|
DAPSONE 100 MG TABLET
|
Facility
|
IP
|
$129.17
|
|
|
Service Code
|
NDC 70954013610
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.83 |
| Max. Negotiated Rate |
$116.25 |
| Rate for Payer: Aetna American Axle |
$83.96
|
| Rate for Payer: Aetna Commercial |
$109.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.96
|
| Rate for Payer: Cash Price |
$103.34
|
| Rate for Payer: Cofinity Commercial |
$111.09
|
| Rate for Payer: Cofinity Commercial |
$90.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.34
|
| Rate for Payer: Healthscope Commercial |
$116.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.79
|
| Rate for Payer: PHP Commercial |
$109.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.96
|
| Rate for Payer: Priority Health SBD |
$81.38
|
| Rate for Payer: UMR Bronson Commercial |
$56.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.88
|
|
|
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 Commercial |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.34
|
| 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: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.88
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UMR Bronson Commercial |
$106.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
DAPSONE 100 MG TABLET
|
Facility
|
OP
|
$250.98
|
|
|
Service Code
|
NDC 47781033431
|
| Hospital Charge Code |
2131
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.86 |
| Max. Negotiated Rate |
$225.88 |
| Rate for Payer: Aetna American Axle |
$163.14
|
| Rate for Payer: Aetna Commercial |
$213.33
|
| Rate for Payer: Aetna Medicare |
$125.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.14
|
| Rate for Payer: BCBS Complete |
$100.39
|
| Rate for Payer: Cash Price |
$200.78
|
| Rate for Payer: Cofinity Commercial |
$175.69
|
| Rate for Payer: Cofinity Commercial |
$215.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.69
|
| 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: PHP Commercial |
$213.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.14
|
| Rate for Payer: Priority Health SBD |
$158.12
|
| Rate for Payer: UMR Bronson Commercial |
$92.86
|
| 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 Commercial |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.34
|
| 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: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.88
|
| 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
|
$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 Commercial |
$164.88
|
| Rate for Payer: Cofinity Commercial |
$202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.88
|
| 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: PHP Commercial |
$200.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.11
|
| 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
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$141.08
|
|
|
Service Code
|
NDC 70954013510
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.08 |
| Max. Negotiated Rate |
$126.97 |
| Rate for Payer: Aetna American Axle |
$91.70
|
| Rate for Payer: Aetna Commercial |
$119.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.70
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cofinity Commercial |
$121.33
|
| Rate for Payer: Cofinity Commercial |
$98.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.86
|
| Rate for Payer: Healthscope Commercial |
$126.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.92
|
| Rate for Payer: PHP Commercial |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.70
|
| Rate for Payer: Priority Health SBD |
$88.88
|
| Rate for Payer: UMR Bronson Commercial |
$62.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.81
|
|
|
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 Commercial |
$113.31
|
| Rate for Payer: Cofinity Commercial |
$92.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.23
|
| 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: PHP Commercial |
$112.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.64
|
| Rate for Payer: Priority Health SBD |
$83.01
|
| Rate for Payer: UMR Bronson Commercial |
$48.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.82
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
IP
|
$264.10
|
|
|
Service Code
|
NDC 13925050430
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$237.69 |
| Rate for Payer: Aetna American Axle |
$171.66
|
| Rate for Payer: Aetna Commercial |
$224.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.66
|
| Rate for Payer: Cash Price |
$211.28
|
| Rate for Payer: Cofinity Commercial |
$184.87
|
| Rate for Payer: Cofinity Commercial |
$227.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.28
|
| Rate for Payer: Healthscope Commercial |
$237.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.49
|
| Rate for Payer: PHP Commercial |
$224.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.66
|
| Rate for Payer: Priority Health SBD |
$166.38
|
| Rate for Payer: UMR Bronson Commercial |
$116.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.07
|
|
|
DAPSONE 25 MG TABLET
|
Facility
|
OP
|
$264.10
|
|
|
Service Code
|
NDC 13925050430
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.72 |
| Max. Negotiated Rate |
$237.69 |
| Rate for Payer: Aetna American Axle |
$171.66
|
| Rate for Payer: Aetna Commercial |
$224.49
|
| Rate for Payer: Aetna Medicare |
$132.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.66
|
| Rate for Payer: BCBS Complete |
$105.64
|
| Rate for Payer: Cash Price |
$211.28
|
| Rate for Payer: Cofinity Commercial |
$184.87
|
| Rate for Payer: Cofinity Commercial |
$227.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.28
|
| Rate for Payer: Healthscope Commercial |
$237.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.49
|
| Rate for Payer: PHP Commercial |
$224.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.66
|
| Rate for Payer: Priority Health SBD |
$166.38
|
| Rate for Payer: UMR Bronson Commercial |
$97.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.07
|
|
|
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 Commercial |
$113.31
|
| Rate for Payer: Cofinity Commercial |
$92.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.23
|
| 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: PHP Commercial |
$112.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.64
|
| Rate for Payer: Priority Health SBD |
$83.01
|
| 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 Commercial |
$164.88
|
| Rate for Payer: Cofinity Commercial |
$202.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.88
|
| 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: PHP Commercial |
$200.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.11
|
| Rate for Payer: Priority Health SBD |
$148.40
|
| 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
|
$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 Commercial |
$113.31
|
| Rate for Payer: Cofinity Commercial |
$92.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.23
|
| 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: PHP Commercial |
$112.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.64
|
| 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
|
$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 Commercial |
$113.31
|
| Rate for Payer: Cofinity Commercial |
$92.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.23
|
| 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: PHP Commercial |
$112.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.64
|
| 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
|
$141.08
|
|
|
Service Code
|
NDC 70954013510
|
| Hospital Charge Code |
2132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$126.97 |
| Rate for Payer: Aetna American Axle |
$91.70
|
| Rate for Payer: Aetna Commercial |
$119.92
|
| Rate for Payer: Aetna Medicare |
$70.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.70
|
| Rate for Payer: BCBS Complete |
$56.43
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cofinity Commercial |
$121.33
|
| Rate for Payer: Cofinity Commercial |
$98.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.86
|
| Rate for Payer: Healthscope Commercial |
$126.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.92
|
| Rate for Payer: PHP Commercial |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.70
|
| Rate for Payer: Priority Health SBD |
$88.88
|
| Rate for Payer: UMR Bronson Commercial |
$52.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.81
|
|
|
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 Commercial |
$37.67
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.67
|
| 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: PHP Commercial |
$45.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.98
|
| 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
|
$91.80
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna American Axle |
$36.02
|
| Rate for Payer: Aetna American Axle |
$40.35
|
| Rate for Payer: Aetna American Axle |
$51.12
|
| Rate for Payer: Aetna American Axle |
$43.45
|
| Rate for Payer: Aetna American Axle |
$34.71
|
| Rate for Payer: Aetna American Axle |
$55.69
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Commercial |
$47.10
|
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna Commercial |
$45.39
|
| Rate for Payer: Aetna Commercial |
$66.84
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Commercial |
$56.81
|
| Rate for Payer: Aetna Medicare |
$31.04
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna Medicare |
$39.32
|
| Rate for Payer: Aetna Medicare |
$27.70
|
| Rate for Payer: Aetna Medicare |
$33.42
|
| Rate for Payer: Aetna Medicare |
$26.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.45
|
| Rate for Payer: BCBS Complete |
$26.74
|
| Rate for Payer: BCBS Complete |
$21.36
|
| Rate for Payer: BCBS Complete |
$31.46
|
| Rate for Payer: BCBS Complete |
$24.83
|
| Rate for Payer: BCBS Complete |
$22.16
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Complete |
$34.27
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cash Price |
$44.33
|
| Rate for Payer: Cash Price |
$53.47
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$59.97
|
| Rate for Payer: Cofinity Commercial |
$38.79
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$55.05
|
| Rate for Payer: Cofinity Commercial |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$47.65
|
| Rate for Payer: Cofinity Commercial |
$57.48
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$43.46
|
| Rate for Payer: Cofinity Commercial |
$46.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.91
|
| Rate for Payer: Healthscope Commercial |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$60.16
|
| Rate for Payer: Healthscope Commercial |
$49.87
|
| Rate for Payer: Healthscope Commercial |
$70.78
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.97
|
| 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: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: PHP Commercial |
$66.84
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$47.10
|
| Rate for Payer: PHP Commercial |
$45.39
|
| Rate for Payer: PHP Commercial |
$56.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.02
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: Priority Health SBD |
$53.97
|
| Rate for Payer: Priority Health SBD |
$42.11
|
| Rate for Payer: Priority Health SBD |
$39.11
|
| Rate for Payer: Priority Health SBD |
$49.54
|
| Rate for Payer: Priority Health SBD |
$33.64
|
| Rate for Payer: Priority Health SBD |
$34.91
|
| Rate for Payer: UMR Bronson Commercial |
$20.50
|
| Rate for Payer: UMR Bronson Commercial |
$24.73
|
| Rate for Payer: UMR Bronson Commercial |
$22.97
|
| Rate for Payer: UMR Bronson Commercial |
$19.76
|
| Rate for Payer: UMR Bronson Commercial |
$31.70
|
| Rate for Payer: UMR Bronson Commercial |
$29.10
|
| Rate for Payer: UMR Bronson Commercial |
$33.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.05
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53.81
|
|
|
Service Code
|
HCPCS J0873
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.02
|
| Rate for Payer: BCBS MAPPO |
$0.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.04
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Cofinity Commercial |
$37.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.04
|
| 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: Mclaren Medicaid |
$0.02
|
| Rate for Payer: Mclaren Medicare |
$0.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.04
|
| Rate for Payer: Meridian Medicaid |
$0.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.74
|
| Rate for Payer: PACE Medicare |
$0.04
|
| Rate for Payer: PACE SWMI |
$0.04
|
| Rate for Payer: PHP Commercial |
$45.74
|
| Rate for Payer: PHP Medicare Advantage |
$0.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.98
|
| Rate for Payer: Priority Health Medicare |
$0.04
|
| Rate for Payer: Priority Health SBD |
$33.90
|
| Rate for Payer: Railroad Medicare Medicare |
$0.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.04
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Medicare Advantage |
$0.04
|
| Rate for Payer: UHCCP Medicaid |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$19.91
|
| Rate for Payer: VA VA |
$0.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.36
|
|
|
DAPTOMYCIN 350 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$53.40
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
186972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$48.06 |
| Rate for Payer: Aetna American Axle |
$34.71
|
| Rate for Payer: Aetna American Axle |
$55.69
|
| Rate for Payer: Aetna American Axle |
$51.12
|
| Rate for Payer: Aetna American Axle |
$36.02
|
| Rate for Payer: Aetna American Axle |
$40.35
|
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$45.39
|
| Rate for Payer: Aetna Commercial |
$47.10
|
| Rate for Payer: Aetna Commercial |
$66.84
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Commercial |
$72.82
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.71
|
| 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) |
$51.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$44.33
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$55.05
|
| Rate for Payer: Cofinity Commercial |
$43.46
|
| Rate for Payer: Cofinity Commercial |
$38.79
|
| Rate for Payer: Cofinity Commercial |
$47.65
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$59.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.91
|
| 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 |
$70.78
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$49.87
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Healthscope Commercial |
$48.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.25
|
| 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 |
$40.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$45.39
|
| Rate for Payer: PHP Commercial |
$47.10
|
| Rate for Payer: PHP Commercial |
$66.84
|
| Rate for Payer: PHP Commercial |
$72.82
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$53.97
|
| Rate for Payer: Priority Health SBD |
$49.54
|
| Rate for Payer: Priority Health SBD |
$33.64
|
| Rate for Payer: Priority Health SBD |
$34.91
|
| Rate for Payer: Priority Health SBD |
$39.11
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UMR Bronson Commercial |
$40.39
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
| Rate for Payer: UMR Bronson Commercial |
$27.32
|
| Rate for Payer: UMR Bronson Commercial |
$37.69
|
| Rate for Payer: UMR Bronson Commercial |
$34.60
|
| Rate for Payer: UMR Bronson Commercial |
$23.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| 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 |
$40.05
|
|
|
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 Commercial |
$52.15
|
| Rate for Payer: Cofinity Commercial |
$64.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.15
|
| 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: PHP Commercial |
$63.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.42
|
| 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
|
$74.50
|
|
|
Service Code
|
HCPCS J0873
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| 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 |
$0.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.02
|
| Rate for Payer: BCBS MAPPO |
$0.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.04
|
| Rate for Payer: Cash Price |
$59.60
|
| Rate for Payer: Cash Price |
$59.60
|
| Rate for Payer: Cofinity Commercial |
$64.07
|
| Rate for Payer: Cofinity Commercial |
$52.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.04
|
| 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: Mclaren Medicaid |
$0.02
|
| Rate for Payer: Mclaren Medicare |
$0.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.04
|
| Rate for Payer: Meridian Medicaid |
$0.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.33
|
| Rate for Payer: PACE Medicare |
$0.04
|
| Rate for Payer: PACE SWMI |
$0.04
|
| Rate for Payer: PHP Commercial |
$63.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.42
|
| Rate for Payer: Priority Health Medicare |
$0.04
|
| Rate for Payer: Priority Health SBD |
$46.94
|
| Rate for Payer: Railroad Medicare Medicare |
$0.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.04
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Medicare Advantage |
$0.04
|
| Rate for Payer: UHCCP Medicaid |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$27.57
|
| Rate for Payer: VA VA |
$0.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.88
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,333.32
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$493.33 |
| Max. Negotiated Rate |
$1,199.99 |
| Rate for Payer: Aetna American Axle |
$866.66
|
| Rate for Payer: Aetna American Axle |
$56.09
|
| Rate for Payer: Aetna American Axle |
$55.83
|
| Rate for Payer: Aetna American Axle |
$56.26
|
| Rate for Payer: Aetna American Axle |
$41.74
|
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna American Axle |
$83.97
|
| Rate for Payer: Aetna American Axle |
$61.27
|
| Rate for Payer: Aetna American Axle |
$37.66
|
| Rate for Payer: Aetna American Axle |
$864.08
|
| Rate for Payer: Aetna Commercial |
$1,129.95
|
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: Aetna Commercial |
$109.81
|
| Rate for Payer: Aetna Commercial |
$73.58
|
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Aetna Commercial |
$1,133.32
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Commercial |
$73.35
|
| Rate for Payer: Aetna Commercial |
$49.25
|
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: Aetna Medicare |
$64.59
|
| Rate for Payer: Aetna Medicare |
$666.66
|
| Rate for Payer: Aetna Medicare |
$43.28
|
| Rate for Payer: Aetna Medicare |
$43.15
|
| Rate for Payer: Aetna Medicare |
$47.13
|
| Rate for Payer: Aetna Medicare |
$32.11
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna Medicare |
$42.95
|
| Rate for Payer: Aetna Medicare |
$664.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.08
|
| 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) |
$83.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.83
|
| Rate for Payer: BCBS Complete |
$51.68
|
| Rate for Payer: BCBS Complete |
$37.70
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: BCBS Complete |
$531.74
|
| Rate for Payer: BCBS Complete |
$34.36
|
| Rate for Payer: BCBS Complete |
$25.69
|
| Rate for Payer: BCBS Complete |
$533.33
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS Complete |
$34.62
|
| Rate for Payer: BCBS Complete |
$34.52
|
| Rate for Payer: Cash Price |
$46.35
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cash Price |
$69.25
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Cofinity Commercial |
$60.12
|
| Rate for Payer: Cofinity Commercial |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$933.32
|
| Rate for Payer: Cofinity Commercial |
$111.10
|
| Rate for Payer: Cofinity Commercial |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$44.95
|
| Rate for Payer: Cofinity Commercial |
$55.23
|
| Rate for Payer: Cofinity Commercial |
$40.56
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$49.83
|
| Rate for Payer: Cofinity Commercial |
$930.54
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$90.43
|
| Rate for Payer: Cofinity Commercial |
$81.06
|
| Rate for Payer: Cofinity Commercial |
$1,143.24
|
| Rate for Payer: Cofinity Commercial |
$1,146.66
|
| Rate for Payer: Cofinity Commercial |
$74.44
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$933.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$930.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.41
|
| 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 |
$51.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.25
|
| Rate for Payer: Healthscope Commercial |
$57.80
|
| Rate for Payer: Healthscope Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$77.90
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$52.15
|
| Rate for Payer: Healthscope Commercial |
$84.83
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$1,196.41
|
| Rate for Payer: Healthscope Commercial |
$116.27
|
| Rate for Payer: Healthscope Commercial |
$1,199.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$933.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$999.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.35
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$1,129.95
|
| Rate for Payer: PHP Commercial |
$109.81
|
| Rate for Payer: PHP Commercial |
$73.35
|
| Rate for Payer: PHP Commercial |
$80.12
|
| Rate for Payer: PHP Commercial |
$1,133.32
|
| Rate for Payer: PHP Commercial |
$73.58
|
| Rate for Payer: PHP Commercial |
$54.59
|
| Rate for Payer: PHP Commercial |
$49.25
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.83
|
| Rate for Payer: Priority Health SBD |
$40.46
|
| Rate for Payer: Priority Health SBD |
$36.50
|
| Rate for Payer: Priority Health SBD |
$54.11
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: Priority Health SBD |
$54.53
|
| Rate for Payer: Priority Health SBD |
$59.38
|
| Rate for Payer: Priority Health SBD |
$839.99
|
| Rate for Payer: Priority Health SBD |
$81.39
|
| Rate for Payer: Priority Health SBD |
$837.49
|
| Rate for Payer: UMR Bronson Commercial |
$31.78
|
| Rate for Payer: UMR Bronson Commercial |
$21.44
|
| Rate for Payer: UMR Bronson Commercial |
$31.93
|
| Rate for Payer: UMR Bronson Commercial |
$32.03
|
| Rate for Payer: UMR Bronson Commercial |
$23.76
|
| Rate for Payer: UMR Bronson Commercial |
$491.86
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: UMR Bronson Commercial |
$47.80
|
| Rate for Payer: UMR Bronson Commercial |
$493.33
|
| Rate for Payer: UMR Bronson Commercial |
$34.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$999.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.92
|
|
|
DAPTOMYCIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$86.56
|
|
|
Service Code
|
HCPCS J0878
|
| Hospital Charge Code |
36989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna American Axle |
$56.26
|
| Rate for Payer: Aetna American Axle |
$56.09
|
| Rate for Payer: Aetna American Axle |
$55.83
|
| Rate for Payer: Aetna American Axle |
$866.66
|
| Rate for Payer: Aetna American Axle |
$83.97
|
| Rate for Payer: Aetna American Axle |
$864.08
|
| Rate for Payer: Aetna American Axle |
$41.74
|
| Rate for Payer: Aetna American Axle |
$61.27
|
| Rate for Payer: Aetna Commercial |
$80.12
|
| Rate for Payer: Aetna Commercial |
$73.58
|
| Rate for Payer: Aetna Commercial |
$1,133.32
|
| Rate for Payer: Aetna Commercial |
$54.59
|
| Rate for Payer: Aetna Commercial |
$1,129.95
|
| Rate for Payer: Aetna Commercial |
$109.81
|
| Rate for Payer: Aetna Commercial |
$73.35
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.83
|
| Rate for Payer: Cash Price |
$51.38
|
| Rate for Payer: Cash Price |
$69.25
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cash Price |
$75.41
|
| Rate for Payer: Cash Price |
$1,063.48
|
| Rate for Payer: Cash Price |
$1,066.66
|
| Rate for Payer: Cash Price |
$103.35
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cofinity Commercial |
$55.23
|
| Rate for Payer: Cofinity Commercial |
$111.10
|
| Rate for Payer: Cofinity Commercial |
$44.95
|
| Rate for Payer: Cofinity Commercial |
$1,146.66
|
| Rate for Payer: Cofinity Commercial |
$1,143.24
|
| Rate for Payer: Cofinity Commercial |
$930.54
|
| Rate for Payer: Cofinity Commercial |
$933.32
|
| Rate for Payer: Cofinity Commercial |
$90.43
|
| Rate for Payer: Cofinity Commercial |
$60.12
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Cofinity Commercial |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$60.59
|
| Rate for Payer: Cofinity Commercial |
$74.44
|
| Rate for Payer: Cofinity Commercial |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$81.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$930.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$933.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,063.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,066.66
|
| Rate for Payer: Healthscope Commercial |
$116.27
|
| Rate for Payer: Healthscope Commercial |
$84.83
|
| Rate for Payer: Healthscope Commercial |
$77.90
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Healthscope Commercial |
$77.66
|
| Rate for Payer: Healthscope Commercial |
$57.80
|
| Rate for Payer: Healthscope Commercial |
$1,199.99
|
| Rate for Payer: Healthscope Commercial |
$1,196.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$933.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$930.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$997.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$999.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.32
|
| Rate for Payer: PHP Commercial |
$73.58
|
| Rate for Payer: PHP Commercial |
$1,133.32
|
| Rate for Payer: PHP Commercial |
$73.35
|
| Rate for Payer: PHP Commercial |
$54.59
|
| Rate for Payer: PHP Commercial |
$80.12
|
| Rate for Payer: PHP Commercial |
$109.81
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: PHP Commercial |
$1,129.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.66
|
| Rate for Payer: Priority Health SBD |
$839.99
|
| Rate for Payer: Priority Health SBD |
$837.49
|
| Rate for Payer: Priority Health SBD |
$81.39
|
| Rate for Payer: Priority Health SBD |
$40.46
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: Priority Health SBD |
$54.11
|
| Rate for Payer: Priority Health SBD |
$59.38
|
| Rate for Payer: Priority Health SBD |
$54.53
|
| Rate for Payer: UMR Bronson Commercial |
$586.66
|
| Rate for Payer: UMR Bronson Commercial |
$28.26
|
| Rate for Payer: UMR Bronson Commercial |
$37.97
|
| Rate for Payer: UMR Bronson Commercial |
$38.09
|
| Rate for Payer: UMR Bronson Commercial |
$584.91
|
| Rate for Payer: UMR Bronson Commercial |
$41.47
|
| Rate for Payer: UMR Bronson Commercial |
$37.79
|
| Rate for Payer: UMR Bronson Commercial |
$56.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$999.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$997.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.42
|
|
|
DARATUMUMAB 1,800 MG-HYALURONIDASE-FIHJ 30,000 UNIT/15 ML SUBCUT SOLN
|
Facility
|
OP
|
$44,776.64
|
|
|
Service Code
|
HCPCS J9144
|
| Hospital Charge Code |
193506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.79 |
| Max. Negotiated Rate |
$40,298.98 |
| Rate for Payer: Aetna American Axle |
$29,104.82
|
| Rate for Payer: Aetna Commercial |
$38,060.14
|
| Rate for Payer: Aetna Medicare |
$57.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29,104.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.46
|
| Rate for Payer: BCBS Complete |
$31.27
|
| Rate for Payer: BCBS MAPPO |
$55.57
|
| Rate for Payer: BCN Medicare Advantage |
$55.57
|
| Rate for Payer: Cash Price |
$35,821.31
|
| Rate for Payer: Cash Price |
$35,821.31
|
| Rate for Payer: Cofinity Commercial |
$31,343.65
|
| Rate for Payer: Cofinity Commercial |
$38,507.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$31,343.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,821.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.57
|
| Rate for Payer: Healthscope Commercial |
$40,298.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31,343.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33,582.48
|
| Rate for Payer: Mclaren Medicaid |
$29.79
|
| Rate for Payer: Mclaren Medicare |
$55.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.35
|
| Rate for Payer: Meridian Medicaid |
$31.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38,060.14
|
| Rate for Payer: PACE Medicare |
$52.79
|
| Rate for Payer: PACE SWMI |
$55.57
|
| Rate for Payer: PHP Commercial |
$38,060.14
|
| Rate for Payer: PHP Medicare Advantage |
$55.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29,104.82
|
| Rate for Payer: Priority Health Medicare |
$55.57
|
| Rate for Payer: Priority Health SBD |
$28,209.28
|
| Rate for Payer: Railroad Medicare Medicare |
$55.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.57
|
| Rate for Payer: UHC Exchange |
$106.20
|
| Rate for Payer: UHC Medicare Advantage |
$55.57
|
| Rate for Payer: UHCCP Medicaid |
$29.79
|
| Rate for Payer: UMR Bronson Commercial |
$16,567.36
|
| Rate for Payer: VA VA |
$55.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33,582.48
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,341.28
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,030.16 |
| Max. Negotiated Rate |
$2,107.15 |
| Rate for Payer: Aetna American Axle |
$1,521.83
|
| Rate for Payer: Aetna American Axle |
$4,945.95
|
| Rate for Payer: Aetna American Axle |
$4,970.80
|
| Rate for Payer: Aetna Commercial |
$6,467.79
|
| Rate for Payer: Aetna Commercial |
$1,990.09
|
| Rate for Payer: Aetna Commercial |
$6,500.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,521.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,970.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,945.95
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cash Price |
$6,087.33
|
| Rate for Payer: Cash Price |
$1,873.02
|
| Rate for Payer: Cofinity Commercial |
$2,013.50
|
| Rate for Payer: Cofinity Commercial |
$6,543.88
|
| Rate for Payer: Cofinity Commercial |
$5,326.41
|
| Rate for Payer: Cofinity Commercial |
$6,576.75
|
| Rate for Payer: Cofinity Commercial |
$5,353.17
|
| Rate for Payer: Cofinity Commercial |
$1,638.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,326.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,638.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,353.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,117.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,873.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,087.33
|
| Rate for Payer: Healthscope Commercial |
$6,848.24
|
| Rate for Payer: Healthscope Commercial |
$2,107.15
|
| Rate for Payer: Healthscope Commercial |
$6,882.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,638.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,326.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,353.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,706.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,755.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,735.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,990.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,500.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,467.79
|
| Rate for Payer: PHP Commercial |
$6,500.27
|
| Rate for Payer: PHP Commercial |
$6,467.79
|
| Rate for Payer: PHP Commercial |
$1,990.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,945.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,970.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,521.83
|
| Rate for Payer: Priority Health SBD |
$4,817.85
|
| Rate for Payer: Priority Health SBD |
$4,793.77
|
| Rate for Payer: Priority Health SBD |
$1,475.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,030.16
|
| Rate for Payer: UMR Bronson Commercial |
$3,364.85
|
| Rate for Payer: UMR Bronson Commercial |
$3,348.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,735.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,755.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,706.87
|
|
|
DARATUMUMAB 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,341.28
|
|
|
Service Code
|
HCPCS J9145
|
| Hospital Charge Code |
176546
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$2,107.15 |
| Rate for Payer: Aetna American Axle |
$1,521.83
|
| Rate for Payer: Aetna American Axle |
$1,529.49
|
| Rate for Payer: Aetna American Axle |
$4,970.80
|
| Rate for Payer: Aetna American Axle |
$4,945.95
|
| Rate for Payer: Aetna Commercial |
$6,500.27
|
| Rate for Payer: Aetna Commercial |
$1,990.09
|
| Rate for Payer: Aetna Commercial |
$2,000.10
|
| Rate for Payer: Aetna Commercial |
$6,467.79
|
| Rate for Payer: Aetna Medicare |
$74.22
|
| Rate for Payer: Aetna Medicare |
$74.22
|
| Rate for Payer: Aetna Medicare |
$74.22
|
| Rate for Payer: Aetna Medicare |
$74.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,945.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,521.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,970.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,529.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.21
|
| Rate for Payer: BCBS Complete |
$40.17
|
| Rate for Payer: BCBS Complete |
$40.17
|
| Rate for Payer: BCBS Complete |
$40.17
|
| Rate for Payer: BCBS Complete |
$40.17
|
| Rate for Payer: BCBS MAPPO |
$71.37
|
| Rate for Payer: BCBS MAPPO |
$71.37
|
| Rate for Payer: BCBS MAPPO |
$71.37
|
| Rate for Payer: BCBS MAPPO |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$71.37
|
| Rate for Payer: Cash Price |
$6,087.33
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cash Price |
$6,087.33
|
| Rate for Payer: Cash Price |
$1,882.45
|
| Rate for Payer: Cash Price |
$1,873.02
|
| Rate for Payer: Cash Price |
$1,882.45
|
| Rate for Payer: Cash Price |
$6,117.90
|
| Rate for Payer: Cash Price |
$1,873.02
|
| Rate for Payer: Cofinity Commercial |
$2,023.63
|
| Rate for Payer: Cofinity Commercial |
$1,638.90
|
| Rate for Payer: Cofinity Commercial |
$2,013.50
|
| Rate for Payer: Cofinity Commercial |
$1,647.14
|
| Rate for Payer: Cofinity Commercial |
$6,576.75
|
| Rate for Payer: Cofinity Commercial |
$5,353.17
|
| Rate for Payer: Cofinity Commercial |
$5,326.41
|
| Rate for Payer: Cofinity Commercial |
$6,543.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,638.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,326.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,353.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,647.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,087.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,873.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,117.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,882.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.37
|
| Rate for Payer: Healthscope Commercial |
$2,107.15
|
| Rate for Payer: Healthscope Commercial |
$2,117.75
|
| Rate for Payer: Healthscope Commercial |
$6,882.64
|
| Rate for Payer: Healthscope Commercial |
$6,848.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,647.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,353.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,326.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,638.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,764.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,735.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,755.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,706.87
|
| Rate for Payer: Mclaren Medicaid |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$38.25
|
| Rate for Payer: Mclaren Medicare |
$71.37
|
| Rate for Payer: Mclaren Medicare |
$71.37
|
| Rate for Payer: Mclaren Medicare |
$71.37
|
| Rate for Payer: Mclaren Medicare |
$71.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.94
|
| Rate for Payer: Meridian Medicaid |
$40.17
|
| Rate for Payer: Meridian Medicaid |
$40.17
|
| Rate for Payer: Meridian Medicaid |
$40.17
|
| Rate for Payer: Meridian Medicaid |
$40.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,990.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,500.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,467.79
|
| Rate for Payer: PACE Medicare |
$67.80
|
| Rate for Payer: PACE Medicare |
$67.80
|
| Rate for Payer: PACE Medicare |
$67.80
|
| Rate for Payer: PACE Medicare |
$67.80
|
| Rate for Payer: PACE SWMI |
$71.37
|
| Rate for Payer: PACE SWMI |
$71.37
|
| Rate for Payer: PACE SWMI |
$71.37
|
| Rate for Payer: PACE SWMI |
$71.37
|
| Rate for Payer: PHP Commercial |
$6,467.79
|
| Rate for Payer: PHP Commercial |
$1,990.09
|
| Rate for Payer: PHP Commercial |
$2,000.10
|
| Rate for Payer: PHP Commercial |
$6,500.27
|
| Rate for Payer: PHP Medicare Advantage |
$71.37
|
| Rate for Payer: PHP Medicare Advantage |
$71.37
|
| Rate for Payer: PHP Medicare Advantage |
$71.37
|
| Rate for Payer: PHP Medicare Advantage |
$71.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,945.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,970.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,521.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,529.49
|
| Rate for Payer: Priority Health Medicare |
$71.37
|
| Rate for Payer: Priority Health Medicare |
$71.37
|
| Rate for Payer: Priority Health Medicare |
$71.37
|
| Rate for Payer: Priority Health Medicare |
$71.37
|
| Rate for Payer: Priority Health SBD |
$1,482.43
|
| Rate for Payer: Priority Health SBD |
$4,793.77
|
| Rate for Payer: Priority Health SBD |
$1,475.01
|
| Rate for Payer: Priority Health SBD |
$4,817.85
|
| Rate for Payer: Railroad Medicare Medicare |
$71.37
|
| Rate for Payer: Railroad Medicare Medicare |
$71.37
|
| Rate for Payer: Railroad Medicare Medicare |
$71.37
|
| Rate for Payer: Railroad Medicare Medicare |
$71.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.37
|
| Rate for Payer: UHC Exchange |
$136.40
|
| Rate for Payer: UHC Exchange |
$136.40
|
| Rate for Payer: UHC Exchange |
$136.40
|
| Rate for Payer: UHC Exchange |
$136.40
|
| Rate for Payer: UHC Medicare Advantage |
$71.37
|
| Rate for Payer: UHC Medicare Advantage |
$71.37
|
| Rate for Payer: UHC Medicare Advantage |
$71.37
|
| Rate for Payer: UHC Medicare Advantage |
$71.37
|
| Rate for Payer: UHCCP Medicaid |
$38.25
|
| Rate for Payer: UHCCP Medicaid |
$38.25
|
| Rate for Payer: UHCCP Medicaid |
$38.25
|
| Rate for Payer: UHCCP Medicaid |
$38.25
|
| Rate for Payer: UMR Bronson Commercial |
$2,815.39
|
| Rate for Payer: UMR Bronson Commercial |
$870.63
|
| Rate for Payer: UMR Bronson Commercial |
$866.27
|
| Rate for Payer: UMR Bronson Commercial |
$2,829.53
|
| Rate for Payer: VA VA |
$71.37
|
| Rate for Payer: VA VA |
$71.37
|
| Rate for Payer: VA VA |
$71.37
|
| Rate for Payer: VA VA |
$71.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,755.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,764.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,706.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,735.53
|
|
