health SBD |
$1,876.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.15
|
| Rate for Payer: UHC Medicare Advantage |
$1.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,102.17
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,234.13
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,978.84
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,310.69 |
| Max. Negotiated Rate |
$2,680.96 |
| Rate for Payer: Aetna American Axle |
$1,936.25
|
| Rate for Payer: Aetna Commercial |
$2,532.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,936.25
|
| Rate for Payer: Cash Price |
$2,383.07
|
| Rate for Payer: Cofinity Commercial |
$2,085.19
|
| Rate for Payer: Cofinity Commercial |
$2,561.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.07
|
| Rate for Payer: Healthscope Commercial |
$2,680.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,085.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,234.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,532.01
|
| Rate for Payer: PHP Commercial |
$2,532.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,085.19
|
| Rate for Payer: Priority Health SBD |
$1,876.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,310.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,234.13
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,694.63
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,505.64 |
| Max. Negotiated Rate |
$5,125.17 |
| Rate for Payer: Aetna American Axle |
$3,701.51
|
| Rate for Payer: Aetna Commercial |
$4,840.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,701.51
|
| Rate for Payer: Cash Price |
$4,555.70
|
| Rate for Payer: Cofinity Commercial |
$3,986.24
|
| Rate for Payer: Cofinity Commercial |
$4,897.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,555.70
|
| Rate for Payer: Healthscope Commercial |
$5,125.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,986.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,270.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,840.44
|
| Rate for Payer: PHP Commercial |
$4,840.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,986.24
|
| Rate for Payer: Priority Health SBD |
$3,587.62
|
| Rate for Payer: UMR Bronson Commercial |
$2,505.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,270.97
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,694.63
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$5,125.17 |
| Rate for Payer: Aetna American Axle |
$3,701.51
|
| Rate for Payer: Aetna Commercial |
$4,840.44
|
| Rate for Payer: Aetna Medicare |
$19.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,701.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.58
|
| Rate for Payer: BCBS Complete |
$10.83
|
| Rate for Payer: BCBS MAPPO |
$18.86
|
| Rate for Payer: BCBS Trust/PPO |
$60.93
|
| Rate for Payer: BCN Medicare Advantage |
$18.86
|
| Rate for Payer: Cash Price |
$4,555.70
|
| Rate for Payer: Cash Price |
$4,555.70
|
| Rate for Payer: Cofinity Commercial |
$3,986.24
|
| Rate for Payer: Cofinity Commercial |
$4,897.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,555.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$5,125.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,986.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,270.97
|
| Rate for Payer: Mclaren Medicaid |
$10.32
|
| Rate for Payer: Mclaren Medicare |
$18.86
|
| Rate for Payer: Meridian Medicaid |
$10.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,840.44
|
| Rate for Payer: PACE Medicare |
$17.92
|
| Rate for Payer: PACE SWMI |
$18.86
|
| Rate for Payer: PHP Commercial |
$4,840.44
|
| Rate for Payer: PHP Medicare Advantage |
$18.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,986.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.92
|
| Rate for Payer: Priority Health Medicare |
$18.86
|
| Rate for Payer: Priority Health Narrow Network |
$47.14
|
| Rate for Payer: Priority Health SBD |
$3,587.62
|
| Rate for Payer: Railroad Medicare Medicare |
$18.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.86
|
| Rate for Payer: UHC Medicare Advantage |
$19.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,107.01
|
| Rate for Payer: VA VA |
$18.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,270.97
|
|
|
FERRIC SUBSULFATE 1.04 GM TOPICAL PASTE
|
Facility
|
IP
|
$83.99
|
|
|
Service Code
|
NDC 48783-112-08
|
| Hospital Charge Code |
155166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna American Axle |
$54.59
|
| Rate for Payer: Aetna Commercial |
$71.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.59
|
| Rate for Payer: Cash Price |
$67.19
|
| Rate for Payer: Cofinity Commercial |
$58.79
|
| Rate for Payer: Cofinity Commercial |
$72.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.19
|
| Rate for Payer: Healthscope Commercial |
$75.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.39
|
| Rate for Payer: PHP Commercial |
$71.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.79
|
| Rate for Payer: Priority Health SBD |
$52.91
|
| Rate for Payer: UMR Bronson Commercial |
$36.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.99
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
IP
|
$56.57
|
|
|
Service Code
|
NDC 59365-6065-1
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$50.91 |
| Rate for Payer: Aetna American Axle |
$36.77
|
| Rate for Payer: Aetna Commercial |
$48.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.77
|
| Rate for Payer: Cash Price |
$45.26
|
| Rate for Payer: Cofinity Commercial |
$39.60
|
| Rate for Payer: Cofinity Commercial |
$48.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.26
|
| Rate for Payer: Healthscope Commercial |
$50.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.08
|
| Rate for Payer: PHP Commercial |
$48.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.60
|
| Rate for Payer: Priority Health SBD |
$35.64
|
| Rate for Payer: UMR Bronson Commercial |
$24.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.43
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
IP
|
$56.57
|
|
|
Service Code
|
NDC 59365-6065-0
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$50.91 |
| Rate for Payer: Aetna American Axle |
$36.77
|
| Rate for Payer: Aetna Commercial |
$48.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.77
|
| Rate for Payer: Cash Price |
$45.26
|
| Rate for Payer: Cofinity Commercial |
$39.60
|
| Rate for Payer: Cofinity Commercial |
$48.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.26
|
| Rate for Payer: Healthscope Commercial |
$50.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.08
|
| Rate for Payer: PHP Commercial |
$48.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.60
|
| Rate for Payer: Priority Health SBD |
$35.64
|
| Rate for Payer: UMR Bronson Commercial |
$24.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.43
|
|
|
FERROUS FUMARATE 324 MG (106 MG IRON) TABLET
|
Facility
|
IP
|
$378.35
|
|
|
Service Code
|
NDC 5199118142
|
| Hospital Charge Code |
3063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.47 |
| Max. Negotiated Rate |
$340.52 |
| Rate for Payer: Aetna American Axle |
$245.93
|
| Rate for Payer: Aetna Commercial |
$321.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.93
|
| Rate for Payer: Cash Price |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$264.84
|
| Rate for Payer: Cofinity Commercial |
$325.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.68
|
| Rate for Payer: Healthscope Commercial |
$340.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.60
|
| Rate for Payer: PHP Commercial |
$321.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.84
|
| Rate for Payer: Priority Health SBD |
$238.36
|
| Rate for Payer: UMR Bronson Commercial |
$166.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.76
|
|
|
FERROUS FUMARATE 324 MG (106 MG IRON) TABLET
|
Facility
|
IP
|
$390.10
|
|
|
Service Code
|
NDC 6025818201
|
| Hospital Charge Code |
3063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.64 |
| Max. Negotiated Rate |
$351.09 |
| Rate for Payer: Aetna American Axle |
$253.56
|
| Rate for Payer: Aetna Commercial |
$331.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.56
|
| Rate for Payer: Cash Price |
$312.08
|
| Rate for Payer: Cofinity Commercial |
$273.07
|
| Rate for Payer: Cofinity Commercial |
$335.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.08
|
| Rate for Payer: Healthscope Commercial |
$351.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$273.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.58
|
| Rate for Payer: PHP Commercial |
$331.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.07
|
| Rate for Payer: Priority Health SBD |
$245.76
|
| Rate for Payer: UMR Bronson Commercial |
$171.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.58
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
IP
|
$64.63
|
|
|
Service Code
|
NDC 5038362750
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$58.17 |
| Rate for Payer: Aetna American Axle |
$42.01
|
| Rate for Payer: Aetna Commercial |
$54.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.01
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Cofinity Commercial |
$55.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.70
|
| Rate for Payer: Healthscope Commercial |
$58.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.94
|
| Rate for Payer: PHP Commercial |
$54.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.24
|
| Rate for Payer: Priority Health SBD |
$40.72
|
| Rate for Payer: UMR Bronson Commercial |
$28.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.47
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
IP
|
$139.83
|
|
|
Service Code
|
NDC 5483801150
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.53 |
| Max. Negotiated Rate |
$125.85 |
| Rate for Payer: Aetna American Axle |
$90.89
|
| Rate for Payer: Aetna Commercial |
$118.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.89
|
| Rate for Payer: Cash Price |
$111.86
|
| Rate for Payer: Cofinity Commercial |
$120.25
|
| Rate for Payer: Cofinity Commercial |
$97.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.86
|
| Rate for Payer: Healthscope Commercial |
$125.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$118.86
|
| Rate for Payer: PHP Commercial |
$118.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.88
|
| Rate for Payer: Priority Health SBD |
$88.09
|
| Rate for Payer: UMR Bronson Commercial |
$61.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.87
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 3932805750
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.04
|
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.04
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.90
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.51
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.98
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIXIR
|
Facility
|
IP
|
$73.79
|
|
|
Service Code
|
NDC 5038377816
|
| Hospital Charge Code |
179529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna American Axle |
$47.96
|
| Rate for Payer: Aetna Commercial |
$62.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.96
|
| Rate for Payer: Cash Price |
$59.03
|
| Rate for Payer: Cofinity Commercial |
$51.65
|
| Rate for Payer: Cofinity Commercial |
$63.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.03
|
| Rate for Payer: Healthscope Commercial |
$66.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.72
|
| Rate for Payer: PHP Commercial |
$62.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.65
|
| Rate for Payer: Priority Health SBD |
$46.49
|
| Rate for Payer: UMR Bronson Commercial |
$32.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.34
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
NDC 121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna American Axle |
$7.59
|
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.18
|
| Rate for Payer: Priority Health SBD |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$5.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1.47
|
|
|
Service Code
|
NDC 245010889
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna American Axle |
$0.96
|
| Rate for Payer: Aetna Commercial |
$1.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.03
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.25
|
| Rate for Payer: PHP Commercial |
$1.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.03
|
| Rate for Payer: Priority Health SBD |
$0.93
|
| Rate for Payer: UMR Bronson Commercial |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.10
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$119.90
|
|
|
Service Code
|
NDC 245010811
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.76 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna American Axle |
$77.94
|
| Rate for Payer: Aetna Commercial |
$101.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.94
|
| Rate for Payer: Cash Price |
$95.92
|
| Rate for Payer: Cofinity Commercial |
$103.11
|
| Rate for Payer: Cofinity Commercial |
$83.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.92
|
| Rate for Payer: Healthscope Commercial |
$107.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.92
|
| Rate for Payer: PHP Commercial |
$101.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.93
|
| Rate for Payer: Priority Health SBD |
$75.54
|
| Rate for Payer: UMR Bronson Commercial |
$52.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.92
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
NDC 6936716620
|
| Hospital Charge Code |
3077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna American Axle |
$128.70
|
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.70
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$170.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.40
|
| Rate for Payer: Healthscope Commercial |
$178.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.30
|
| Rate for Payer: PHP Commercial |
$168.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.60
|
| Rate for Payer: Priority Health SBD |
$124.74
|
| Rate for Payer: UMR Bronson Commercial |
$87.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.50
|
|
