|
ELECTIVE KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$8,903.12
|
|
|
Service Code
|
APR-DRG 3261
|
| Min. Negotiated Rate |
$8,479.16 |
| Max. Negotiated Rate |
$8,903.12 |
| Rate for Payer: BCBS Complete |
$8,903.12
|
| Rate for Payer: Mclaren Medicaid |
$8,479.16
|
| Rate for Payer: Meridian Medicaid |
$8,903.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,479.16
|
| Rate for Payer: UHC Medicaid |
$8,479.16
|
| Rate for Payer: UHCCP Medicaid |
$8,479.16
|
|
|
ELECTIVE KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$10,225.76
|
|
|
Service Code
|
APR-DRG 3262
|
| Min. Negotiated Rate |
$9,738.81 |
| Max. Negotiated Rate |
$10,225.76 |
| Rate for Payer: BCBS Complete |
$10,225.76
|
| Rate for Payer: Mclaren Medicaid |
$9,738.81
|
| Rate for Payer: Meridian Medicaid |
$10,225.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,738.81
|
| Rate for Payer: UHC Medicaid |
$9,738.81
|
| Rate for Payer: UHCCP Medicaid |
$9,738.81
|
|
|
ELECTIVE KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$22,349.81
|
|
|
Service Code
|
APR-DRG 3264
|
| Min. Negotiated Rate |
$21,285.53 |
| Max. Negotiated Rate |
$22,349.81 |
| Rate for Payer: BCBS Complete |
$22,349.81
|
| Rate for Payer: Mclaren Medicaid |
$21,285.53
|
| Rate for Payer: Meridian Medicaid |
$22,349.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,285.53
|
| Rate for Payer: UHC Medicaid |
$21,285.53
|
| Rate for Payer: UHCCP Medicaid |
$21,285.53
|
|
|
ELECTIVE KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$13,487.25
|
|
|
Service Code
|
APR-DRG 3263
|
| Min. Negotiated Rate |
$12,845.00 |
| Max. Negotiated Rate |
$13,487.25 |
| Rate for Payer: BCBS Complete |
$13,487.25
|
| Rate for Payer: Mclaren Medicaid |
$12,845.00
|
| Rate for Payer: Meridian Medicaid |
$13,487.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,845.00
|
| Rate for Payer: UHC Medicaid |
$12,845.00
|
| Rate for Payer: UHCCP Medicaid |
$12,845.00
|
|
|
ELECTROLYTE-A INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
28113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.10
|
| Rate for Payer: UHC Core |
$24.93
|
| Rate for Payer: UHC Exchange |
$18.81
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
ELECTROLYTE-A INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
28113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
ELECTROLYTE-A IV - BOLUS
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
168933
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.10
|
| Rate for Payer: UHC Core |
$24.93
|
| Rate for Payer: UHC Exchange |
$18.81
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
ELECTROLYTE-A IV - BOLUS
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
168933
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
ELECTROLYTE-A IV - DKA
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
168932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$23.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.10
|
| Rate for Payer: UHC Core |
$24.93
|
| Rate for Payer: UHC Exchange |
$18.81
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
ELECTROLYTE-A IV - DKA
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338022104
|
| Hospital Charge Code |
168932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Advantage |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
ELECTROLYTE-R INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$95.70
|
|
|
Service Code
|
NDC 00990796709
|
| Hospital Charge Code |
28115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.11 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Aetna American Axle |
$62.20
|
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.20
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Advantage |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.78
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: Priority Health SBD |
$60.29
|
| Rate for Payer: UMR Bronson Commercial |
$42.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
|
|
ELECTROLYTE-R INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$95.70
|
|
|
Service Code
|
NDC 00990796709
|
| Hospital Charge Code |
28115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Aetna American Axle |
$62.20
|
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna Medicare |
$47.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.20
|
| Rate for Payer: BCBS Complete |
$38.28
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Advantage |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.78
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: Priority Health SBD |
$60.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.20
|
| Rate for Payer: UHC Core |
$49.86
|
| Rate for Payer: UHC Exchange |
$37.61
|
| Rate for Payer: UMR Bronson Commercial |
$35.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
|
|
ELOSULFASE ALFA 5 MG/5 ML (1 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,932.56
|
|
|
Service Code
|
HCPCS J1322
|
| Hospital Charge Code |
169847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.15 |
| Max. Negotiated Rate |
$6,239.30 |
| Rate for Payer: Aetna American Axle |
$4,506.16
|
| Rate for Payer: Aetna Commercial |
$5,892.68
|
| Rate for Payer: Aetna Medicare |
$324.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,506.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$389.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$389.94
|
| Rate for Payer: BCBS Complete |
$171.32
|
| Rate for Payer: BCBS MAPPO |
$311.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.49
|
| Rate for Payer: BCN Commercial |
$1,011.49
|
| Rate for Payer: BCN Medicare Advantage |
$311.95
|
| Rate for Payer: Cash Price |
$5,546.05
|
| Rate for Payer: Cash Price |
$5,546.05
|
| Rate for Payer: Cofinity Advantage |
$4,852.79
|
| Rate for Payer: Cofinity Commercial |
$5,962.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,546.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.95
|
| Rate for Payer: Healthscope Commercial |
$6,239.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,852.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,199.42
|
| Rate for Payer: Mclaren Medicaid |
$311.95
|
| Rate for Payer: Mclaren Medicare |
$311.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$327.55
|
| Rate for Payer: Meridian Medicaid |
$327.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$358.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$343.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,892.68
|
| Rate for Payer: Nomi Health Commercial |
$935.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,199.42
|
| Rate for Payer: PACE Medicare |
$296.35
|
| Rate for Payer: PACE SWMI |
$311.95
|
| Rate for Payer: PHP Commercial |
$5,892.68
|
| Rate for Payer: PHP Medicare Advantage |
$311.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$973.57
|
| Rate for Payer: Priority Health Medicare |
$311.95
|
| Rate for Payer: Priority Health SBD |
$4,367.51
|
| Rate for Payer: Priority Health Tiered Network |
$778.86
|
| Rate for Payer: Railroad Medicare Medicare |
$311.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.70
|
| Rate for Payer: UHC Core |
$514.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$311.95
|
| Rate for Payer: UHC Exchange |
$514.70
|
| Rate for Payer: UHC Medicaid |
$163.15
|
| Rate for Payer: UHCCP Medicaid |
$163.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,565.05
|
| Rate for Payer: VA VA |
$311.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,199.42
|
|
|
ELOSULFASE ALFA 5 MG/5 ML (1 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,932.56
|
|
|
Service Code
|
HCPCS J1322
|
| Hospital Charge Code |
169847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,050.33 |
| Max. Negotiated Rate |
$6,239.30 |
| Rate for Payer: Aetna American Axle |
$4,506.16
|
| Rate for Payer: Aetna Commercial |
$5,892.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,506.16
|
| Rate for Payer: Cash Price |
$5,546.05
|
| Rate for Payer: Cofinity Advantage |
$4,852.79
|
| Rate for Payer: Cofinity Commercial |
$5,962.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,546.05
|
| Rate for Payer: Healthscope Commercial |
$6,239.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,852.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,199.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,892.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,199.42
|
| Rate for Payer: PHP Commercial |
$5,892.68
|
| Rate for Payer: Priority Health SBD |
$4,367.51
|
| Rate for Payer: UMR Bronson Commercial |
$3,050.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,199.42
|
|
|
ELOTUZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,155.74
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
176616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$5,540.17 |
| Rate for Payer: Aetna American Axle |
$4,001.23
|
| Rate for Payer: Aetna Commercial |
$5,232.38
|
| Rate for Payer: Aetna Medicare |
$8.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,001.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.05
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$8.04
|
| Rate for Payer: BCBS Trust/PPO |
$26.03
|
| Rate for Payer: BCN Commercial |
$26.03
|
| Rate for Payer: BCN Medicare Advantage |
$8.04
|
| Rate for Payer: Cash Price |
$4,924.59
|
| Rate for Payer: Cash Price |
$4,924.59
|
| Rate for Payer: Cofinity Advantage |
$4,309.02
|
| Rate for Payer: Cofinity Commercial |
$5,293.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,924.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.04
|
| Rate for Payer: Healthscope Commercial |
$5,540.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,309.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,616.81
|
| Rate for Payer: Mclaren Medicaid |
$8.04
|
| Rate for Payer: Mclaren Medicare |
$8.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.44
|
| Rate for Payer: Meridian Medicaid |
$8.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,232.38
|
| Rate for Payer: Nomi Health Commercial |
$24.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,616.81
|
| Rate for Payer: PACE Medicare |
$7.64
|
| Rate for Payer: PACE SWMI |
$8.04
|
| Rate for Payer: PHP Commercial |
$5,232.38
|
| Rate for Payer: PHP Medicare Advantage |
$8.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.88
|
| Rate for Payer: Priority Health Medicare |
$8.04
|
| Rate for Payer: Priority Health SBD |
$3,878.12
|
| Rate for Payer: Priority Health Tiered Network |
$19.90
|
| Rate for Payer: Railroad Medicare Medicare |
$8.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.27
|
| Rate for Payer: UHC Core |
$13.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.04
|
| Rate for Payer: UHC Exchange |
$13.27
|
| Rate for Payer: UHC Medicaid |
$4.20
|
| Rate for Payer: UHCCP Medicaid |
$4.20
|
| Rate for Payer: UMR Bronson Commercial |
$2,277.62
|
| Rate for Payer: VA VA |
$8.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,616.81
|
|
|
ELOTUZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,155.74
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
176616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,708.53 |
| Max. Negotiated Rate |
$5,540.17 |
| Rate for Payer: Aetna American Axle |
$4,001.23
|
| Rate for Payer: Aetna Commercial |
$5,232.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,001.23
|
| Rate for Payer: Cash Price |
$4,924.59
|
| Rate for Payer: Cofinity Advantage |
$4,309.02
|
| Rate for Payer: Cofinity Commercial |
$5,293.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,924.59
|
| Rate for Payer: Healthscope Commercial |
$5,540.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,309.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,616.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,232.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,616.81
|
| Rate for Payer: PHP Commercial |
$5,232.38
|
| Rate for Payer: Priority Health SBD |
$3,878.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,708.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,616.81
|
|
|
ELOTUZUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$8,207.58
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
176617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$7,386.82 |
| Rate for Payer: Aetna American Axle |
$5,334.93
|
| Rate for Payer: Aetna Commercial |
$6,976.44
|
| Rate for Payer: Aetna Medicare |
$8.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,334.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.05
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$8.04
|
| Rate for Payer: BCBS Trust/PPO |
$26.03
|
| Rate for Payer: BCN Commercial |
$26.03
|
| Rate for Payer: BCN Medicare Advantage |
$8.04
|
| Rate for Payer: Cash Price |
$6,566.06
|
| Rate for Payer: Cash Price |
$6,566.06
|
| Rate for Payer: Cofinity Advantage |
$5,745.31
|
| Rate for Payer: Cofinity Commercial |
$7,058.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,566.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.04
|
| Rate for Payer: Healthscope Commercial |
$7,386.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,745.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,155.69
|
| Rate for Payer: Mclaren Medicaid |
$8.04
|
| Rate for Payer: Mclaren Medicare |
$8.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.44
|
| Rate for Payer: Meridian Medicaid |
$8.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,976.44
|
| Rate for Payer: Nomi Health Commercial |
$24.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,155.69
|
| Rate for Payer: PACE Medicare |
$7.64
|
| Rate for Payer: PACE SWMI |
$8.04
|
| Rate for Payer: PHP Commercial |
$6,976.44
|
| Rate for Payer: PHP Medicare Advantage |
$8.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.88
|
| Rate for Payer: Priority Health Medicare |
$8.04
|
| Rate for Payer: Priority Health SBD |
$5,170.78
|
| Rate for Payer: Priority Health Tiered Network |
$19.90
|
| Rate for Payer: Railroad Medicare Medicare |
$8.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.27
|
| Rate for Payer: UHC Core |
$13.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.04
|
| Rate for Payer: UHC Exchange |
$13.27
|
| Rate for Payer: UHC Medicaid |
$4.20
|
| Rate for Payer: UHCCP Medicaid |
$4.20
|
| Rate for Payer: UMR Bronson Commercial |
$3,036.80
|
| Rate for Payer: VA VA |
$8.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,155.69
|
|
|
ELOTUZUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$8,207.58
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
176617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,611.34 |
| Max. Negotiated Rate |
$7,386.82 |
| Rate for Payer: Aetna American Axle |
$5,334.93
|
| Rate for Payer: Aetna Commercial |
$6,976.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,334.93
|
| Rate for Payer: Cash Price |
$6,566.06
|
| Rate for Payer: Cofinity Advantage |
$5,745.31
|
| Rate for Payer: Cofinity Commercial |
$7,058.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,566.06
|
| Rate for Payer: Healthscope Commercial |
$7,386.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,745.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,155.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,976.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,155.69
|
| Rate for Payer: PHP Commercial |
$6,976.44
|
| Rate for Payer: Priority Health SBD |
$5,170.78
|
| Rate for Payer: UMR Bronson Commercial |
$3,611.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,155.69
|
|
|
ELRANATAMAB-BCMM 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$66,710.36
|
|
|
Service Code
|
HCPCS J1323
|
| Hospital Charge Code |
205012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.69 |
| Max. Negotiated Rate |
$60,039.32 |
| Rate for Payer: Aetna American Axle |
$43,361.73
|
| Rate for Payer: Aetna American Axle |
$25,104.18
|
| Rate for Payer: Aetna Commercial |
$32,828.55
|
| Rate for Payer: Aetna Commercial |
$56,703.81
|
| Rate for Payer: Aetna Medicare |
$194.26
|
| Rate for Payer: Aetna Medicare |
$194.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,104.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43,361.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$233.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$233.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$233.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$233.49
|
| Rate for Payer: BCBS Complete |
$102.59
|
| Rate for Payer: BCBS Complete |
$102.59
|
| Rate for Payer: BCBS MAPPO |
$186.79
|
| Rate for Payer: BCBS MAPPO |
$186.79
|
| Rate for Payer: BCBS Trust/PPO |
$611.28
|
| Rate for Payer: BCBS Trust/PPO |
$611.28
|
| Rate for Payer: BCN Commercial |
$611.28
|
| Rate for Payer: BCN Commercial |
$611.28
|
| Rate for Payer: BCN Medicare Advantage |
$186.79
|
| Rate for Payer: BCN Medicare Advantage |
$186.79
|
| Rate for Payer: Cash Price |
$30,897.46
|
| Rate for Payer: Cash Price |
$53,368.29
|
| Rate for Payer: Cash Price |
$53,368.29
|
| Rate for Payer: Cash Price |
$30,897.46
|
| Rate for Payer: Cofinity Advantage |
$46,697.25
|
| Rate for Payer: Cofinity Advantage |
$27,035.27
|
| Rate for Payer: Cofinity Commercial |
$33,214.77
|
| Rate for Payer: Cofinity Commercial |
$57,370.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,897.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53,368.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.79
|
| Rate for Payer: Healthscope Commercial |
$34,759.64
|
| Rate for Payer: Healthscope Commercial |
$60,039.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46,697.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27,035.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28,966.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50,032.77
|
| Rate for Payer: Mclaren Medicaid |
$186.79
|
| Rate for Payer: Mclaren Medicaid |
$186.79
|
| Rate for Payer: Mclaren Medicare |
$186.79
|
| Rate for Payer: Mclaren Medicare |
$186.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.13
|
| Rate for Payer: Meridian Medicaid |
$196.13
|
| Rate for Payer: Meridian Medicaid |
$196.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$205.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$205.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32,828.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56,703.81
|
| Rate for Payer: Nomi Health Commercial |
$560.37
|
| Rate for Payer: Nomi Health Commercial |
$560.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50,032.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28,966.37
|
| Rate for Payer: PACE Medicare |
$177.45
|
| Rate for Payer: PACE Medicare |
$177.45
|
| Rate for Payer: PACE SWMI |
$186.79
|
| Rate for Payer: PACE SWMI |
$186.79
|
| Rate for Payer: PHP Commercial |
$32,828.55
|
| Rate for Payer: PHP Commercial |
$56,703.81
|
| Rate for Payer: PHP Medicare Advantage |
$186.79
|
| Rate for Payer: PHP Medicare Advantage |
$186.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$580.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$580.56
|
| Rate for Payer: Priority Health Medicare |
$186.79
|
| Rate for Payer: Priority Health Medicare |
$186.79
|
| Rate for Payer: Priority Health SBD |
$24,331.75
|
| Rate for Payer: Priority Health SBD |
$42,027.53
|
| Rate for Payer: Priority Health Tiered Network |
$464.45
|
| Rate for Payer: Priority Health Tiered Network |
$464.45
|
| Rate for Payer: Railroad Medicare Medicare |
$186.79
|
| Rate for Payer: Railroad Medicare Medicare |
$186.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.06
|
| Rate for Payer: UHC Core |
$311.06
|
| Rate for Payer: UHC Core |
$311.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$186.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$186.79
|
| Rate for Payer: UHC Exchange |
$311.06
|
| Rate for Payer: UHC Exchange |
$311.06
|
| Rate for Payer: UHC Medicaid |
$97.69
|
| Rate for Payer: UHC Medicaid |
$97.69
|
| Rate for Payer: UHCCP Medicaid |
$97.69
|
| Rate for Payer: UHCCP Medicaid |
$97.69
|
| Rate for Payer: UMR Bronson Commercial |
$14,290.07
|
| Rate for Payer: UMR Bronson Commercial |
$24,682.83
|
| Rate for Payer: VA VA |
$186.79
|
| Rate for Payer: VA VA |
$186.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50,032.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28,966.37
|
|
|
ELRANATAMAB-BCMM 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$38,621.82
|
|
|
Service Code
|
HCPCS J1323
|
| Hospital Charge Code |
205012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16,993.60 |
| Max. Negotiated Rate |
$34,759.64 |
| Rate for Payer: Aetna American Axle |
$25,104.18
|
| Rate for Payer: Aetna American Axle |
$43,361.73
|
| Rate for Payer: Aetna Commercial |
$32,828.55
|
| Rate for Payer: Aetna Commercial |
$56,703.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,104.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43,361.73
|
| Rate for Payer: Cash Price |
$30,897.46
|
| Rate for Payer: Cash Price |
$53,368.29
|
| Rate for Payer: Cofinity Advantage |
$46,697.25
|
| Rate for Payer: Cofinity Advantage |
$27,035.27
|
| Rate for Payer: Cofinity Commercial |
$57,370.91
|
| Rate for Payer: Cofinity Commercial |
$33,214.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,897.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53,368.29
|
| Rate for Payer: Healthscope Commercial |
$34,759.64
|
| Rate for Payer: Healthscope Commercial |
$60,039.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46,697.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27,035.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28,966.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50,032.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32,828.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56,703.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28,966.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50,032.77
|
| Rate for Payer: PHP Commercial |
$32,828.55
|
| Rate for Payer: PHP Commercial |
$56,703.81
|
| Rate for Payer: Priority Health SBD |
$42,027.53
|
| Rate for Payer: Priority Health SBD |
$24,331.75
|
| Rate for Payer: UMR Bronson Commercial |
$16,993.60
|
| Rate for Payer: UMR Bronson Commercial |
$29,352.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28,966.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50,032.77
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
OP
|
$965.31
|
|
|
Service Code
|
NDC 00078069719
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.16 |
| Max. Negotiated Rate |
$868.78 |
| Rate for Payer: Aetna American Axle |
$627.45
|
| Rate for Payer: Aetna Commercial |
$820.51
|
| Rate for Payer: Aetna Medicare |
$482.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.45
|
| Rate for Payer: BCBS Complete |
$386.12
|
| Rate for Payer: Cash Price |
$772.25
|
| Rate for Payer: Cofinity Advantage |
$675.72
|
| Rate for Payer: Cofinity Commercial |
$830.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.25
|
| Rate for Payer: Healthscope Commercial |
$868.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$772.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.98
|
| Rate for Payer: PHP Commercial |
$820.51
|
| Rate for Payer: Priority Health SBD |
$608.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.45
|
| Rate for Payer: UHC Core |
$502.93
|
| Rate for Payer: UHC Exchange |
$379.37
|
| Rate for Payer: UMR Bronson Commercial |
$357.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.98
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$28,959.13
|
|
|
Service Code
|
NDC 00078069761
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12,742.02 |
| Max. Negotiated Rate |
$26,063.22 |
| Rate for Payer: Aetna American Axle |
$18,823.43
|
| Rate for Payer: Aetna Commercial |
$24,615.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,823.43
|
| Rate for Payer: Cash Price |
$23,167.30
|
| Rate for Payer: Cofinity Advantage |
$20,271.39
|
| Rate for Payer: Cofinity Commercial |
$24,904.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,167.30
|
| Rate for Payer: Healthscope Commercial |
$26,063.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,271.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,719.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,615.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,719.35
|
| Rate for Payer: PHP Commercial |
$24,615.26
|
| Rate for Payer: Priority Health SBD |
$18,244.25
|
| Rate for Payer: UMR Bronson Commercial |
$12,742.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,719.35
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
OP
|
$28,959.13
|
|
|
Service Code
|
NDC 00078069723
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10,714.88 |
| Max. Negotiated Rate |
$26,063.22 |
| Rate for Payer: Aetna American Axle |
$18,823.43
|
| Rate for Payer: Aetna Commercial |
$24,615.26
|
| Rate for Payer: Aetna Medicare |
$14,479.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,823.43
|
| Rate for Payer: BCBS Complete |
$11,583.65
|
| Rate for Payer: Cash Price |
$23,167.30
|
| Rate for Payer: Cofinity Advantage |
$20,271.39
|
| Rate for Payer: Cofinity Commercial |
$24,904.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,167.30
|
| Rate for Payer: Healthscope Commercial |
$26,063.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,271.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,719.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,167.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,615.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,719.35
|
| Rate for Payer: PHP Commercial |
$24,615.26
|
| Rate for Payer: Priority Health SBD |
$18,244.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,823.43
|
| Rate for Payer: UHC Core |
$15,087.71
|
| Rate for Payer: UHC Exchange |
$11,380.94
|
| Rate for Payer: UMR Bronson Commercial |
$10,714.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,719.35
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$28,959.13
|
|
|
Service Code
|
NDC 00078069723
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12,742.02 |
| Max. Negotiated Rate |
$26,063.22 |
| Rate for Payer: Aetna American Axle |
$18,823.43
|
| Rate for Payer: Aetna Commercial |
$24,615.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,823.43
|
| Rate for Payer: Cash Price |
$23,167.30
|
| Rate for Payer: Cofinity Advantage |
$20,271.39
|
| Rate for Payer: Cofinity Commercial |
$24,904.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,167.30
|
| Rate for Payer: Healthscope Commercial |
$26,063.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,271.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,719.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,615.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,719.35
|
| Rate for Payer: PHP Commercial |
$24,615.26
|
| Rate for Payer: Priority Health SBD |
$18,244.25
|
| Rate for Payer: UMR Bronson Commercial |
$12,742.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,719.35
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
OP
|
$28,959.13
|
|
|
Service Code
|
NDC 00078069761
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10,714.88 |
| Max. Negotiated Rate |
$26,063.22 |
| Rate for Payer: Aetna American Axle |
$18,823.43
|
| Rate for Payer: Aetna Commercial |
$24,615.26
|
| Rate for Payer: Aetna Medicare |
$14,479.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,823.43
|
| Rate for Payer: BCBS Complete |
$11,583.65
|
| Rate for Payer: Cash Price |
$23,167.30
|
| Rate for Payer: Cofinity Advantage |
$20,271.39
|
| Rate for Payer: Cofinity Commercial |
$24,904.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,167.30
|
| Rate for Payer: Healthscope Commercial |
$26,063.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,271.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,719.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,167.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,615.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,719.35
|
| Rate for Payer: PHP Commercial |
$24,615.26
|
| Rate for Payer: Priority Health SBD |
$18,244.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,823.43
|
| Rate for Payer: UHC Core |
$15,087.71
|
| Rate for Payer: UHC Exchange |
$11,380.94
|
| Rate for Payer: UMR Bronson Commercial |
$10,714.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,719.35
|
|
