|
GABAPENTIN 600 MG TABLET
|
Facility
|
IP
|
$441.80
|
|
|
Service Code
|
NDC 68462-126-01
|
| Hospital Charge Code |
25855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Aetna American Axle |
$287.17
|
| Rate for Payer: Aetna Commercial |
$375.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.17
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$397.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$375.53
|
| Rate for Payer: PHP Commercial |
$375.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.26
|
| Rate for Payer: Priority Health SBD |
$278.33
|
| Rate for Payer: UMR Bronson Commercial |
$194.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.35
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$32.10
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna American Axle |
$41.73
|
| Rate for Payer: Aetna American Axle |
$83.46
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Commercial |
$109.14
|
| Rate for Payer: Aetna Commercial |
$54.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.73
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cash Price |
$102.72
|
| Rate for Payer: Cash Price |
$51.36
|
| Rate for Payer: Cofinity Commercial |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$110.42
|
| Rate for Payer: Cofinity Commercial |
$89.88
|
| Rate for Payer: Cofinity Commercial |
$55.21
|
| Rate for Payer: Cofinity Commercial |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.36
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Healthscope Commercial |
$57.78
|
| Rate for Payer: Healthscope Commercial |
$115.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.57
|
| Rate for Payer: PHP Commercial |
$54.57
|
| Rate for Payer: PHP Commercial |
$109.14
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.94
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health SBD |
$80.89
|
| Rate for Payer: Priority Health SBD |
$40.45
|
| Rate for Payer: UMR Bronson Commercial |
$14.12
|
| Rate for Payer: UMR Bronson Commercial |
$56.50
|
| Rate for Payer: UMR Bronson Commercial |
$28.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.15
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
HCPCS A9578
|
| Hospital Charge Code |
41137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$282.48 |
| Max. Negotiated Rate |
$577.80 |
| Rate for Payer: Aetna American Axle |
$417.30
|
| Rate for Payer: Aetna Commercial |
$545.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.30
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cofinity Commercial |
$449.40
|
| Rate for Payer: Cofinity Commercial |
$552.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.60
|
| Rate for Payer: Healthscope Commercial |
$577.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$449.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$545.70
|
| Rate for Payer: PHP Commercial |
$545.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.40
|
| Rate for Payer: Priority Health SBD |
$404.46
|
| Rate for Payer: UMR Bronson Commercial |
$282.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.50
|
|
|
GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.50
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
152500
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Aetna American Axle |
$18.52
|
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.52
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$24.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.80
|
| Rate for Payer: Healthscope Commercial |
$25.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.22
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.95
|
| Rate for Payer: Priority Health SBD |
$17.96
|
| Rate for Payer: UMR Bronson Commercial |
$12.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.38
|
|
|
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$474.44
|
|
|
Service Code
|
HCPCS A9575
|
| Hospital Charge Code |
167582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$208.75 |
| Max. Negotiated Rate |
$427.00 |
| Rate for Payer: Aetna American Axle |
$308.39
|
| Rate for Payer: Aetna Commercial |
$403.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.39
|
| Rate for Payer: Cash Price |
$379.55
|
| Rate for Payer: Cofinity Commercial |
$332.11
|
| Rate for Payer: Cofinity Commercial |
$408.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.55
|
| Rate for Payer: Healthscope Commercial |
$427.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.27
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.11
|
| Rate for Payer: Priority Health SBD |
$298.90
|
| Rate for Payer: UMR Bronson Commercial |
$208.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.83
|
|
|
GADOTERIDOL 279.3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$285.15
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
10100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.47 |
| Max. Negotiated Rate |
$256.64 |
| Rate for Payer: Aetna American Axle |
$185.35
|
| Rate for Payer: Aetna Commercial |
$242.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.35
|
| Rate for Payer: Cash Price |
$228.12
|
| Rate for Payer: Cofinity Commercial |
$199.60
|
| Rate for Payer: Cofinity Commercial |
$245.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.12
|
| Rate for Payer: Healthscope Commercial |
$256.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.38
|
| Rate for Payer: PHP Commercial |
$242.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.60
|
| Rate for Payer: Priority Health SBD |
$179.64
|
| Rate for Payer: UMR Bronson Commercial |
$125.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.86
|
|
|
GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$631.68
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
93574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$277.94 |
| Max. Negotiated Rate |
$568.51 |
| Rate for Payer: Aetna American Axle |
$410.59
|
| Rate for Payer: Aetna Commercial |
$536.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.59
|
| Rate for Payer: Cash Price |
$505.34
|
| Rate for Payer: Cofinity Commercial |
$442.18
|
| Rate for Payer: Cofinity Commercial |
$543.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.34
|
| Rate for Payer: Healthscope Commercial |
$568.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$536.93
|
| Rate for Payer: PHP Commercial |
$536.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.18
|
| Rate for Payer: Priority Health SBD |
$397.96
|
| Rate for Payer: UMR Bronson Commercial |
$277.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.76
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
IP
|
$238.83
|
|
|
Service Code
|
NDC 70436-004-06
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$214.95 |
| Rate for Payer: Aetna American Axle |
$155.24
|
| Rate for Payer: Aetna Commercial |
$203.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.24
|
| Rate for Payer: Cash Price |
$191.06
|
| Rate for Payer: Cofinity Commercial |
$167.18
|
| Rate for Payer: Cofinity Commercial |
$205.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.06
|
| Rate for Payer: Healthscope Commercial |
$214.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.01
|
| Rate for Payer: PHP Commercial |
$203.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.18
|
| Rate for Payer: Priority Health SBD |
$150.46
|
| Rate for Payer: UMR Bronson Commercial |
$105.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.12
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
IP
|
$175.11
|
|
|
Service Code
|
NDC 57237-049-60
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.05 |
| Max. Negotiated Rate |
$157.60 |
| Rate for Payer: Aetna American Axle |
$113.82
|
| Rate for Payer: Aetna Commercial |
$148.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.82
|
| Rate for Payer: Cash Price |
$140.09
|
| Rate for Payer: Cofinity Commercial |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$150.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.09
|
| Rate for Payer: Healthscope Commercial |
$157.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.84
|
| Rate for Payer: PHP Commercial |
$148.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.58
|
| Rate for Payer: Priority Health SBD |
$110.32
|
| Rate for Payer: UMR Bronson Commercial |
$77.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.33
|
|
|
GALANTAMINE ER 24 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$473.09
|
|
|
Service Code
|
NDC 0591-3498-30
|
| Hospital Charge Code |
41140
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.16 |
| Max. Negotiated Rate |
$425.78 |
| Rate for Payer: Aetna American Axle |
$307.51
|
| Rate for Payer: Aetna Commercial |
$402.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.51
|
| Rate for Payer: Cash Price |
$378.47
|
| Rate for Payer: Cofinity Commercial |
$331.16
|
| Rate for Payer: Cofinity Commercial |
$406.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.47
|
| Rate for Payer: Healthscope Commercial |
$425.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.13
|
| Rate for Payer: PHP Commercial |
$402.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.16
|
| Rate for Payer: Priority Health SBD |
$298.05
|
| Rate for Payer: UMR Bronson Commercial |
$208.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.82
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$200.88
|
|
|
Service Code
|
NDC 65862-744-30
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.39 |
| Max. Negotiated Rate |
$180.79 |
| Rate for Payer: Aetna American Axle |
$130.57
|
| Rate for Payer: Aetna Commercial |
$170.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.57
|
| Rate for Payer: Cash Price |
$160.70
|
| Rate for Payer: Cofinity Commercial |
$140.62
|
| Rate for Payer: Cofinity Commercial |
$172.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.70
|
| Rate for Payer: Healthscope Commercial |
$180.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.75
|
| Rate for Payer: PHP Commercial |
$170.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.62
|
| Rate for Payer: Priority Health SBD |
$126.55
|
| Rate for Payer: UMR Bronson Commercial |
$88.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.66
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$476.08
|
|
|
Service Code
|
NDC 0591-3496-30
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.48 |
| Max. Negotiated Rate |
$428.47 |
| Rate for Payer: Aetna American Axle |
$309.45
|
| Rate for Payer: Aetna Commercial |
$404.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.45
|
| Rate for Payer: Cash Price |
$380.86
|
| Rate for Payer: Cofinity Commercial |
$333.26
|
| Rate for Payer: Cofinity Commercial |
$409.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.86
|
| Rate for Payer: Healthscope Commercial |
$428.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.67
|
| Rate for Payer: PHP Commercial |
$404.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.26
|
| Rate for Payer: Priority Health SBD |
$299.93
|
| Rate for Payer: UMR Bronson Commercial |
$209.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.06
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$126.87
|
|
|
Service Code
|
NDC 47335-835-83
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.82 |
| Max. Negotiated Rate |
$114.18 |
| Rate for Payer: Aetna American Axle |
$82.47
|
| Rate for Payer: Aetna Commercial |
$107.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.47
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cofinity Commercial |
$109.11
|
| Rate for Payer: Cofinity Commercial |
$88.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.50
|
| Rate for Payer: Healthscope Commercial |
$114.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.84
|
| Rate for Payer: PHP Commercial |
$107.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.81
|
| Rate for Payer: Priority Health SBD |
$79.93
|
| Rate for Payer: UMR Bronson Commercial |
$55.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.15
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$528.14
|
|
|
Service Code
|
NDC 10147-0891-3
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$475.33 |
| Rate for Payer: Aetna American Axle |
$343.29
|
| Rate for Payer: Aetna Commercial |
$448.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.29
|
| Rate for Payer: Cash Price |
$422.51
|
| Rate for Payer: Cofinity Commercial |
$369.70
|
| Rate for Payer: Cofinity Commercial |
$454.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.51
|
| Rate for Payer: Healthscope Commercial |
$475.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.92
|
| Rate for Payer: PHP Commercial |
$448.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.70
|
| Rate for Payer: Priority Health SBD |
$332.73
|
| Rate for Payer: UMR Bronson Commercial |
$232.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.10
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$487.52
|
|
|
Service Code
|
NDC 0378-8105-93
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.51 |
| Max. Negotiated Rate |
$438.77 |
| Rate for Payer: Aetna American Axle |
$316.89
|
| Rate for Payer: Aetna Commercial |
$414.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.89
|
| Rate for Payer: Cash Price |
$390.02
|
| Rate for Payer: Cofinity Commercial |
$341.26
|
| Rate for Payer: Cofinity Commercial |
$419.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.02
|
| Rate for Payer: Healthscope Commercial |
$438.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$365.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$414.39
|
| Rate for Payer: PHP Commercial |
$414.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.26
|
| Rate for Payer: Priority Health SBD |
$307.14
|
| Rate for Payer: UMR Bronson Commercial |
$214.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$365.64
|
|
|
GAMMAKED 10 GRAM/100 ML (10 %) INJECTION SOLUTION
|
Facility
|
IP
|
$3,917.71
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
153286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,723.79 |
| Max. Negotiated Rate |
$3,525.94 |
| Rate for Payer: Aetna American Axle |
$2,546.51
|
| Rate for Payer: Aetna Commercial |
$3,330.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,546.51
|
| Rate for Payer: Cash Price |
$3,134.17
|
| Rate for Payer: Cofinity Commercial |
$2,742.40
|
| Rate for Payer: Cofinity Commercial |
$3,369.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,134.17
|
| Rate for Payer: Healthscope Commercial |
$3,525.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,742.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,938.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,330.05
|
| Rate for Payer: PHP Commercial |
$3,330.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,742.40
|
| Rate for Payer: Priority Health SBD |
$2,468.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,723.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,938.28
|
|
|
GAMMAKED 10 GRAM/100 ML (10 %) INJECTION SOLUTION
|
Facility
|
OP
|
$3,917.71
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
153286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$3,525.94 |
| Rate for Payer: Aetna American Axle |
$2,546.51
|
| Rate for Payer: Aetna Commercial |
$3,330.05
|
| Rate for Payer: Aetna Medicare |
$51.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,546.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.23
|
| Rate for Payer: BCBS Complete |
$28.60
|
| Rate for Payer: BCBS MAPPO |
$49.79
|
| Rate for Payer: BCBS Trust/PPO |
$160.87
|
| Rate for Payer: BCN Medicare Advantage |
$49.79
|
| Rate for Payer: Cash Price |
$3,134.17
|
| Rate for Payer: Cash Price |
$3,134.17
|
| Rate for Payer: Cofinity Commercial |
$2,742.40
|
| Rate for Payer: Cofinity Commercial |
$3,369.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,134.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.79
|
| Rate for Payer: Healthscope Commercial |
$3,525.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,742.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,938.28
|
| Rate for Payer: Mclaren Medicaid |
$27.23
|
| Rate for Payer: Mclaren Medicare |
$49.79
|
| Rate for Payer: Meridian Medicaid |
$28.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,330.05
|
| Rate for Payer: PACE Medicare |
$47.30
|
| Rate for Payer: PACE SWMI |
$49.79
|
| Rate for Payer: PHP Commercial |
$3,330.05
|
| Rate for Payer: PHP Medicare Advantage |
$49.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,742.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.69
|
| Rate for Payer: Priority Health Medicare |
$49.79
|
| Rate for Payer: Priority Health Narrow Network |
$115.75
|
| Rate for Payer: Priority Health SBD |
$2,468.16
|
| Rate for Payer: Railroad Medicare Medicare |
$49.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.79
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,449.55
|
| Rate for Payer: VA VA |
$49.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,938.28
|
|
|
GAMMAKED 20 GRAM/200 ML (10 %) INJECTION SOLUTION
|
Facility
|
OP
|
$7,835.42
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
153287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$7,051.88 |
| Rate for Payer: Aetna American Axle |
$5,093.02
|
| Rate for Payer: Aetna Commercial |
$6,660.11
|
| Rate for Payer: Aetna Medicare |
$51.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,093.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.23
|
| Rate for Payer: BCBS Complete |
$28.60
|
| Rate for Payer: BCBS MAPPO |
$49.79
|
| Rate for Payer: BCBS Trust/PPO |
$160.87
|
| Rate for Payer: BCN Medicare Advantage |
$49.79
|
| Rate for Payer: Cash Price |
$6,268.34
|
| Rate for Payer: Cash Price |
$6,268.34
|
| Rate for Payer: Cofinity Commercial |
$5,484.79
|
| Rate for Payer: Cofinity Commercial |
$6,738.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,268.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.79
|
| Rate for Payer: Healthscope Commercial |
$7,051.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,484.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,876.56
|
| Rate for Payer: Mclaren Medicaid |
$27.23
|
| Rate for Payer: Mclaren Medicare |
$49.79
|
| Rate for Payer: Meridian Medicaid |
$28.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,660.11
|
| Rate for Payer: PACE Medicare |
$47.30
|
| Rate for Payer: PACE SWMI |
$49.79
|
| Rate for Payer: PHP Commercial |
$6,660.11
|
| Rate for Payer: PHP Medicare Advantage |
$49.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,484.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.69
|
| Rate for Payer: Priority Health Medicare |
$49.79
|
| Rate for Payer: Priority Health Narrow Network |
$115.75
|
| Rate for Payer: Priority Health SBD |
$4,936.31
|
| Rate for Payer: Railroad Medicare Medicare |
$49.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.79
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UMR Bronson Commercial |
$2,899.11
|
| Rate for Payer: VA VA |
$49.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,876.56
|
|
|
GAMMAKED 5 GRAM/50 ML (10 %) INJECTION SOLUTION
|
Facility
|
IP
|
$1,958.86
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
153285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$861.90 |
| Max. Negotiated Rate |
$1,762.97 |
| Rate for Payer: Aetna American Axle |
$1,273.26
|
| Rate for Payer: Aetna Commercial |
$1,665.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.26
|
| Rate for Payer: Cash Price |
$1,567.09
|
| Rate for Payer: Cofinity Commercial |
$1,371.20
|
| Rate for Payer: Cofinity Commercial |
$1,684.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.09
|
| Rate for Payer: Healthscope Commercial |
$1,762.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,371.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,665.03
|
| Rate for Payer: PHP Commercial |
$1,665.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.20
|
| Rate for Payer: Priority Health SBD |
$1,234.08
|
| Rate for Payer: UMR Bronson Commercial |
$861.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.14
|
|
|
GAMMAKED 5 GRAM/50 ML (10 %) INJECTION SOLUTION
|
Facility
|
OP
|
$1,958.86
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
153285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$1,762.97 |
| Rate for Payer: Aetna American Axle |
$1,273.26
|
| Rate for Payer: Aetna Commercial |
$1,665.03
|
| Rate for Payer: Aetna Medicare |
$51.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.23
|
| Rate for Payer: BCBS Complete |
$28.60
|
| Rate for Payer: BCBS MAPPO |
$49.79
|
| Rate for Payer: BCBS Trust/PPO |
$160.87
|
| Rate for Payer: BCN Medicare Advantage |
$49.79
|
| Rate for Payer: Cash Price |
$1,567.09
|
| Rate for Payer: Cash Price |
$1,567.09
|
| Rate for Payer: Cofinity Commercial |
$1,371.20
|
| Rate for Payer: Cofinity Commercial |
$1,684.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,567.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.79
|
| Rate for Payer: Healthscope Commercial |
$1,762.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,371.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,469.14
|
| Rate for Payer: Mclaren Medicaid |
$27.23
|
| Rate for Payer: Mclaren Medicare |
$49.79
|
| Rate for Payer: Meridian Medicaid |
$28.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,665.03
|
| Rate for Payer: PACE Medicare |
$47.30
|
| Rate for Payer: PACE SWMI |
$49.79
|
| Rate for Payer: PHP Commercial |
$1,665.03
|
| Rate for Payer: PHP Medicare Advantage |
$49.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.69
|
| Rate for Payer: Priority Health Medicare |
$49.79
|
| Rate for Payer: Priority Health Narrow Network |
$115.75
|
| Rate for Payer: Priority Health SBD |
$1,234.08
|
| Rate for Payer: Railroad Medicare Medicare |
$49.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.79
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UMR Bronson Commercial |
$724.78
|
| Rate for Payer: VA VA |
$49.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,469.14
|
|
|
GAMUNEX-C 10 GRAM/100 ML (10 %) INJECTION SOLUTION
|
Facility
|
OP
|
$4,114.19
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107780
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$3,702.77 |
| Rate for Payer: Aetna American Axle |
$2,674.22
|
| Rate for Payer: Aetna Commercial |
$3,497.06
|
| Rate for Payer: Aetna Medicare |
$51.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,674.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.23
|
| Rate for Payer: BCBS Complete |
$28.60
|
| Rate for Payer: BCBS MAPPO |
$49.79
|
| Rate for Payer: BCBS Trust/PPO |
$160.87
|
| Rate for Payer: BCN Medicare Advantage |
$49.79
|
| Rate for Payer: Cash Price |
$3,291.35
|
| Rate for Payer: Cash Price |
$3,291.35
|
| Rate for Payer: Cofinity Commercial |
$2,879.93
|
| Rate for Payer: Cofinity Commercial |
$3,538.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,291.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.79
|
| Rate for Payer: Healthscope Commercial |
$3,702.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,879.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,085.64
|
| Rate for Payer: Mclaren Medicaid |
$27.23
|
| Rate for Payer: Mclaren Medicare |
$49.79
|
| Rate for Payer: Meridian Medicaid |
$28.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,497.06
|
| Rate for Payer: PACE Medicare |
$47.30
|
| Rate for Payer: PACE SWMI |
$49.79
|
| Rate for Payer: PHP Commercial |
$3,497.06
|
| Rate for Payer: PHP Medicare Advantage |
$49.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,879.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.69
|
| Rate for Payer: Priority Health Medicare |
$49.79
|
| Rate for Payer: Priority Health Narrow Network |
$115.75
|
| Rate for Payer: Priority Health SBD |
$2,591.94
|
| Rate for Payer: Railroad Medicare Medicare |
$49.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.79
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,522.25
|
| Rate for Payer: VA VA |
$49.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,085.64
|
|
|
GAMUNEX-C 10 GRAM/100 ML (10 %) INJECTION SOLUTION
|
Facility
|
IP
|
$4,114.19
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107780
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,810.24 |
| Max. Negotiated Rate |
$3,702.77 |
| Rate for Payer: Aetna American Axle |
$2,674.22
|
| Rate for Payer: Aetna Commercial |
$3,497.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,674.22
|
| Rate for Payer: Cash Price |
$3,291.35
|
| Rate for Payer: Cofinity Commercial |
$2,879.93
|
| Rate for Payer: Cofinity Commercial |
$3,538.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,291.35
|
| Rate for Payer: Healthscope Commercial |
$3,702.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,879.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,085.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,497.06
|
| Rate for Payer: PHP Commercial |
$3,497.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,879.93
|
| Rate for Payer: Priority Health SBD |
$2,591.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,810.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,085.64
|
|
|
GAMUNEX-C 2.5 GRAM/25 ML (10 %) INJECTION SOLUTION
|
Facility
|
IP
|
$1,028.55
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$452.56 |
| Max. Negotiated Rate |
$925.70 |
| Rate for Payer: Aetna American Axle |
$668.56
|
| Rate for Payer: Aetna Commercial |
$874.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$668.56
|
| Rate for Payer: Cash Price |
$822.84
|
| Rate for Payer: Cofinity Commercial |
$719.98
|
| Rate for Payer: Cofinity Commercial |
$884.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$822.84
|
| Rate for Payer: Healthscope Commercial |
$925.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$719.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$771.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$874.27
|
| Rate for Payer: PHP Commercial |
$874.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.98
|
| Rate for Payer: Priority Health SBD |
$647.99
|
| Rate for Payer: UMR Bronson Commercial |
$452.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$771.41
|
|
|
GAMUNEX-C 5 GRAM/50 ML (10 %) INJECTION SOLUTION
|
Facility
|
IP
|
$2,057.10
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$905.12 |
| Max. Negotiated Rate |
$1,851.39 |
| Rate for Payer: Aetna American Axle |
$1,337.12
|
| Rate for Payer: Aetna Commercial |
$1,748.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,337.12
|
| Rate for Payer: Cash Price |
$1,645.68
|
| Rate for Payer: Cofinity Commercial |
$1,439.97
|
| Rate for Payer: Cofinity Commercial |
$1,769.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,645.68
|
| Rate for Payer: Healthscope Commercial |
$1,851.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,439.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,542.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,748.54
|
| Rate for Payer: PHP Commercial |
$1,748.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.97
|
| Rate for Payer: Priority Health SBD |
$1,295.97
|
| Rate for Payer: UMR Bronson Commercial |
$905.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,542.82
|
|
|
GAMUNEX-C 5 GRAM/50 ML (10 %) INJECTION SOLUTION
|
Facility
|
OP
|
$2,057.10
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107778
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$1,851.39 |
| Rate for Payer: Aetna American Axle |
$1,337.12
|
| Rate for Payer: Aetna Commercial |
$1,748.54
|
| Rate for Payer: Aetna Medicare |
$51.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,337.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.23
|
| Rate for Payer: BCBS Complete |
$28.60
|
| Rate for Payer: BCBS MAPPO |
$49.79
|
| Rate for Payer: BCBS Trust/PPO |
$160.87
|
| Rate for Payer: BCN Medicare Advantage |
$49.79
|
| Rate for Payer: Cash Price |
$1,645.68
|
| Rate for Payer: Cash Price |
$1,645.68
|
| Rate for Payer: Cofinity Commercial |
$1,769.11
|
| Rate for Payer: Cofinity Commercial |
$1,439.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,645.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.79
|
| Rate for Payer: Healthscope Commercial |
$1,851.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,439.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,542.82
|
| Rate for Payer: Mclaren Medicaid |
$27.23
|
| Rate for Payer: Mclaren Medicare |
$49.79
|
| Rate for Payer: Meridian Medicaid |
$28.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,748.54
|
| Rate for Payer: PACE Medicare |
$47.30
|
| Rate for Payer: PACE SWMI |
$49.79
|
| Rate for Payer: PHP Commercial |
$1,748.54
|
| Rate for Payer: PHP Medicare Advantage |
$49.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.69
|
| Rate for Payer: Priority Health Medicare |
$49.79
|
| Rate for Payer: Priority Health Narrow Network |
$115.75
|
| Rate for Payer: Priority Health SBD |
$1,295.97
|
| Rate for Payer: Railroad Medicare Medicare |
$49.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.79
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: UMR Bronson Commercial |
$761.13
|
| Rate for Payer: VA VA |
$49.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,542.82
|
|
