GEMCITABINE 2 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$975.79
|
|
Service Code
|
HCPCS J9201
|
Hospital Charge Code |
105417
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$429.35 |
Max. Negotiated Rate |
$878.21 |
Rate for Payer: Aetna American Axle |
$634.26
|
Rate for Payer: Aetna Commercial |
$829.42
|
Rate for Payer: Aetna New Business (MI Preferred) |
$634.26
|
Rate for Payer: Cash Price |
$780.63
|
Rate for Payer: Cofinity Commercial |
$683.05
|
Rate for Payer: Cofinity Commercial |
$839.18
|
Rate for Payer: Encore Health Key Benefits Commercial |
$780.63
|
Rate for Payer: Healthscope Commercial |
$878.21
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$683.05
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.84
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$829.42
|
Rate for Payer: PHP Commercial |
$829.42
|
Rate for Payer: Priority Health Cigna Priority Health |
$683.05
|
Rate for Payer: Priority Health SBD |
$614.75
|
Rate for Payer: UMR Bronson Commercial |
$429.35
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.84
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$202.35
|
|
Service Code
|
NDC 60687-224-01
|
Hospital Charge Code |
3378
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$89.03 |
Max. Negotiated Rate |
$182.12 |
Rate for Payer: Aetna American Axle |
$131.53
|
Rate for Payer: Aetna Commercial |
$172.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$131.53
|
Rate for Payer: Cash Price |
$161.88
|
Rate for Payer: Cofinity Commercial |
$141.64
|
Rate for Payer: Cofinity Commercial |
$174.02
|
Rate for Payer: Encore Health Key Benefits Commercial |
$161.88
|
Rate for Payer: Healthscope Commercial |
$182.12
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.64
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.76
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.00
|
Rate for Payer: PHP Commercial |
$172.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$141.64
|
Rate for Payer: Priority Health SBD |
$127.48
|
Rate for Payer: UMR Bronson Commercial |
$89.03
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.76
|
|
GEMFIBROZIL 600 MG TABLET
|
Facility
|
IP
|
$2.03
|
|
Service Code
|
NDC 60687-224-11
|
Hospital Charge Code |
3378
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$0.89 |
Max. Negotiated Rate |
$1.83 |
Rate for Payer: Aetna American Axle |
$1.32
|
Rate for Payer: Aetna Commercial |
$1.73
|
Rate for Payer: Aetna New Business (MI Preferred) |
$1.32
|
Rate for Payer: Cash Price |
$1.62
|
Rate for Payer: Cofinity Commercial |
$1.42
|
Rate for Payer: Cofinity Commercial |
$1.75
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1.62
|
Rate for Payer: Healthscope Commercial |
$1.83
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.42
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.52
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.73
|
Rate for Payer: PHP Commercial |
$1.73
|
Rate for Payer: Priority Health Cigna Priority Health |
$1.42
|
Rate for Payer: Priority Health SBD |
$1.28
|
Rate for Payer: UMR Bronson Commercial |
$0.89
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.52
|
|
GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN
|
Facility
|
OP
|
$43,778.90
|
|
Service Code
|
HCPCS J9203
|
Hospital Charge Code |
184519
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$123.78 |
Max. Negotiated Rate |
$39,401.01 |
Rate for Payer: Aetna American Axle |
$28,456.28
|
Rate for Payer: Aetna Commercial |
$37,212.06
|
Rate for Payer: Aetna Medicare |
$235.33
|
Rate for Payer: Aetna New Business (MI Preferred) |
$28,456.28
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$282.85
|
Rate for Payer: Amish Plain Church Group Commercial |
$282.85
|
Rate for Payer: BCBS Complete |
$129.98
|
Rate for Payer: BCBS MAPPO |
$226.28
|
Rate for Payer: BCBS Trust/PPO |
$731.20
|
Rate for Payer: BCN Medicare Advantage |
$226.28
|
Rate for Payer: Cash Price |
$35,023.12
|
Rate for Payer: Cash Price |
$35,023.12
|
Rate for Payer: Cofinity Commercial |
$30,645.23
|
Rate for Payer: Cofinity Commercial |
$37,649.85
|
Rate for Payer: Encore Health Key Benefits Commercial |
$35,023.12
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.28
|
Rate for Payer: Healthscope Commercial |
$39,401.01
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,645.23
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$32,834.18
|
Rate for Payer: Mclaren Medicaid |
$123.78
|
Rate for Payer: Mclaren Medicare |
$226.28
|
Rate for Payer: Meridian Medicaid |
$129.98
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.59
|
Rate for Payer: MI Amish Medical Board Commercial |
$260.22
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37,212.06
|
Rate for Payer: PACE Medicare |
$214.97
|
Rate for Payer: PACE SWMI |
$226.28
|
Rate for Payer: PHP Commercial |
$37,212.06
|
Rate for Payer: PHP Medicare Advantage |
$226.28
|
Rate for Payer: Priority Health Choice Medicaid |
$123.78
|
Rate for Payer: Priority Health Cigna Priority Health |
$30,645.23
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$651.53
|
Rate for Payer: Priority Health Medicare |
$226.28
|
Rate for Payer: Priority Health Narrow Network |
$521.22
|
Rate for Payer: Priority Health SBD |
$27,580.71
|
Rate for Payer: Railroad Medicare Medicare |
$226.28
|
Rate for Payer: UHC Dual Complete DSNP |
$226.28
|
Rate for Payer: UHC Medicare Advantage |
$233.07
|
Rate for Payer: UMR Bronson Commercial |
$16,198.19
|
Rate for Payer: VA VA |
$226.28
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32,834.18
|
|
GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN
|
Facility
|
IP
|
$43,778.90
|
|
Service Code
|
HCPCS J9203
|
Hospital Charge Code |
184519
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$19,262.72 |
Max. Negotiated Rate |
$39,401.01 |
Rate for Payer: Aetna American Axle |
$28,456.28
|
Rate for Payer: Aetna Commercial |
$37,212.06
|
Rate for Payer: Aetna New Business (MI Preferred) |
$28,456.28
|
Rate for Payer: Cash Price |
$35,023.12
|
Rate for Payer: Cofinity Commercial |
$37,649.85
|
Rate for Payer: Cofinity Commercial |
$30,645.23
|
Rate for Payer: Encore Health Key Benefits Commercial |
$35,023.12
|
Rate for Payer: Healthscope Commercial |
$39,401.01
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,645.23
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$32,834.18
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37,212.06
|
Rate for Payer: PHP Commercial |
$37,212.06
|
Rate for Payer: Priority Health Cigna Priority Health |
$30,645.23
|
Rate for Payer: Priority Health SBD |
$27,580.71
|
Rate for Payer: UMR Bronson Commercial |
$19,262.72
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32,834.18
|
|
GENIOPLASTY; SLIDING OSTEOTOMY, SINGLE PIECE
|
Facility
|
OP
|
$9,009.23
|
|
Service Code
|
CPT 21121
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$520.63 |
Max. Negotiated Rate |
$9,009.23 |
Rate for Payer: Aetna Medicare |
$2,976.31
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
Rate for Payer: BCBS Complete |
$1,643.84
|
Rate for Payer: BCBS MAPPO |
$2,861.84
|
Rate for Payer: BCBS Trust/PPO |
$1,803.85
|
Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
Rate for Payer: Mclaren Medicaid |
$1,565.43
|
Rate for Payer: Mclaren Medicare |
$2,861.84
|
Rate for Payer: Meridian Medicaid |
$1,643.84
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
Rate for Payer: PACE Medicare |
$2,718.75
|
Rate for Payer: PACE SWMI |
$2,861.84
|
Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
Rate for Payer: Priority Health Medicare |
$2,861.84
|
Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$572.69
|
Rate for Payer: UHC Core |
$3,604.00
|
Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
Rate for Payer: UHC Exchange |
$520.63
|
Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
Rate for Payer: VA VA |
$2,861.84
|
|
GENTAMICIN 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$131.36
|
|
Service Code
|
NDC 45802-056-35
|
Hospital Charge Code |
3423
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$57.80 |
Max. Negotiated Rate |
$118.22 |
Rate for Payer: Aetna American Axle |
$85.38
|
Rate for Payer: Aetna Commercial |
$111.66
|
Rate for Payer: Aetna New Business (MI Preferred) |
$85.38
|
Rate for Payer: Cash Price |
$105.09
|
Rate for Payer: Cofinity Commercial |
$112.97
|
Rate for Payer: Cofinity Commercial |
$91.95
|
Rate for Payer: Encore Health Key Benefits Commercial |
$105.09
|
Rate for Payer: Healthscope Commercial |
$118.22
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.95
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.52
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.66
|
Rate for Payer: PHP Commercial |
$111.66
|
Rate for Payer: Priority Health Cigna Priority Health |
$91.95
|
Rate for Payer: Priority Health SBD |
$82.76
|
Rate for Payer: UMR Bronson Commercial |
$57.80
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.52
|
|
GENTAMICIN 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$30.40
|
|
Service Code
|
NDC 0713-0683-15
|
Hospital Charge Code |
3423
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$13.38 |
Max. Negotiated Rate |
$27.36 |
Rate for Payer: Aetna American Axle |
$19.76
|
Rate for Payer: Aetna Commercial |
$25.84
|
Rate for Payer: Aetna New Business (MI Preferred) |
$19.76
|
Rate for Payer: Cash Price |
$24.32
|
Rate for Payer: Cofinity Commercial |
$21.28
|
Rate for Payer: Cofinity Commercial |
$26.14
|
Rate for Payer: Encore Health Key Benefits Commercial |
$24.32
|
Rate for Payer: Healthscope Commercial |
$27.36
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.28
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.80
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.84
|
Rate for Payer: PHP Commercial |
$25.84
|
Rate for Payer: Priority Health Cigna Priority Health |
$21.28
|
Rate for Payer: Priority Health SBD |
$19.15
|
Rate for Payer: UMR Bronson Commercial |
$13.38
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.80
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$18.23
|
|
Service Code
|
NDC 60758-188-05
|
Hospital Charge Code |
3428
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$8.02 |
Max. Negotiated Rate |
$16.41 |
Rate for Payer: Aetna American Axle |
$11.85
|
Rate for Payer: Aetna Commercial |
$15.50
|
Rate for Payer: Aetna New Business (MI Preferred) |
$11.85
|
Rate for Payer: Cash Price |
$14.58
|
Rate for Payer: Cofinity Commercial |
$12.76
|
Rate for Payer: Cofinity Commercial |
$15.68
|
Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
Rate for Payer: Healthscope Commercial |
$16.41
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.76
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.67
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.50
|
Rate for Payer: PHP Commercial |
$15.50
|
Rate for Payer: Priority Health Cigna Priority Health |
$12.76
|
Rate for Payer: Priority Health SBD |
$11.48
|
Rate for Payer: UMR Bronson Commercial |
$8.02
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.67
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$18.77
|
|
Service Code
|
NDC 61314-633-05
|
Hospital Charge Code |
3428
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$8.26 |
Max. Negotiated Rate |
$16.89 |
Rate for Payer: Aetna American Axle |
$12.20
|
Rate for Payer: Aetna Commercial |
$15.95
|
Rate for Payer: Aetna New Business (MI Preferred) |
$12.20
|
Rate for Payer: Cash Price |
$15.02
|
Rate for Payer: Cofinity Commercial |
$13.14
|
Rate for Payer: Cofinity Commercial |
$16.14
|
Rate for Payer: Encore Health Key Benefits Commercial |
$15.02
|
Rate for Payer: Healthscope Commercial |
$16.89
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.14
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.08
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.95
|
Rate for Payer: PHP Commercial |
$15.95
|
Rate for Payer: Priority Health Cigna Priority Health |
$13.14
|
Rate for Payer: Priority Health SBD |
$11.83
|
Rate for Payer: UMR Bronson Commercial |
$8.26
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.08
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$116.24
|
|
Service Code
|
NDC 24208-580-60
|
Hospital Charge Code |
3428
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$51.15 |
Max. Negotiated Rate |
$104.62 |
Rate for Payer: Aetna American Axle |
$75.56
|
Rate for Payer: Aetna Commercial |
$98.80
|
Rate for Payer: Aetna New Business (MI Preferred) |
$75.56
|
Rate for Payer: Cash Price |
$92.99
|
Rate for Payer: Cofinity Commercial |
$81.37
|
Rate for Payer: Cofinity Commercial |
$99.97
|
Rate for Payer: Encore Health Key Benefits Commercial |
$92.99
|
Rate for Payer: Healthscope Commercial |
$104.62
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.37
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.18
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.80
|
Rate for Payer: PHP Commercial |
$98.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$81.37
|
Rate for Payer: Priority Health SBD |
$73.23
|
Rate for Payer: UMR Bronson Commercial |
$51.15
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.18
|
|
GENTAMICIN 100 MG/50 ML IN NS PREMIX (BMH OSC)
|
Facility
|
IP
|
$71.67
|
|
Service Code
|
HCPCS J1580
|
Hospital Charge Code |
169406
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$31.53 |
Max. Negotiated Rate |
$64.50 |
Rate for Payer: Aetna American Axle |
$46.59
|
Rate for Payer: Aetna Commercial |
$60.92
|
Rate for Payer: Aetna New Business (MI Preferred) |
$46.59
|
Rate for Payer: Cash Price |
$57.34
|
Rate for Payer: Cofinity Commercial |
$50.17
|
Rate for Payer: Cofinity Commercial |
$61.64
|
Rate for Payer: Encore Health Key Benefits Commercial |
$57.34
|
Rate for Payer: Healthscope Commercial |
$64.50
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.17
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.75
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.92
|
Rate for Payer: PHP Commercial |
$60.92
|
Rate for Payer: Priority Health Cigna Priority Health |
$50.17
|
Rate for Payer: Priority Health SBD |
$45.15
|
Rate for Payer: UMR Bronson Commercial |
$31.53
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.75
|
|
GENTAMICIN 100 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$71.67
|
|
Service Code
|
HCPCS J1580
|
Hospital Charge Code |
15912
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$31.53 |
Max. Negotiated Rate |
$64.50 |
Rate for Payer: Aetna American Axle |
$46.59
|
Rate for Payer: Aetna Commercial |
$60.92
|
Rate for Payer: Aetna New Business (MI Preferred) |
$46.59
|
Rate for Payer: Cash Price |
$57.34
|
Rate for Payer: Cofinity Commercial |
$50.17
|
Rate for Payer: Cofinity Commercial |
$61.64
|
Rate for Payer: Encore Health Key Benefits Commercial |
$57.34
|
Rate for Payer: Healthscope Commercial |
$64.50
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.17
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.75
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.92
|
Rate for Payer: PHP Commercial |
$60.92
|
Rate for Payer: Priority Health Cigna Priority Health |
$50.17
|
Rate for Payer: Priority Health SBD |
$45.15
|
Rate for Payer: UMR Bronson Commercial |
$31.53
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.75
|
|
GENTAMICIN 120 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$80.41
|
|
Service Code
|
HCPCS J1580
|
Hospital Charge Code |
114156
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$35.38 |
Max. Negotiated Rate |
$72.37 |
Rate for Payer: Aetna American Axle |
$52.27
|
Rate for Payer: Aetna Commercial |
$68.35
|
Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
Rate for Payer: Cash Price |
$64.33
|
Rate for Payer: Cofinity Commercial |
$56.29
|
Rate for Payer: Cofinity Commercial |
$69.15
|
Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
Rate for Payer: Healthscope Commercial |
$72.37
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.35
|
Rate for Payer: PHP Commercial |
$68.35
|
Rate for Payer: Priority Health Cigna Priority Health |
$56.29
|
Rate for Payer: Priority Health SBD |
$50.66
|
Rate for Payer: UMR Bronson Commercial |
$35.38
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
GENTAMICIN 14 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
IP
|
$209.86
|
|
Service Code
|
NDC 9900-0000-88
|
Hospital Charge Code |
500593
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$92.34 |
Max. Negotiated Rate |
$188.87 |
Rate for Payer: Aetna American Axle |
$136.41
|
Rate for Payer: Aetna Commercial |
$178.38
|
Rate for Payer: Aetna New Business (MI Preferred) |
$136.41
|
Rate for Payer: Cash Price |
$167.89
|
Rate for Payer: Cofinity Commercial |
$180.48
|
Rate for Payer: Cofinity Commercial |
$146.90
|
Rate for Payer: Encore Health Key Benefits Commercial |
$167.89
|
Rate for Payer: Healthscope Commercial |
$188.87
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.90
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.40
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.38
|
Rate for Payer: PHP Commercial |
$178.38
|
Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
Rate for Payer: Priority Health SBD |
$132.21
|
Rate for Payer: UMR Bronson Commercial |
$92.34
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.40
|
|
GENTAMICIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$336.40
|
|
Service Code
|
HCPCS J1580
|
Hospital Charge Code |
3426
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$8.66 |
Max. Negotiated Rate |
$302.76 |
Rate for Payer: Aetna American Axle |
$218.66
|
Rate for Payer: Aetna American Axle |
$35.59
|
Rate for Payer: Aetna Commercial |
$285.94
|
Rate for Payer: Aetna Commercial |
$46.55
|
Rate for Payer: Aetna New Business (MI Preferred) |
$218.66
|
Rate for Payer: Aetna New Business (MI Preferred) |
$35.59
|
Rate for Payer: BCBS Complete |
$134.56
|
Rate for Payer: BCBS Complete |
$21.90
|
Rate for Payer: BCBS Trust/PPO |
$8.66
|
Rate for Payer: BCBS Trust/PPO |
$8.66
|
Rate for Payer: Cash Price |
$43.81
|
Rate for Payer: Cash Price |
$269.12
|
Rate for Payer: Cash Price |
$43.81
|
Rate for Payer: Cash Price |
$269.12
|
Rate for Payer: Cofinity Commercial |
$47.09
|
Rate for Payer: Cofinity Commercial |
$235.48
|
Rate for Payer: Cofinity Commercial |
$38.33
|
Rate for Payer: Cofinity Commercial |
$289.30
|
Rate for Payer: Encore Health Key Benefits Commercial |
$43.81
|
Rate for Payer: Encore Health Key Benefits Commercial |
$269.12
|
Rate for Payer: Healthscope Commercial |
$49.28
|
Rate for Payer: Healthscope Commercial |
$302.76
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.33
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.30
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.07
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.55
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.94
|
Rate for Payer: PHP Commercial |
$46.55
|
Rate for Payer: PHP Commercial |
$285.94
|
Rate for Payer: Priority Health Cigna Priority Health |
$38.33
|
Rate for Payer: Priority Health Cigna Priority Health |
$235.48
|
Rate for Payer: Priority Health SBD |
$34.50
|
Rate for Payer: Priority Health SBD |
$211.93
|
Rate for Payer: UMR Bronson Commercial |
$124.47
|
Rate for Payer: UMR Bronson Commercial |
$20.26
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.30
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.07
|
|
GENTAMICIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$336.40
|
|
Service Code
|
HCPCS J1580
|
Hospital Charge Code |
3426
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$148.02 |
Max. Negotiated Rate |
$302.76 |
Rate for Payer: Aetna American Axle |
$218.66
|
Rate for Payer: Aetna American Axle |
$12.71
|
Rate for Payer: Aetna American Axle |
$35.59
|
Rate for Payer: Aetna Commercial |
$46.55
|
Rate for Payer: Aetna Commercial |
$285.94
|
Rate for Payer: Aetna Commercial |
$16.62
|
Rate for Payer: Aetna New Business (MI Preferred) |
$218.66
|
Rate for Payer: Aetna New Business (MI Preferred) |
$12.71
|
Rate for Payer: Aetna New Business (MI Preferred) |
$35.59
|
Rate for Payer: Cash Price |
$43.81
|
Rate for Payer: Cash Price |
$269.12
|
Rate for Payer: Cash Price |
$15.64
|
Rate for Payer: Cofinity Commercial |
$16.81
|
Rate for Payer: Cofinity Commercial |
$13.68
|
Rate for Payer: Cofinity Commercial |
$235.48
|
Rate for Payer: Cofinity Commercial |
$289.30
|
Rate for Payer: Cofinity Commercial |
$38.33
|
Rate for Payer: Cofinity Commercial |
$47.09
|
Rate for Payer: Encore Health Key Benefits Commercial |
$15.64
|
Rate for Payer: Encore Health Key Benefits Commercial |
$269.12
|
Rate for Payer: Encore Health Key Benefits Commercial |
$43.81
|
Rate for Payer: Healthscope Commercial |
$17.60
|
Rate for Payer: Healthscope Commercial |
$302.76
|
Rate for Payer: Healthscope Commercial |
$49.28
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.68
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.48
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.33
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.66
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.07
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.30
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.62
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$285.94
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.55
|
Rate for Payer: PHP Commercial |
$16.62
|
Rate for Payer: PHP Commercial |
$285.94
|
Rate for Payer: PHP Commercial |
$46.55
|
Rate for Payer: Priority Health Cigna Priority Health |
$38.33
|
Rate for Payer: Priority Health Cigna Priority Health |
$235.48
|
Rate for Payer: Priority Health Cigna Priority Health |
$13.68
|
Rate for Payer: Priority Health SBD |
$211.93
|
Rate for Payer: Priority Health SBD |
$12.32
|
Rate for Payer: Priority Health SBD |
$34.50
|
Rate for Payer: UMR Bronson Commercial |
$8.60
|
Rate for Payer: UMR Bronson Commercial |
$24.09
|
Rate for Payer: UMR Bronson Commercial |
$148.02
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.30
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.07
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.66
|
|
GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$66.43
|
|
Service Code
|
HCPCS J1580
|
Hospital Charge Code |
15906
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$29.23 |
Max. Negotiated Rate |
$59.79 |
Rate for Payer: Aetna American Axle |
$43.18
|
Rate for Payer: Aetna Commercial |
$56.47
|
Rate for Payer: Aetna New Business (MI Preferred) |
$43.18
|
Rate for Payer: Cash Price |
$53.14
|
Rate for Payer: Cofinity Commercial |
$46.50
|
Rate for Payer: Cofinity Commercial |
$57.13
|
Rate for Payer: Encore Health Key Benefits Commercial |
$53.14
|
Rate for Payer: Healthscope Commercial |
$59.79
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.50
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.82
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.47
|
Rate for Payer: PHP Commercial |
$56.47
|
Rate for Payer: Priority Health Cigna Priority Health |
$46.50
|
Rate for Payer: Priority Health SBD |
$41.85
|
Rate for Payer: UMR Bronson Commercial |
$29.23
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.82
|
|
GENTAMICIN 9 MG/ML FORTIFIED OPHTHAMIC DROPS
|
Facility
|
IP
|
$177.35
|
|
Service Code
|
NDC 9900-0000-87
|
Hospital Charge Code |
500592
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$78.03 |
Max. Negotiated Rate |
$159.62 |
Rate for Payer: Aetna American Axle |
$115.28
|
Rate for Payer: Aetna Commercial |
$150.75
|
Rate for Payer: Aetna New Business (MI Preferred) |
$115.28
|
Rate for Payer: Cash Price |
$141.88
|
Rate for Payer: Cofinity Commercial |
$124.14
|
Rate for Payer: Cofinity Commercial |
$152.52
|
Rate for Payer: Encore Health Key Benefits Commercial |
$141.88
|
Rate for Payer: Healthscope Commercial |
$159.62
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.14
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.01
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.75
|
Rate for Payer: PHP Commercial |
$150.75
|
Rate for Payer: Priority Health Cigna Priority Health |
$124.14
|
Rate for Payer: Priority Health SBD |
$111.73
|
Rate for Payer: UMR Bronson Commercial |
$78.03
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.01
|
|
GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$27.93
|
|
Service Code
|
HCPCS J1580
|
Hospital Charge Code |
117665
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$12.29 |
Max. Negotiated Rate |
$25.14 |
Rate for Payer: Aetna American Axle |
$18.15
|
Rate for Payer: Aetna Commercial |
$23.74
|
Rate for Payer: Aetna New Business (MI Preferred) |
$18.15
|
Rate for Payer: Cash Price |
$22.34
|
Rate for Payer: Cofinity Commercial |
$19.55
|
Rate for Payer: Cofinity Commercial |
$24.02
|
Rate for Payer: Encore Health Key Benefits Commercial |
$22.34
|
Rate for Payer: Healthscope Commercial |
$25.14
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.55
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.95
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.74
|
Rate for Payer: PHP Commercial |
$23.74
|
Rate for Payer: Priority Health Cigna Priority Health |
$19.55
|
Rate for Payer: Priority Health SBD |
$17.60
|
Rate for Payer: UMR Bronson Commercial |
$12.29
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.95
|
|
GIVOSIRAN 189 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$107,575.00
|
|
Service Code
|
HCPCS J0223
|
Hospital Charge Code |
192158
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$61.31 |
Max. Negotiated Rate |
$96,817.50 |
Rate for Payer: Aetna American Axle |
$69,923.75
|
Rate for Payer: Aetna Commercial |
$91,438.75
|
Rate for Payer: Aetna Medicare |
$116.56
|
Rate for Payer: Aetna New Business (MI Preferred) |
$69,923.75
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.10
|
Rate for Payer: Amish Plain Church Group Commercial |
$140.10
|
Rate for Payer: BCBS Complete |
$64.38
|
Rate for Payer: BCBS MAPPO |
$112.08
|
Rate for Payer: BCBS Trust/PPO |
$362.18
|
Rate for Payer: BCN Medicare Advantage |
$112.08
|
Rate for Payer: Cash Price |
$86,060.00
|
Rate for Payer: Cash Price |
$86,060.00
|
Rate for Payer: Cofinity Commercial |
$92,514.50
|
Rate for Payer: Cofinity Commercial |
$75,302.50
|
Rate for Payer: Encore Health Key Benefits Commercial |
$86,060.00
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.08
|
Rate for Payer: Healthscope Commercial |
$96,817.50
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75,302.50
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$80,681.25
|
Rate for Payer: Mclaren Medicaid |
$61.31
|
Rate for Payer: Mclaren Medicare |
$112.08
|
Rate for Payer: Meridian Medicaid |
$64.38
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.68
|
Rate for Payer: MI Amish Medical Board Commercial |
$128.89
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91,438.75
|
Rate for Payer: PACE Medicare |
$106.48
|
Rate for Payer: PACE SWMI |
$112.08
|
Rate for Payer: PHP Commercial |
$91,438.75
|
Rate for Payer: PHP Medicare Advantage |
$112.08
|
Rate for Payer: Priority Health Choice Medicaid |
$61.31
|
Rate for Payer: Priority Health Cigna Priority Health |
$75,302.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.20
|
Rate for Payer: Priority Health Medicare |
$112.08
|
Rate for Payer: Priority Health Narrow Network |
$263.36
|
Rate for Payer: Priority Health SBD |
$67,772.25
|
Rate for Payer: Railroad Medicare Medicare |
$112.08
|
Rate for Payer: UHC Dual Complete DSNP |
$112.08
|
Rate for Payer: UHC Medicare Advantage |
$115.44
|
Rate for Payer: UMR Bronson Commercial |
$39,802.75
|
Rate for Payer: VA VA |
$112.08
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80,681.25
|
|
GIVOSIRAN 189 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$107,575.00
|
|
Service Code
|
HCPCS J0223
|
Hospital Charge Code |
192158
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$47,333.00 |
Max. Negotiated Rate |
$96,817.50 |
Rate for Payer: Aetna American Axle |
$69,923.75
|
Rate for Payer: Aetna Commercial |
$91,438.75
|
Rate for Payer: Aetna New Business (MI Preferred) |
$69,923.75
|
Rate for Payer: Cash Price |
$86,060.00
|
Rate for Payer: Cofinity Commercial |
$75,302.50
|
Rate for Payer: Cofinity Commercial |
$92,514.50
|
Rate for Payer: Encore Health Key Benefits Commercial |
$86,060.00
|
Rate for Payer: Healthscope Commercial |
$96,817.50
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75,302.50
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$80,681.25
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91,438.75
|
Rate for Payer: PHP Commercial |
$91,438.75
|
Rate for Payer: Priority Health Cigna Priority Health |
$75,302.50
|
Rate for Payer: Priority Health SBD |
$67,772.25
|
Rate for Payer: UMR Bronson Commercial |
$47,333.00
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80,681.25
|
|
GLASSIA (ALPHA-1-PROTEINASE INHIBITOR) 1 GRAM/50 ML(2 %) IV SOLN
|
Facility
|
IP
|
$1.57
|
|
Service Code
|
HCPCS J0257
|
Hospital Charge Code |
106274
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.69 |
Max. Negotiated Rate |
$1.41 |
Rate for Payer: Aetna American Axle |
$1.02
|
Rate for Payer: Aetna Commercial |
$1.33
|
Rate for Payer: Aetna New Business (MI Preferred) |
$1.02
|
Rate for Payer: Cash Price |
$1.26
|
Rate for Payer: Cofinity Commercial |
$1.10
|
Rate for Payer: Cofinity Commercial |
$1.35
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1.26
|
Rate for Payer: Healthscope Commercial |
$1.41
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.10
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.18
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.33
|
Rate for Payer: PHP Commercial |
$1.33
|
Rate for Payer: Priority Health Cigna Priority Health |
$1.10
|
Rate for Payer: Priority Health SBD |
$0.99
|
Rate for Payer: UMR Bronson Commercial |
$0.69
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.18
|
|
GLASSIA (ALPHA-1-PROTEINASE INHIBITOR) 1 GRAM/50 ML(2 %) IV SOLN
|
Facility
|
OP
|
$1.57
|
|
Service Code
|
HCPCS J0257
|
Hospital Charge Code |
106274
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$0.58 |
Max. Negotiated Rate |
$17.29 |
Rate for Payer: Aetna American Axle |
$1.02
|
Rate for Payer: Aetna Commercial |
$1.33
|
Rate for Payer: Aetna Medicare |
$5.57
|
Rate for Payer: Aetna New Business (MI Preferred) |
$1.02
|
Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.69
|
Rate for Payer: Amish Plain Church Group Commercial |
$6.69
|
Rate for Payer: BCBS Complete |
$3.07
|
Rate for Payer: BCBS MAPPO |
$5.35
|
Rate for Payer: BCBS Trust/PPO |
$17.29
|
Rate for Payer: BCN Medicare Advantage |
$5.35
|
Rate for Payer: Cash Price |
$1.26
|
Rate for Payer: Cash Price |
$1.26
|
Rate for Payer: Cofinity Commercial |
$1.35
|
Rate for Payer: Cofinity Commercial |
$1.10
|
Rate for Payer: Encore Health Key Benefits Commercial |
$1.26
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.35
|
Rate for Payer: Healthscope Commercial |
$1.41
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.10
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.18
|
Rate for Payer: Mclaren Medicaid |
$2.93
|
Rate for Payer: Mclaren Medicare |
$5.35
|
Rate for Payer: Meridian Medicaid |
$3.07
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.62
|
Rate for Payer: MI Amish Medical Board Commercial |
$6.16
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.33
|
Rate for Payer: PACE Medicare |
$5.09
|
Rate for Payer: PACE SWMI |
$5.35
|
Rate for Payer: PHP Commercial |
$1.33
|
Rate for Payer: PHP Medicare Advantage |
$5.35
|
Rate for Payer: Priority Health Choice Medicaid |
$2.93
|
Rate for Payer: Priority Health Cigna Priority Health |
$1.10
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.91
|
Rate for Payer: Priority Health Medicare |
$5.35
|
Rate for Payer: Priority Health Narrow Network |
$12.73
|
Rate for Payer: Priority Health SBD |
$0.99
|
Rate for Payer: Railroad Medicare Medicare |
$5.35
|
Rate for Payer: UHC Dual Complete DSNP |
$5.35
|
Rate for Payer: UHC Medicare Advantage |
$5.51
|
Rate for Payer: UMR Bronson Commercial |
$0.58
|
Rate for Payer: VA VA |
$5.35
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.18
|
|
GLIMEPIRIDE 1 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
Service Code
|
NDC 16729-001-01
|
Hospital Charge Code |
16355
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$85.82 |
Max. Negotiated Rate |
$175.54 |
Rate for Payer: Aetna American Axle |
$126.78
|
Rate for Payer: Aetna Commercial |
$165.79
|
Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
Rate for Payer: Cash Price |
$156.04
|
Rate for Payer: Cofinity Commercial |
$136.54
|
Rate for Payer: Cofinity Commercial |
$167.74
|
Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
Rate for Payer: Healthscope Commercial |
$175.54
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.54
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.79
|
Rate for Payer: PHP Commercial |
$165.79
|
Rate for Payer: Priority Health Cigna Priority Health |
$136.54
|
Rate for Payer: Priority Health SBD |
$122.88
|
Rate for Payer: UMR Bronson Commercial |
$85.82
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|