|
DAPSONE 100 MG TABLET
|
Facility
|
OP
|
$132.63
|
|
|
Service Code
|
NDC 70954013610
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.07 |
| Max. Negotiated Rate |
$119.37 |
| Rate for Payer: Aetna American Axle |
$86.21
|
| Rate for Payer: Aetna Commercial |
$112.74
|
| Rate for Payer: Aetna Medicare |
$66.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.21
|
| Rate for Payer: BCBS Complete |
$53.05
|
| Rate for Payer: Cash Price |
$106.10
|
| Rate for Payer: Cofinity Advantage |
$92.84
|
| Rate for Payer: Cofinity Commercial |
$114.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.10
|
| Rate for Payer: Healthscope Commercial |
$119.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.47
|
| Rate for Payer: PHP Commercial |
$112.74
|
| Rate for Payer: Priority Health SBD |
$83.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.21
|
| Rate for Payer: UHC Core |
$69.10
|
| Rate for Payer: UHC Exchange |
$52.12
|
| Rate for Payer: UMR Bronson Commercial |
$49.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.47
|
|
|
DAPSONE 100 MG TABLET
|
Facility
|
IP
|
$132.63
|
|
|
Service Code
|
NDC 70954013610
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$119.37 |
| Rate for Payer: Aetna American Axle |
$86.21
|
| Rate for Payer: Aetna Commercial |
$112.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.21
|
| Rate for Payer: Cash Price |
$106.10
|
| Rate for Payer: Cofinity Advantage |
$92.84
|
| Rate for Payer: Cofinity Commercial |
$114.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.10
|
| Rate for Payer: Healthscope Commercial |
$119.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.47
|
| Rate for Payer: PHP Commercial |
$112.74
|
| Rate for Payer: Priority Health SBD |
$83.56
|
| Rate for Payer: UMR Bronson Commercial |
$58.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.47
|
|
|
DAPSONE 100 MG TABLET
|
Facility
|
OP
|
$289.05
|
|
|
Service Code
|
NDC 49938010130
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna Medicare |
$144.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Advantage |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.88
|
| Rate for Payer: UHC Core |
$150.60
|
| Rate for Payer: UHC Exchange |
$113.60
|
| Rate for Payer: UMR Bronson Commercial |
$106.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
DAPSONE 100 MG TABLET
|
Facility
|
IP
|
$250.98
|
|
|
Service Code
|
NDC 47781033431
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.43 |
| Max. Negotiated Rate |
$225.88 |
| Rate for Payer: Aetna American Axle |
$163.14
|
| Rate for Payer: Aetna Commercial |
$213.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.14
|
| Rate for Payer: Cash Price |
$200.78
|
| Rate for Payer: Cofinity Advantage |
$175.69
|
| Rate for Payer: Cofinity Commercial |
$215.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.78
|
| Rate for Payer: Healthscope Commercial |
$225.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.24
|
| Rate for Payer: PHP Commercial |
$213.33
|
| Rate for Payer: Priority Health SBD |
$158.12
|
| Rate for Payer: UMR Bronson Commercial |
$110.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.24
|
|
|
DAPSONE 100 MG TABLET
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 49938010130
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Advantage |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UMR Bronson Commercial |
$127.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$131.76
|
|
|
Service Code
|
NDC 64980056703
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.97 |
| Max. Negotiated Rate |
$118.58 |
| Rate for Payer: Aetna American Axle |
$85.64
|
| Rate for Payer: Aetna Commercial |
$112.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.64
|
| Rate for Payer: Cash Price |
$105.41
|
| Rate for Payer: Cofinity Advantage |
$92.23
|
| Rate for Payer: Cofinity Commercial |
$113.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.41
|
| Rate for Payer: Healthscope Commercial |
$118.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.82
|
| Rate for Payer: PHP Commercial |
$112.00
|
| Rate for Payer: Priority Health SBD |
$83.01
|
| Rate for Payer: UMR Bronson Commercial |
$57.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.82
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
OP
|
$131.76
|
|
|
Service Code
|
NDC 69367037830
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$118.58 |
| Rate for Payer: Aetna American Axle |
$85.64
|
| Rate for Payer: Aetna Commercial |
$112.00
|
| Rate for Payer: Aetna Medicare |
$65.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.64
|
| Rate for Payer: BCBS Complete |
$52.70
|
| Rate for Payer: Cash Price |
$105.41
|
| Rate for Payer: Cofinity Advantage |
$92.23
|
| Rate for Payer: Cofinity Commercial |
$113.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.41
|
| Rate for Payer: Healthscope Commercial |
$118.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.82
|
| Rate for Payer: PHP Commercial |
$112.00
|
| Rate for Payer: Priority Health SBD |
$83.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.64
|
| Rate for Payer: UHC Core |
$68.65
|
| Rate for Payer: UHC Exchange |
$51.78
|
| Rate for Payer: UMR Bronson Commercial |
$48.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.82
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
OP
|
$79.78
|
|
|
Service Code
|
NDC 70954013510
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$71.80 |
| Rate for Payer: Aetna American Axle |
$51.86
|
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: Aetna Medicare |
$39.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.86
|
| Rate for Payer: BCBS Complete |
$31.91
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cofinity Advantage |
$55.85
|
| Rate for Payer: Cofinity Commercial |
$68.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.82
|
| Rate for Payer: Healthscope Commercial |
$71.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.84
|
| Rate for Payer: PHP Commercial |
$67.81
|
| Rate for Payer: Priority Health SBD |
$50.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.86
|
| Rate for Payer: UHC Core |
$41.57
|
| Rate for Payer: UHC Exchange |
$31.35
|
| Rate for Payer: UMR Bronson Commercial |
$29.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.84
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$131.76
|
|
|
Service Code
|
NDC 69367037830
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.97 |
| Max. Negotiated Rate |
$118.58 |
| Rate for Payer: Aetna American Axle |
$85.64
|
| Rate for Payer: Aetna Commercial |
$112.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.64
|
| Rate for Payer: Cash Price |
$105.41
|
| Rate for Payer: Cofinity Advantage |
$92.23
|
| Rate for Payer: Cofinity Commercial |
$113.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.41
|
| Rate for Payer: Healthscope Commercial |
$118.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.82
|
| Rate for Payer: PHP Commercial |
$112.00
|
| Rate for Payer: Priority Health SBD |
$83.01
|
| Rate for Payer: UMR Bronson Commercial |
$57.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.82
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$79.78
|
|
|
Service Code
|
NDC 70954013510
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$71.80 |
| Rate for Payer: Aetna American Axle |
$51.86
|
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.86
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cofinity Advantage |
$55.85
|
| Rate for Payer: Cofinity Commercial |
$68.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.82
|
| Rate for Payer: Healthscope Commercial |
$71.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.84
|
| Rate for Payer: PHP Commercial |
$67.81
|
| Rate for Payer: Priority Health SBD |
$50.26
|
| Rate for Payer: UMR Bronson Commercial |
$35.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.84
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
OP
|
$131.76
|
|
|
Service Code
|
NDC 64980056703
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$118.58 |
| Rate for Payer: Aetna American Axle |
$85.64
|
| Rate for Payer: Aetna Commercial |
$112.00
|
| Rate for Payer: Aetna Medicare |
$65.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.64
|
| Rate for Payer: BCBS Complete |
$52.70
|
| Rate for Payer: Cash Price |
$105.41
|
| Rate for Payer: Cofinity Advantage |
$92.23
|
| Rate for Payer: Cofinity Commercial |
$113.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.41
|
| Rate for Payer: Healthscope Commercial |
$118.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.82
|
| Rate for Payer: PHP Commercial |
$112.00
|
| Rate for Payer: Priority Health SBD |
$83.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.64
|
| Rate for Payer: UHC Core |
$68.65
|
| Rate for Payer: UHC Exchange |
$51.78
|
| Rate for Payer: UMR Bronson Commercial |
$48.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.82
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
OP
|
$235.55
|
|
|
Service Code
|
NDC 49938010230
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.15 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna American Axle |
$153.11
|
| Rate for Payer: Aetna Commercial |
$200.22
|
| Rate for Payer: Aetna Medicare |
$117.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.11
|
| Rate for Payer: BCBS Complete |
$94.22
|
| Rate for Payer: Cash Price |
$188.44
|
| Rate for Payer: Cofinity Advantage |
$164.88
|
| Rate for Payer: Cofinity Commercial |
$202.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.44
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.66
|
| Rate for Payer: PHP Commercial |
$200.22
|
| Rate for Payer: Priority Health SBD |
$148.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.11
|
| Rate for Payer: UHC Core |
$122.72
|
| Rate for Payer: UHC Exchange |
$92.57
|
| Rate for Payer: UMR Bronson Commercial |
$87.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.66
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$235.55
|
|
|
Service Code
|
NDC 49938010230
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.64 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna American Axle |
$153.11
|
| Rate for Payer: Aetna Commercial |
$200.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.11
|
| Rate for Payer: Cash Price |
$188.44
|
| Rate for Payer: Cofinity Advantage |
$164.88
|
| Rate for Payer: Cofinity Commercial |
$202.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.44
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.66
|
| Rate for Payer: PHP Commercial |
$200.22
|
| Rate for Payer: Priority Health SBD |
$148.40
|
| Rate for Payer: UMR Bronson Commercial |
$103.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.66
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$53.81
|
|
|
Service Code
|
HCPCS J0873
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$48.43 |
| Rate for Payer: Aetna American Axle |
$34.98
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.98
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cofinity Advantage |
$37.67
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.05
|
| Rate for Payer: Healthscope Commercial |
$48.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.36
|
| Rate for Payer: PHP Commercial |
$45.74
|
| Rate for Payer: Priority Health SBD |
$33.90
|
| Rate for Payer: UMR Bronson Commercial |
$23.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.36
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53.81
|
|
|
Service Code
|
HCPCS J0873
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$48.43 |
| Rate for Payer: Aetna American Axle |
$34.98
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Medicare |
$26.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.98
|
| Rate for Payer: BCBS Complete |
$21.52
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cofinity Advantage |
$37.67
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.05
|
| Rate for Payer: Healthscope Commercial |
$48.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.36
|
| Rate for Payer: PHP Commercial |
$45.74
|
| Rate for Payer: Priority Health SBD |
$33.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$19.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.36
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna American Axle |
$55.69
|
| Rate for Payer: Aetna American Axle |
$37.08
|
| Rate for Payer: Aetna American Axle |
$23.95
|
| Rate for Payer: Aetna American Axle |
$36.34
|
| Rate for Payer: Aetna American Axle |
$36.02
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Commercial |
$47.52
|
| Rate for Payer: Aetna Commercial |
$48.49
|
| Rate for Payer: Aetna Commercial |
$47.10
|
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna Commercial |
$31.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$45.64
|
| Rate for Payer: Cash Price |
$29.48
|
| Rate for Payer: Cash Price |
$44.72
|
| Rate for Payer: Cash Price |
$44.33
|
| Rate for Payer: Cofinity Advantage |
$39.94
|
| Rate for Payer: Cofinity Advantage |
$38.79
|
| Rate for Payer: Cofinity Advantage |
$25.80
|
| Rate for Payer: Cofinity Advantage |
$59.97
|
| Rate for Payer: Cofinity Advantage |
$39.13
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$47.65
|
| Rate for Payer: Cofinity Commercial |
$49.06
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Commercial |
$31.69
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$33.16
|
| Rate for Payer: Healthscope Commercial |
$51.34
|
| Rate for Payer: Healthscope Commercial |
$49.87
|
| Rate for Payer: Healthscope Commercial |
$50.31
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.92
|
| Rate for Payer: PHP Commercial |
$47.52
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: PHP Commercial |
$48.49
|
| Rate for Payer: PHP Commercial |
$31.32
|
| Rate for Payer: PHP Commercial |
$47.10
|
| Rate for Payer: Priority Health SBD |
$53.97
|
| Rate for Payer: Priority Health SBD |
$34.91
|
| Rate for Payer: Priority Health SBD |
$23.22
|
| Rate for Payer: Priority Health SBD |
$35.22
|
| Rate for Payer: Priority Health SBD |
$35.94
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UMR Bronson Commercial |
$37.69
|
| Rate for Payer: UMR Bronson Commercial |
$24.60
|
| Rate for Payer: UMR Bronson Commercial |
$25.10
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
| Rate for Payer: UMR Bronson Commercial |
$40.39
|
| Rate for Payer: UMR Bronson Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.92
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.78
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$59.20 |
| Rate for Payer: Aetna American Axle |
$42.76
|
| Rate for Payer: Aetna American Axle |
$23.95
|
| Rate for Payer: Aetna American Axle |
$36.34
|
| Rate for Payer: Aetna American Axle |
$37.08
|
| Rate for Payer: Aetna American Axle |
$36.02
|
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna American Axle |
$55.69
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Commercial |
$31.32
|
| Rate for Payer: Aetna Commercial |
$48.49
|
| Rate for Payer: Aetna Commercial |
$47.52
|
| Rate for Payer: Aetna Commercial |
$55.91
|
| Rate for Payer: Aetna Commercial |
$47.10
|
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna Medicare |
$18.43
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna Medicare |
$32.89
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Aetna Medicare |
$28.52
|
| Rate for Payer: Aetna Medicare |
$27.70
|
| Rate for Payer: Aetna Medicare |
$27.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: BCBS Complete |
$22.16
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Complete |
$22.82
|
| Rate for Payer: BCBS Complete |
$26.31
|
| Rate for Payer: BCBS Complete |
$34.27
|
| Rate for Payer: BCBS Complete |
$14.74
|
| Rate for Payer: BCBS Complete |
$22.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$44.72
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$29.48
|
| Rate for Payer: Cash Price |
$52.62
|
| Rate for Payer: Cash Price |
$45.64
|
| Rate for Payer: Cash Price |
$45.64
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$29.48
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$44.33
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$52.62
|
| Rate for Payer: Cash Price |
$44.33
|
| Rate for Payer: Cash Price |
$44.72
|
| Rate for Payer: Cofinity Advantage |
$39.94
|
| Rate for Payer: Cofinity Advantage |
$39.13
|
| Rate for Payer: Cofinity Advantage |
$38.79
|
| Rate for Payer: Cofinity Advantage |
$25.80
|
| Rate for Payer: Cofinity Advantage |
$46.05
|
| Rate for Payer: Cofinity Advantage |
$59.97
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$56.57
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$31.69
|
| Rate for Payer: Cofinity Commercial |
$47.65
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$49.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$51.34
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$59.20
|
| Rate for Payer: Healthscope Commercial |
$49.87
|
| Rate for Payer: Healthscope Commercial |
$33.16
|
| Rate for Payer: Healthscope Commercial |
$50.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.64
|
| Rate for Payer: PHP Commercial |
$48.49
|
| Rate for Payer: PHP Commercial |
$47.52
|
| Rate for Payer: PHP Commercial |
$31.32
|
| Rate for Payer: PHP Commercial |
$47.10
|
| Rate for Payer: PHP Commercial |
$55.91
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$53.97
|
| Rate for Payer: Priority Health SBD |
$35.22
|
| Rate for Payer: Priority Health SBD |
$41.44
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: Priority Health SBD |
$34.91
|
| Rate for Payer: Priority Health SBD |
$23.22
|
| Rate for Payer: Priority Health SBD |
$35.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$20.68
|
| Rate for Payer: UMR Bronson Commercial |
$21.11
|
| Rate for Payer: UMR Bronson Commercial |
$20.50
|
| Rate for Payer: UMR Bronson Commercial |
$13.63
|
| Rate for Payer: UMR Bronson Commercial |
$33.97
|
| Rate for Payer: UMR Bronson Commercial |
$31.70
|
| Rate for Payer: UMR Bronson Commercial |
$24.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.79
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.50
|
|
|
Service Code
|
HCPCS J0873
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$67.05 |
| Rate for Payer: Aetna American Axle |
$48.42
|
| Rate for Payer: Aetna Commercial |
$63.33
|
| Rate for Payer: Aetna Medicare |
$37.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.42
|
| Rate for Payer: BCBS Complete |
$29.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$59.60
|
| Rate for Payer: Cash Price |
$59.60
|
| Rate for Payer: Cofinity Advantage |
$52.15
|
| Rate for Payer: Cofinity Commercial |
$64.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$67.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.88
|
| Rate for Payer: PHP Commercial |
$63.33
|
| Rate for Payer: Priority Health SBD |
$46.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$27.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.88
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.50
|
|
|
Service Code
|
HCPCS J0873
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$67.05 |
| Rate for Payer: Aetna American Axle |
$48.42
|
| Rate for Payer: Aetna Commercial |
$63.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.42
|
| Rate for Payer: Cash Price |
$59.60
|
| Rate for Payer: Cofinity Advantage |
$52.15
|
| Rate for Payer: Cofinity Commercial |
$64.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$67.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.88
|
| Rate for Payer: PHP Commercial |
$63.33
|
| Rate for Payer: Priority Health SBD |
$46.94
|
| Rate for Payer: UMR Bronson Commercial |
$32.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.88
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.26
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$84.83 |
| Rate for Payer: Aetna American Axle |
$61.27
|
| Rate for Payer: Aetna American Axle |
$42.38
|
| Rate for Payer: Aetna American Axle |
$37.66
|
| Rate for Payer: Aetna American Axle |
$41.74
|
| Rate for Payer: Aetna American Axle |
$42.37
|
| Rate for Payer: Aetna American Axle |
$83.97
|
| Rate for Payer: Aetna American Axle |
$866.66
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Commercial |
$109.81
|
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Aetna Commercial |
$55.42
|
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$1,133.32
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: Aetna Medicare |
$666.66
|
| Rate for Payer: Aetna Medicare |
$47.13
|
| Rate for Payer: Aetna Medicare |
$64.59
|
| Rate for Payer: Aetna Medicare |
$32.59
|
| Rate for Payer: Aetna Medicare |
$32.11
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna Medicare |
$32.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.37
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: BCBS Complete |
$26.08
|
| Rate for Payer: BCBS Complete |
$25.69
|
| Rate for Payer: BCBS Complete |
$51.68
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS Complete |
$533.33
|
| Rate for Payer: BCBS Complete |
$37.70
|
| Rate for Payer: BCBS Complete |
$26.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Advantage |
$45.64
|
| Rate for Payer: Cofinity Advantage |
$66.63
|
| Rate for Payer: Cofinity Advantage |
$40.56
|
| Rate for Payer: Cofinity Advantage |
$45.63
|
| Rate for Payer: Cofinity Advantage |
$65.98
|
| Rate for Payer: Cofinity Advantage |
$44.95
|
| Rate for Payer: Cofinity Advantage |
$90.43
|
| Rate for Payer: Cofinity Advantage |
$933.32
|
| Rate for Payer: Cofinity Commercial |
$55.23
|
| Rate for Payer: Cofinity Commercial |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$111.10
|
| Rate for Payer: Cofinity Commercial |
$1,146.66
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Cofinity Commercial |
$81.06
|
| Rate for Payer: Cofinity Commercial |
$56.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.41
|
| Rate for Payer: Healthscope Commercial |
$116.27
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Healthscope Commercial |
$57.80
|
| Rate for Payer: Healthscope Commercial |
$84.83
|
| Rate for Payer: Healthscope Commercial |
$58.68
|
| Rate for Payer: Healthscope Commercial |
$1,199.99
|
| Rate for Payer: Healthscope Commercial |
$58.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$933.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$999.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,066.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$999.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.45
|
| Rate for Payer: PHP Commercial |
$109.81
|
| Rate for Payer: PHP Commercial |
$54.59
|
| Rate for Payer: PHP Commercial |
$55.42
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$80.12
|
| Rate for Payer: PHP Commercial |
$55.41
|
| Rate for Payer: PHP Commercial |
$1,133.32
|
| Rate for Payer: Priority Health SBD |
$839.99
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: Priority Health SBD |
$81.39
|
| Rate for Payer: Priority Health SBD |
$41.08
|
| Rate for Payer: Priority Health SBD |
$59.38
|
| Rate for Payer: Priority Health SBD |
$36.50
|
| Rate for Payer: Priority Health SBD |
$40.46
|
| Rate for Payer: Priority Health SBD |
$41.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Core |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UHC Exchange |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$34.88
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: UMR Bronson Commercial |
$24.12
|
| Rate for Payer: UMR Bronson Commercial |
$21.44
|
| Rate for Payer: UMR Bronson Commercial |
$24.12
|
| Rate for Payer: UMR Bronson Commercial |
$47.80
|
| Rate for Payer: UMR Bronson Commercial |
$493.33
|
| Rate for Payer: UMR Bronson Commercial |
$23.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$999.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.69
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.26
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.47 |
| Max. Negotiated Rate |
$84.83 |
| Rate for Payer: Aetna American Axle |
$61.27
|
| Rate for Payer: Aetna American Axle |
$42.38
|
| Rate for Payer: Aetna American Axle |
$42.37
|
| Rate for Payer: Aetna American Axle |
$83.97
|
| Rate for Payer: Aetna American Axle |
$41.74
|
| Rate for Payer: Aetna American Axle |
$866.66
|
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: Aetna Commercial |
$1,133.32
|
| Rate for Payer: Aetna Commercial |
$55.42
|
| Rate for Payer: Aetna Commercial |
$109.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.97
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Cash Price |
$52.15
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cofinity Advantage |
$45.63
|
| Rate for Payer: Cofinity Advantage |
$933.32
|
| Rate for Payer: Cofinity Advantage |
$90.43
|
| Rate for Payer: Cofinity Advantage |
$45.64
|
| Rate for Payer: Cofinity Advantage |
$44.95
|
| Rate for Payer: Cofinity Advantage |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$1,146.66
|
| Rate for Payer: Cofinity Commercial |
$56.06
|
| Rate for Payer: Cofinity Commercial |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$111.10
|
| Rate for Payer: Cofinity Commercial |
$55.23
|
| Rate for Payer: Cofinity Commercial |
$81.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.41
|
| Rate for Payer: Healthscope Commercial |
$58.68
|
| Rate for Payer: Healthscope Commercial |
$116.27
|
| Rate for Payer: Healthscope Commercial |
$58.67
|
| Rate for Payer: Healthscope Commercial |
$1,199.99
|
| Rate for Payer: Healthscope Commercial |
$57.80
|
| Rate for Payer: Healthscope Commercial |
$84.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$933.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$999.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$999.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.16
|
| Rate for Payer: PHP Commercial |
$54.59
|
| Rate for Payer: PHP Commercial |
$80.12
|
| Rate for Payer: PHP Commercial |
$55.42
|
| Rate for Payer: PHP Commercial |
$55.41
|
| Rate for Payer: PHP Commercial |
$109.81
|
| Rate for Payer: PHP Commercial |
$1,133.32
|
| Rate for Payer: Priority Health SBD |
$41.08
|
| Rate for Payer: Priority Health SBD |
$839.99
|
| Rate for Payer: Priority Health SBD |
$81.39
|
| Rate for Payer: Priority Health SBD |
$40.46
|
| Rate for Payer: Priority Health SBD |
$41.07
|
| Rate for Payer: Priority Health SBD |
$59.38
|
| Rate for Payer: UMR Bronson Commercial |
$28.69
|
| Rate for Payer: UMR Bronson Commercial |
$28.26
|
| Rate for Payer: UMR Bronson Commercial |
$28.68
|
| Rate for Payer: UMR Bronson Commercial |
$586.66
|
| Rate for Payer: UMR Bronson Commercial |
$41.47
|
| Rate for Payer: UMR Bronson Commercial |
$56.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$999.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.16
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN
|
Facility
|
OP
|
$47,230.34
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
193506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$42,507.31 |
| Rate for Payer: Aetna American Axle |
$30,699.72
|
| Rate for Payer: Aetna Commercial |
$40,145.79
|
| Rate for Payer: Aetna Medicare |
$57.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,699.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.79
|
| Rate for Payer: BCBS Complete |
$30.22
|
| Rate for Payer: BCBS MAPPO |
$55.03
|
| Rate for Payer: BCBS Trust/PPO |
$178.51
|
| Rate for Payer: BCN Commercial |
$178.51
|
| Rate for Payer: BCN Medicare Advantage |
$55.03
|
| Rate for Payer: Cash Price |
$37,784.27
|
| Rate for Payer: Cash Price |
$37,784.27
|
| Rate for Payer: Cofinity Advantage |
$33,061.24
|
| Rate for Payer: Cofinity Commercial |
$40,618.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37,784.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.03
|
| Rate for Payer: Healthscope Commercial |
$42,507.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,061.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,422.75
|
| Rate for Payer: Mclaren Medicaid |
$55.03
|
| Rate for Payer: Mclaren Medicare |
$55.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.78
|
| Rate for Payer: Meridian Medicaid |
$57.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,145.79
|
| Rate for Payer: Nomi Health Commercial |
$165.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,422.75
|
| Rate for Payer: PACE Medicare |
$52.28
|
| Rate for Payer: PACE SWMI |
$55.03
|
| Rate for Payer: PHP Commercial |
$40,145.79
|
| Rate for Payer: PHP Medicare Advantage |
$55.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$175.27
|
| Rate for Payer: Priority Health Medicare |
$55.03
|
| Rate for Payer: Priority Health SBD |
$29,755.11
|
| Rate for Payer: Priority Health Tiered Network |
$140.22
|
| Rate for Payer: Railroad Medicare Medicare |
$55.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.85
|
| Rate for Payer: UHC Core |
$90.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$55.03
|
| Rate for Payer: UHC Exchange |
$90.85
|
| Rate for Payer: UHC Medicaid |
$28.78
|
| Rate for Payer: UHCCP Medicaid |
$28.78
|
| Rate for Payer: UMR Bronson Commercial |
$17,475.23
|
| Rate for Payer: VA VA |
$55.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,422.75
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,482.02
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$2,233.82 |
| Rate for Payer: Aetna American Axle |
$1,613.31
|
| Rate for Payer: Aetna American Axle |
$5,217.00
|
| Rate for Payer: Aetna American Axle |
$4,970.80
|
| Rate for Payer: Aetna American Axle |
$1,605.24
|
| Rate for Payer: Aetna Commercial |
$2,109.72
|
| Rate for Payer: Aetna Commercial |
$6,822.23
|
| Rate for Payer: Aetna Commercial |
$2,099.16
|
| Rate for Payer: Aetna Commercial |
$6,500.27
|
| Rate for Payer: Aetna Medicare |
$73.60
|
| Rate for Payer: Aetna Medicare |
$73.60
|
| Rate for Payer: Aetna Medicare |
$73.60
|
| Rate for Payer: Aetna Medicare |
$73.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,970.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,605.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,613.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,217.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.46
|
| Rate for Payer: BCBS Complete |
$38.87
|
| Rate for Payer: BCBS Complete |
$38.87
|
| Rate for Payer: BCBS Complete |
$38.87
|
| Rate for Payer: BCBS Complete |
$38.87
|
| Rate for Payer: BCBS MAPPO |
$70.77
|
| Rate for Payer: BCBS MAPPO |
$70.77
|
| Rate for Payer: BCBS MAPPO |
$70.77
|
| Rate for Payer: BCBS MAPPO |
$70.77
|
| Rate for Payer: BCBS Trust/PPO |
$229.53
|
| Rate for Payer: BCBS Trust/PPO |
$229.53
|
| Rate for Payer: BCBS Trust/PPO |
$229.53
|
| Rate for Payer: BCBS Trust/PPO |
$229.53
|
| Rate for Payer: BCN Commercial |
$229.53
|
| Rate for Payer: BCN Commercial |
$229.53
|
| Rate for Payer: BCN Commercial |
$229.53
|
| Rate for Payer: BCN Commercial |
$229.53
|
| Rate for Payer: BCN Medicare Advantage |
$70.77
|
| Rate for Payer: BCN Medicare Advantage |
$70.77
|
| Rate for Payer: BCN Medicare Advantage |
$70.77
|
| Rate for Payer: BCN Medicare Advantage |
$70.77
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cash Price |
$1,985.62
|
| Rate for Payer: Cash Price |
$1,975.68
|
| Rate for Payer: Cash Price |
$6,420.92
|
| Rate for Payer: Cash Price |
$1,985.62
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cash Price |
$6,420.92
|
| Rate for Payer: Cash Price |
$1,975.68
|
| Rate for Payer: Cofinity Advantage |
$5,353.17
|
| Rate for Payer: Cofinity Advantage |
$1,728.72
|
| Rate for Payer: Cofinity Advantage |
$5,618.31
|
| Rate for Payer: Cofinity Advantage |
$1,737.41
|
| Rate for Payer: Cofinity Commercial |
$6,902.49
|
| Rate for Payer: Cofinity Commercial |
$2,134.54
|
| Rate for Payer: Cofinity Commercial |
$6,576.75
|
| Rate for Payer: Cofinity Commercial |
$2,123.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,420.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,975.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,985.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,117.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.77
|
| Rate for Payer: Healthscope Commercial |
$2,233.82
|
| Rate for Payer: Healthscope Commercial |
$6,882.64
|
| Rate for Payer: Healthscope Commercial |
$7,223.53
|
| Rate for Payer: Healthscope Commercial |
$2,222.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,618.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,728.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,353.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,737.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,019.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,735.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,861.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,852.20
|
| Rate for Payer: Mclaren Medicaid |
$70.77
|
| Rate for Payer: Mclaren Medicaid |
$70.77
|
| Rate for Payer: Mclaren Medicaid |
$70.77
|
| Rate for Payer: Mclaren Medicaid |
$70.77
|
| Rate for Payer: Mclaren Medicare |
$70.77
|
| Rate for Payer: Mclaren Medicare |
$70.77
|
| Rate for Payer: Mclaren Medicare |
$70.77
|
| Rate for Payer: Mclaren Medicare |
$70.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.31
|
| Rate for Payer: Meridian Medicaid |
$74.31
|
| Rate for Payer: Meridian Medicaid |
$74.31
|
| Rate for Payer: Meridian Medicaid |
$74.31
|
| Rate for Payer: Meridian Medicaid |
$74.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,500.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,109.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,822.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,099.16
|
| Rate for Payer: Nomi Health Commercial |
$212.31
|
| Rate for Payer: Nomi Health Commercial |
$212.31
|
| Rate for Payer: Nomi Health Commercial |
$212.31
|
| Rate for Payer: Nomi Health Commercial |
$212.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,852.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,861.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,735.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,019.61
|
| Rate for Payer: PACE Medicare |
$67.23
|
| Rate for Payer: PACE Medicare |
$67.23
|
| Rate for Payer: PACE Medicare |
$67.23
|
| Rate for Payer: PACE Medicare |
$67.23
|
| Rate for Payer: PACE SWMI |
$70.77
|
| Rate for Payer: PACE SWMI |
$70.77
|
| Rate for Payer: PACE SWMI |
$70.77
|
| Rate for Payer: PACE SWMI |
$70.77
|
| Rate for Payer: PHP Commercial |
$2,109.72
|
| Rate for Payer: PHP Commercial |
$6,822.23
|
| Rate for Payer: PHP Commercial |
$2,099.16
|
| Rate for Payer: PHP Commercial |
$6,500.27
|
| Rate for Payer: PHP Medicare Advantage |
$70.77
|
| Rate for Payer: PHP Medicare Advantage |
$70.77
|
| Rate for Payer: PHP Medicare Advantage |
$70.77
|
| Rate for Payer: PHP Medicare Advantage |
$70.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$225.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$225.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$225.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$225.09
|
| Rate for Payer: Priority Health Medicare |
$70.77
|
| Rate for Payer: Priority Health Medicare |
$70.77
|
| Rate for Payer: Priority Health Medicare |
$70.77
|
| Rate for Payer: Priority Health Medicare |
$70.77
|
| Rate for Payer: Priority Health SBD |
$1,555.85
|
| Rate for Payer: Priority Health SBD |
$1,563.67
|
| Rate for Payer: Priority Health SBD |
$5,056.47
|
| Rate for Payer: Priority Health SBD |
$4,817.85
|
| Rate for Payer: Priority Health Tiered Network |
$180.07
|
| Rate for Payer: Priority Health Tiered Network |
$180.07
|
| Rate for Payer: Priority Health Tiered Network |
$180.07
|
| Rate for Payer: Priority Health Tiered Network |
$180.07
|
| Rate for Payer: Railroad Medicare Medicare |
$70.77
|
| Rate for Payer: Railroad Medicare Medicare |
$70.77
|
| Rate for Payer: Railroad Medicare Medicare |
$70.77
|
| Rate for Payer: Railroad Medicare Medicare |
$70.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.80
|
| Rate for Payer: UHC Core |
$116.80
|
| Rate for Payer: UHC Core |
$116.80
|
| Rate for Payer: UHC Core |
$116.80
|
| Rate for Payer: UHC Core |
$116.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.77
|
| Rate for Payer: UHC Exchange |
$116.80
|
| Rate for Payer: UHC Exchange |
$116.80
|
| Rate for Payer: UHC Exchange |
$116.80
|
| Rate for Payer: UHC Exchange |
$116.80
|
| Rate for Payer: UHC Medicaid |
$37.01
|
| Rate for Payer: UHC Medicaid |
$37.01
|
| Rate for Payer: UHC Medicaid |
$37.01
|
| Rate for Payer: UHC Medicaid |
$37.01
|
| Rate for Payer: UHCCP Medicaid |
$37.01
|
| Rate for Payer: UHCCP Medicaid |
$37.01
|
| Rate for Payer: UHCCP Medicaid |
$37.01
|
| Rate for Payer: UHCCP Medicaid |
$37.01
|
| Rate for Payer: UMR Bronson Commercial |
$2,829.53
|
| Rate for Payer: UMR Bronson Commercial |
$918.35
|
| Rate for Payer: UMR Bronson Commercial |
$913.75
|
| Rate for Payer: UMR Bronson Commercial |
$2,969.68
|
| Rate for Payer: VA VA |
$70.77
|
| Rate for Payer: VA VA |
$70.77
|
| Rate for Payer: VA VA |
$70.77
|
| Rate for Payer: VA VA |
$70.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,735.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,019.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,861.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,852.20
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,469.60
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,086.62 |
| Max. Negotiated Rate |
$2,222.64 |
| Rate for Payer: Aetna American Axle |
$1,605.24
|
| Rate for Payer: Aetna American Axle |
$5,217.00
|
| Rate for Payer: Aetna American Axle |
$4,970.80
|
| Rate for Payer: Aetna Commercial |
$6,500.27
|
| Rate for Payer: Aetna Commercial |
$2,099.16
|
| Rate for Payer: Aetna Commercial |
$6,822.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,217.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,605.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,970.80
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cash Price |
$1,975.68
|
| Rate for Payer: Cash Price |
$6,420.92
|
| Rate for Payer: Cofinity Advantage |
$5,618.31
|
| Rate for Payer: Cofinity Advantage |
$1,728.72
|
| Rate for Payer: Cofinity Advantage |
$5,353.17
|
| Rate for Payer: Cofinity Commercial |
$6,902.49
|
| Rate for Payer: Cofinity Commercial |
$2,123.86
|
| Rate for Payer: Cofinity Commercial |
$6,576.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,975.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,117.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,420.92
|
| Rate for Payer: Healthscope Commercial |
$6,882.64
|
| Rate for Payer: Healthscope Commercial |
$7,223.53
|
| Rate for Payer: Healthscope Commercial |
$2,222.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,353.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,728.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,618.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,019.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,852.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,735.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,099.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,500.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,822.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,852.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,735.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,019.61
|
| Rate for Payer: PHP Commercial |
$6,500.27
|
| Rate for Payer: PHP Commercial |
$2,099.16
|
| Rate for Payer: PHP Commercial |
$6,822.23
|
| Rate for Payer: Priority Health SBD |
$1,555.85
|
| Rate for Payer: Priority Health SBD |
$4,817.85
|
| Rate for Payer: Priority Health SBD |
$5,056.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,086.62
|
| Rate for Payer: UMR Bronson Commercial |
$3,531.51
|
| Rate for Payer: UMR Bronson Commercial |
$3,364.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,735.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,852.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,019.61
|
|
|
DARBEPOETIN ALFA 100 MCG/0.5 ML IN POLYSORBATE INJECTION SYRINGE
|
Facility
|
OP
|
$2,412.47
|
|
|
Service Code
|
HCPCS J0881
|
| Hospital Charge Code |
116632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2,171.22 |
| Rate for Payer: Aetna American Axle |
$1,568.11
|
| Rate for Payer: Aetna Commercial |
$2,050.60
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,568.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.84
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCN Commercial |
$9.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cash Price |
$1,929.98
|
| Rate for Payer: Cofinity Advantage |
$1,688.73
|
| Rate for Payer: Cofinity Commercial |
$2,074.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,929.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$2,171.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,688.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,809.35
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,050.60
|
| Rate for Payer: Nomi Health Commercial |
$9.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,809.35
|
| Rate for Payer: PACE Medicare |
$2.92
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$2,050.60
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$3.07
|
| Rate for Payer: Priority Health SBD |
$1,519.86
|
| Rate for Payer: Priority Health Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.98
|
| Rate for Payer: UHC Core |
$4.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicaid |
$1.61
|
| Rate for Payer: UHCCP Medicaid |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$892.61
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,809.35
|
|
