|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$80.68
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Aetna American Axle |
$52.44
|
| Rate for Payer: Aetna American Axle |
$43.04
|
| Rate for Payer: Aetna American Axle |
$54.03
|
| Rate for Payer: Aetna American Axle |
$215.85
|
| Rate for Payer: Aetna American Axle |
$121.06
|
| Rate for Payer: Aetna Commercial |
$158.30
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Commercial |
$68.58
|
| Rate for Payer: Aetna Commercial |
$70.66
|
| Rate for Payer: Aetna Commercial |
$282.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.03
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cash Price |
$265.66
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$64.54
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cofinity Advantage |
$130.37
|
| Rate for Payer: Cofinity Advantage |
$58.19
|
| Rate for Payer: Cofinity Advantage |
$232.45
|
| Rate for Payer: Cofinity Advantage |
$56.48
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$71.49
|
| Rate for Payer: Cofinity Commercial |
$160.17
|
| Rate for Payer: Cofinity Commercial |
$285.58
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Cofinity Commercial |
$69.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.50
|
| Rate for Payer: Healthscope Commercial |
$167.62
|
| Rate for Payer: Healthscope Commercial |
$298.86
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$72.61
|
| Rate for Payer: Healthscope Commercial |
$74.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.51
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: PHP Commercial |
$158.30
|
| Rate for Payer: PHP Commercial |
$68.58
|
| Rate for Payer: PHP Commercial |
$70.66
|
| Rate for Payer: PHP Commercial |
$282.26
|
| Rate for Payer: Priority Health SBD |
$50.83
|
| Rate for Payer: Priority Health SBD |
$52.37
|
| Rate for Payer: Priority Health SBD |
$209.20
|
| Rate for Payer: Priority Health SBD |
$117.33
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: UMR Bronson Commercial |
$146.11
|
| Rate for Payer: UMR Bronson Commercial |
$36.58
|
| Rate for Payer: UMR Bronson Commercial |
$29.14
|
| Rate for Payer: UMR Bronson Commercial |
$81.95
|
| Rate for Payer: UMR Bronson Commercial |
$35.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.05
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$186.24
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$167.62 |
| Rate for Payer: Aetna American Axle |
$121.06
|
| Rate for Payer: Aetna American Axle |
$43.04
|
| Rate for Payer: Aetna American Axle |
$54.03
|
| Rate for Payer: Aetna American Axle |
$52.44
|
| Rate for Payer: Aetna American Axle |
$215.85
|
| Rate for Payer: Aetna Commercial |
$70.66
|
| Rate for Payer: Aetna Commercial |
$158.30
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Commercial |
$282.26
|
| Rate for Payer: Aetna Commercial |
$68.58
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna Medicare |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.08
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$56.65
|
| Rate for Payer: BCBS Trust/PPO |
$56.65
|
| Rate for Payer: BCBS Trust/PPO |
$56.65
|
| Rate for Payer: BCBS Trust/PPO |
$56.65
|
| Rate for Payer: BCBS Trust/PPO |
$56.65
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.26
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cash Price |
$148.99
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$64.54
|
| Rate for Payer: Cash Price |
$265.66
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$64.54
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cash Price |
$265.66
|
| Rate for Payer: Cofinity Advantage |
$130.37
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Advantage |
$58.19
|
| Rate for Payer: Cofinity Advantage |
$56.48
|
| Rate for Payer: Cofinity Advantage |
$232.45
|
| Rate for Payer: Cofinity Commercial |
$69.38
|
| Rate for Payer: Cofinity Commercial |
$160.17
|
| Rate for Payer: Cofinity Commercial |
$71.49
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Cofinity Commercial |
$285.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$74.82
|
| Rate for Payer: Healthscope Commercial |
$167.62
|
| Rate for Payer: Healthscope Commercial |
$72.61
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$298.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.35
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Mclaren Medicare |
$3.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: Meridian Medicaid |
$3.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.66
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Nomi Health Commercial |
$9.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.68
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE Medicare |
$3.10
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.26
|
| Rate for Payer: PHP Commercial |
$68.58
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: PHP Commercial |
$158.30
|
| Rate for Payer: PHP Commercial |
$282.26
|
| Rate for Payer: PHP Commercial |
$70.66
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$3.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.43
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health SBD |
$50.83
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: Priority Health SBD |
$209.20
|
| Rate for Payer: Priority Health SBD |
$52.37
|
| Rate for Payer: Priority Health SBD |
$117.33
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Priority Health Tiered Network |
$7.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Core |
$5.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.26
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Exchange |
$5.81
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHC Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UMR Bronson Commercial |
$24.50
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: UMR Bronson Commercial |
$29.85
|
| Rate for Payer: UMR Bronson Commercial |
$68.91
|
| Rate for Payer: UMR Bronson Commercial |
$122.87
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: VA VA |
$3.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.35
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$8,609.07
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$7,748.16 |
| Rate for Payer: Aetna American Axle |
$5,595.90
|
| Rate for Payer: Aetna Commercial |
$7,317.71
|
| Rate for Payer: Aetna Medicare |
$21.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,595.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.69
|
| Rate for Payer: BCBS Complete |
$11.29
|
| Rate for Payer: BCBS MAPPO |
$20.55
|
| Rate for Payer: BCBS Trust/PPO |
$66.45
|
| Rate for Payer: BCN Commercial |
$66.45
|
| Rate for Payer: BCN Medicare Advantage |
$20.55
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cofinity Advantage |
$6,026.35
|
| Rate for Payer: Cofinity Commercial |
$7,403.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,887.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.55
|
| Rate for Payer: Healthscope Commercial |
$7,748.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,026.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,456.80
|
| Rate for Payer: Mclaren Medicaid |
$20.55
|
| Rate for Payer: Mclaren Medicare |
$20.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.58
|
| Rate for Payer: Meridian Medicaid |
$21.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,317.71
|
| Rate for Payer: Nomi Health Commercial |
$61.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,456.80
|
| Rate for Payer: PACE Medicare |
$19.52
|
| Rate for Payer: PACE SWMI |
$20.55
|
| Rate for Payer: PHP Commercial |
$7,317.71
|
| Rate for Payer: PHP Medicare Advantage |
$20.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$63.00
|
| Rate for Payer: Priority Health Medicare |
$20.55
|
| Rate for Payer: Priority Health SBD |
$5,423.71
|
| Rate for Payer: Priority Health Tiered Network |
$50.40
|
| Rate for Payer: Railroad Medicare Medicare |
$20.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.83
|
| Rate for Payer: UHC Core |
$33.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.55
|
| Rate for Payer: UHC Exchange |
$33.83
|
| Rate for Payer: UHC Medicaid |
$10.75
|
| Rate for Payer: UHCCP Medicaid |
$10.75
|
| Rate for Payer: UMR Bronson Commercial |
$3,185.36
|
| Rate for Payer: VA VA |
$20.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,456.80
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$8,609.07
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,787.99 |
| Max. Negotiated Rate |
$7,748.16 |
| Rate for Payer: Aetna American Axle |
$5,595.90
|
| Rate for Payer: Aetna Commercial |
$7,317.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,595.90
|
| Rate for Payer: Cash Price |
$6,887.26
|
| Rate for Payer: Cofinity Advantage |
$6,026.35
|
| Rate for Payer: Cofinity Commercial |
$7,403.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,887.26
|
| Rate for Payer: Healthscope Commercial |
$7,748.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,026.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,456.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,317.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,456.80
|
| Rate for Payer: PHP Commercial |
$7,317.71
|
| Rate for Payer: Priority Health SBD |
$5,423.71
|
| Rate for Payer: UMR Bronson Commercial |
$3,787.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,456.80
|
|
|
ERAVACYCLINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$443.45
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
195057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$399.11 |
| Rate for Payer: Aetna American Axle |
$288.24
|
| Rate for Payer: Aetna Commercial |
$376.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.24
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: Cofinity Advantage |
$310.42
|
| Rate for Payer: Cofinity Commercial |
$381.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.76
|
| Rate for Payer: Healthscope Commercial |
$399.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.59
|
| Rate for Payer: PHP Commercial |
$376.93
|
| Rate for Payer: Priority Health SBD |
$279.37
|
| Rate for Payer: UMR Bronson Commercial |
$195.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.59
|
|
|
ERAVACYCLINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$443.45
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
195057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$399.11 |
| Rate for Payer: Aetna American Axle |
$288.24
|
| Rate for Payer: Aetna Commercial |
$376.93
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: BCBS MAPPO |
$1.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.17
|
| Rate for Payer: BCN Commercial |
$4.17
|
| Rate for Payer: BCN Medicare Advantage |
$1.29
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: Cash Price |
$354.76
|
| Rate for Payer: Cofinity Advantage |
$310.42
|
| Rate for Payer: Cofinity Commercial |
$381.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.29
|
| Rate for Payer: Healthscope Commercial |
$399.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.59
|
| Rate for Payer: Mclaren Medicaid |
$1.29
|
| Rate for Payer: Mclaren Medicare |
$1.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.35
|
| Rate for Payer: Meridian Medicaid |
$1.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.93
|
| Rate for Payer: Nomi Health Commercial |
$3.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.59
|
| Rate for Payer: PACE Medicare |
$1.23
|
| Rate for Payer: PACE SWMI |
$1.29
|
| Rate for Payer: PHP Commercial |
$376.93
|
| Rate for Payer: PHP Medicare Advantage |
$1.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.09
|
| Rate for Payer: Priority Health Medicare |
$1.29
|
| Rate for Payer: Priority Health SBD |
$279.37
|
| Rate for Payer: Priority Health Tiered Network |
$3.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.13
|
| Rate for Payer: UHC Core |
$2.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.29
|
| Rate for Payer: UHC Exchange |
$2.13
|
| Rate for Payer: UHC Medicaid |
$0.67
|
| Rate for Payer: UHCCP Medicaid |
$0.67
|
| Rate for Payer: UMR Bronson Commercial |
$164.08
|
| Rate for Payer: VA VA |
$1.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.59
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$310.20
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna American Axle |
$201.63
|
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna Medicare |
$155.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.63
|
| Rate for Payer: BCBS Complete |
$124.08
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Advantage |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.65
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.63
|
| Rate for Payer: UHC Core |
$161.61
|
| Rate for Payer: UHC Exchange |
$121.91
|
| Rate for Payer: UMR Bronson Commercial |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$310.20
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.49 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna American Axle |
$201.63
|
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.63
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Advantage |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.65
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| Rate for Payer: UMR Bronson Commercial |
$136.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$277.59
|
|
|
Service Code
|
NDC 47781064726
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.14 |
| Max. Negotiated Rate |
$249.83 |
| Rate for Payer: Aetna American Axle |
$180.43
|
| Rate for Payer: Aetna Commercial |
$235.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.43
|
| Rate for Payer: Cash Price |
$222.07
|
| Rate for Payer: Cofinity Advantage |
$194.31
|
| Rate for Payer: Cofinity Commercial |
$238.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.07
|
| Rate for Payer: Healthscope Commercial |
$249.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.19
|
| Rate for Payer: PHP Commercial |
$235.95
|
| Rate for Payer: Priority Health SBD |
$174.88
|
| Rate for Payer: UMR Bronson Commercial |
$122.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.19
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$274.17
|
|
|
Service Code
|
NDC 39328035760
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna American Axle |
$178.21
|
| Rate for Payer: Aetna Commercial |
$233.04
|
| Rate for Payer: Aetna Medicare |
$137.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.21
|
| Rate for Payer: BCBS Complete |
$109.67
|
| Rate for Payer: Cash Price |
$219.34
|
| Rate for Payer: Cofinity Advantage |
$191.92
|
| Rate for Payer: Cofinity Commercial |
$235.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.34
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.63
|
| Rate for Payer: PHP Commercial |
$233.04
|
| Rate for Payer: Priority Health SBD |
$172.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.21
|
| Rate for Payer: UHC Core |
$142.84
|
| Rate for Payer: UHC Exchange |
$107.75
|
| Rate for Payer: UMR Bronson Commercial |
$101.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.63
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 09900001965
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Advantage |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.18
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.18
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$274.17
|
|
|
Service Code
|
NDC 39328035760
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.63 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna American Axle |
$178.21
|
| Rate for Payer: Aetna Commercial |
$233.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.21
|
| Rate for Payer: Cash Price |
$219.34
|
| Rate for Payer: Cofinity Advantage |
$191.92
|
| Rate for Payer: Cofinity Commercial |
$235.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.34
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.63
|
| Rate for Payer: PHP Commercial |
$233.04
|
| Rate for Payer: Priority Health SBD |
$172.73
|
| Rate for Payer: UMR Bronson Commercial |
$120.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.63
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$261.63
|
|
|
Service Code
|
NDC 75834001060
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$235.47 |
| Rate for Payer: Aetna American Axle |
$170.06
|
| Rate for Payer: Aetna Commercial |
$222.39
|
| Rate for Payer: Aetna Medicare |
$130.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.06
|
| Rate for Payer: BCBS Complete |
$104.65
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cofinity Advantage |
$183.14
|
| Rate for Payer: Cofinity Commercial |
$225.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.30
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.22
|
| Rate for Payer: PHP Commercial |
$222.39
|
| Rate for Payer: Priority Health SBD |
$164.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.06
|
| Rate for Payer: UHC Core |
$136.31
|
| Rate for Payer: UHC Exchange |
$102.82
|
| Rate for Payer: UMR Bronson Commercial |
$96.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.22
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$261.63
|
|
|
Service Code
|
NDC 75834001060
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.12 |
| Max. Negotiated Rate |
$235.47 |
| Rate for Payer: Aetna American Axle |
$170.06
|
| Rate for Payer: Aetna Commercial |
$222.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.06
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cofinity Advantage |
$183.14
|
| Rate for Payer: Cofinity Commercial |
$225.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.30
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.22
|
| Rate for Payer: PHP Commercial |
$222.39
|
| Rate for Payer: Priority Health SBD |
$164.83
|
| Rate for Payer: UMR Bronson Commercial |
$115.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.22
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$260.49
|
|
|
Service Code
|
NDC 69367028302
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$234.44 |
| Rate for Payer: Aetna American Axle |
$169.32
|
| Rate for Payer: Aetna Commercial |
$221.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.32
|
| Rate for Payer: Cash Price |
$208.39
|
| Rate for Payer: Cofinity Advantage |
$182.34
|
| Rate for Payer: Cofinity Commercial |
$224.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.39
|
| Rate for Payer: Healthscope Commercial |
$234.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.37
|
| Rate for Payer: PHP Commercial |
$221.42
|
| Rate for Payer: Priority Health SBD |
$164.11
|
| Rate for Payer: UMR Bronson Commercial |
$114.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.37
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$260.49
|
|
|
Service Code
|
NDC 69367028302
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.38 |
| Max. Negotiated Rate |
$234.44 |
| Rate for Payer: Aetna American Axle |
$169.32
|
| Rate for Payer: Aetna Commercial |
$221.42
|
| Rate for Payer: Aetna Medicare |
$130.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.32
|
| Rate for Payer: BCBS Complete |
$104.20
|
| Rate for Payer: Cash Price |
$208.39
|
| Rate for Payer: Cofinity Advantage |
$182.34
|
| Rate for Payer: Cofinity Commercial |
$224.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.39
|
| Rate for Payer: Healthscope Commercial |
$234.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.37
|
| Rate for Payer: PHP Commercial |
$221.42
|
| Rate for Payer: Priority Health SBD |
$164.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.32
|
| Rate for Payer: UHC Core |
$135.72
|
| Rate for Payer: UHC Exchange |
$102.37
|
| Rate for Payer: UMR Bronson Commercial |
$96.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.37
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$277.59
|
|
|
Service Code
|
NDC 47781064726
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.71 |
| Max. Negotiated Rate |
$249.83 |
| Rate for Payer: Aetna American Axle |
$180.43
|
| Rate for Payer: Aetna Commercial |
$235.95
|
| Rate for Payer: Aetna Medicare |
$138.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.43
|
| Rate for Payer: BCBS Complete |
$111.04
|
| Rate for Payer: Cash Price |
$222.07
|
| Rate for Payer: Cofinity Advantage |
$194.31
|
| Rate for Payer: Cofinity Commercial |
$238.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.07
|
| Rate for Payer: Healthscope Commercial |
$249.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.19
|
| Rate for Payer: PHP Commercial |
$235.95
|
| Rate for Payer: Priority Health SBD |
$174.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.43
|
| Rate for Payer: UHC Core |
$144.62
|
| Rate for Payer: UHC Exchange |
$109.09
|
| Rate for Payer: UMR Bronson Commercial |
$102.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.19
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 09900001965
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Advantage |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.18
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.16
|
| Rate for Payer: UHC Core |
$0.13
|
| Rate for Payer: UHC Exchange |
$0.09
|
| Rate for Payer: UMR Bronson Commercial |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.18
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,330.90
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
106773
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.15 |
| Max. Negotiated Rate |
$5,697.81 |
| Rate for Payer: Aetna American Axle |
$4,115.09
|
| Rate for Payer: Aetna Commercial |
$5,381.27
|
| Rate for Payer: Aetna Medicare |
$79.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,115.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.95
|
| Rate for Payer: BCBS Complete |
$42.16
|
| Rate for Payer: BCBS MAPPO |
$76.76
|
| Rate for Payer: BCBS Trust/PPO |
$231.06
|
| Rate for Payer: BCN Commercial |
$231.06
|
| Rate for Payer: BCN Medicare Advantage |
$76.76
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cofinity Advantage |
$4,431.63
|
| Rate for Payer: Cofinity Commercial |
$5,444.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,064.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.76
|
| Rate for Payer: Healthscope Commercial |
$5,697.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,431.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,748.18
|
| Rate for Payer: Mclaren Medicaid |
$76.76
|
| Rate for Payer: Mclaren Medicare |
$76.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.60
|
| Rate for Payer: Meridian Medicaid |
$80.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,381.27
|
| Rate for Payer: Nomi Health Commercial |
$230.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,748.18
|
| Rate for Payer: PACE Medicare |
$72.92
|
| Rate for Payer: PACE SWMI |
$76.76
|
| Rate for Payer: PHP Commercial |
$5,381.27
|
| Rate for Payer: PHP Medicare Advantage |
$76.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$281.78
|
| Rate for Payer: Priority Health Medicare |
$76.76
|
| Rate for Payer: Priority Health SBD |
$3,988.47
|
| Rate for Payer: Priority Health Tiered Network |
$225.42
|
| Rate for Payer: Railroad Medicare Medicare |
$76.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.81
|
| Rate for Payer: UHC Core |
$119.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$76.76
|
| Rate for Payer: UHC Exchange |
$119.81
|
| Rate for Payer: UHC Medicaid |
$40.15
|
| Rate for Payer: UHCCP Medicaid |
$40.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,342.43
|
| Rate for Payer: VA VA |
$76.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,748.18
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
OP
|
$159.34
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$143.41 |
| Rate for Payer: Aetna American Axle |
$103.57
|
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna Commercial |
$135.44
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Medicare |
$79.67
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$63.74
|
| Rate for Payer: BCBS Trust/PPO |
$29.69
|
| Rate for Payer: BCBS Trust/PPO |
$29.69
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: Cash Price |
$127.47
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$127.47
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Advantage |
$111.54
|
| Rate for Payer: Cofinity Advantage |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$137.03
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$143.41
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.50
|
| Rate for Payer: PHP Commercial |
$135.44
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health SBD |
$100.38
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UMR Bronson Commercial |
$58.96
|
| Rate for Payer: UMR Bronson Commercial |
$156.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$159.34
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.11 |
| Max. Negotiated Rate |
$143.41 |
| Rate for Payer: Aetna American Axle |
$103.57
|
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna Commercial |
$135.44
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Cash Price |
$127.47
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Advantage |
$296.80
|
| Rate for Payer: Cofinity Advantage |
$111.54
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$137.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$143.41
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: PHP Commercial |
$135.44
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$100.38
|
| Rate for Payer: UMR Bronson Commercial |
$70.11
|
| Rate for Payer: UMR Bronson Commercial |
$186.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$87.47
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna American Axle |
$56.86
|
| Rate for Payer: Aetna American Axle |
$43.04
|
| Rate for Payer: Aetna American Axle |
$42.80
|
| Rate for Payer: Aetna American Axle |
$103.57
|
| Rate for Payer: Aetna American Axle |
$28.79
|
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna Commercial |
$37.65
|
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Commercial |
$135.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.57
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$127.47
|
| Rate for Payer: Cash Price |
$35.43
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Advantage |
$46.09
|
| Rate for Payer: Cofinity Advantage |
$296.80
|
| Rate for Payer: Cofinity Advantage |
$111.54
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Advantage |
$31.00
|
| Rate for Payer: Cofinity Advantage |
$61.23
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$56.62
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Cofinity Commercial |
$137.03
|
| Rate for Payer: Cofinity Commercial |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.98
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$143.41
|
| Rate for Payer: Healthscope Commercial |
$59.26
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$39.86
|
| Rate for Payer: Healthscope Commercial |
$78.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.22
|
| Rate for Payer: PHP Commercial |
$37.65
|
| Rate for Payer: PHP Commercial |
$74.35
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: PHP Commercial |
$55.96
|
| Rate for Payer: PHP Commercial |
$135.44
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$100.38
|
| Rate for Payer: Priority Health SBD |
$27.90
|
| Rate for Payer: Priority Health SBD |
$41.48
|
| Rate for Payer: Priority Health SBD |
$55.11
|
| Rate for Payer: UMR Bronson Commercial |
$29.14
|
| Rate for Payer: UMR Bronson Commercial |
$19.49
|
| Rate for Payer: UMR Bronson Commercial |
$28.97
|
| Rate for Payer: UMR Bronson Commercial |
$186.56
|
| Rate for Payer: UMR Bronson Commercial |
$38.49
|
| Rate for Payer: UMR Bronson Commercial |
$70.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.22
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna American Axle |
$42.80
|
| Rate for Payer: Aetna American Axle |
$43.04
|
| Rate for Payer: Aetna American Axle |
$103.57
|
| Rate for Payer: Aetna American Axle |
$56.86
|
| Rate for Payer: Aetna American Axle |
$28.79
|
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Commercial |
$37.65
|
| Rate for Payer: Aetna Commercial |
$135.44
|
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Medicare |
$79.67
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna Medicare |
$22.14
|
| Rate for Payer: Aetna Medicare |
$43.73
|
| Rate for Payer: Aetna Medicare |
$33.11
|
| Rate for Payer: Aetna Medicare |
$32.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.80
|
| Rate for Payer: BCBS Complete |
$17.72
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$63.74
|
| Rate for Payer: BCBS Complete |
$26.34
|
| Rate for Payer: BCBS Complete |
$26.49
|
| Rate for Payer: BCBS Complete |
$34.99
|
| Rate for Payer: BCBS Trust/PPO |
$29.69
|
| Rate for Payer: BCBS Trust/PPO |
$29.69
|
| Rate for Payer: BCBS Trust/PPO |
$29.69
|
| Rate for Payer: BCBS Trust/PPO |
$29.69
|
| Rate for Payer: BCBS Trust/PPO |
$29.69
|
| Rate for Payer: BCBS Trust/PPO |
$29.69
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cash Price |
$127.47
|
| Rate for Payer: Cash Price |
$127.47
|
| Rate for Payer: Cash Price |
$35.43
|
| Rate for Payer: Cash Price |
$35.43
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$52.98
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cofinity Advantage |
$46.09
|
| Rate for Payer: Cofinity Advantage |
$31.00
|
| Rate for Payer: Cofinity Advantage |
$61.23
|
| Rate for Payer: Cofinity Advantage |
$111.54
|
| Rate for Payer: Cofinity Advantage |
$296.80
|
| Rate for Payer: Cofinity Advantage |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$56.95
|
| Rate for Payer: Cofinity Commercial |
$137.03
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$56.62
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.98
|
| Rate for Payer: Healthscope Commercial |
$143.41
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$39.86
|
| Rate for Payer: Healthscope Commercial |
$59.26
|
| Rate for Payer: Healthscope Commercial |
$78.72
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.22
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$37.65
|
| Rate for Payer: PHP Commercial |
$55.96
|
| Rate for Payer: PHP Commercial |
$135.44
|
| Rate for Payer: PHP Commercial |
$56.29
|
| Rate for Payer: PHP Commercial |
$74.35
|
| Rate for Payer: Priority Health SBD |
$41.48
|
| Rate for Payer: Priority Health SBD |
$100.38
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$55.11
|
| Rate for Payer: Priority Health SBD |
$27.90
|
| Rate for Payer: Priority Health SBD |
$41.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UMR Bronson Commercial |
$24.36
|
| Rate for Payer: UMR Bronson Commercial |
$24.50
|
| Rate for Payer: UMR Bronson Commercial |
$156.88
|
| Rate for Payer: UMR Bronson Commercial |
$58.96
|
| Rate for Payer: UMR Bronson Commercial |
$32.36
|
| Rate for Payer: UMR Bronson Commercial |
$16.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$65.84
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$59.26 |
| Rate for Payer: Aetna American Axle |
$42.80
|
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.80
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cofinity Advantage |
$46.09
|
| Rate for Payer: Cofinity Commercial |
$56.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.67
|
| Rate for Payer: Healthscope Commercial |
$59.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.38
|
| Rate for Payer: PHP Commercial |
$55.96
|
| Rate for Payer: Priority Health SBD |
$41.48
|
| Rate for Payer: UMR Bronson Commercial |
$28.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.38
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$65.84
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$59.26 |
| Rate for Payer: Aetna American Axle |
$42.80
|
| Rate for Payer: Aetna Commercial |
$55.96
|
| Rate for Payer: Aetna Medicare |
$32.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.80
|
| Rate for Payer: BCBS Complete |
$26.34
|
| Rate for Payer: BCBS Trust/PPO |
$29.69
|
| Rate for Payer: BCN Commercial |
$29.69
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cash Price |
$52.67
|
| Rate for Payer: Cofinity Advantage |
$46.09
|
| Rate for Payer: Cofinity Commercial |
$56.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.67
|
| Rate for Payer: Healthscope Commercial |
$59.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.38
|
| Rate for Payer: PHP Commercial |
$55.96
|
| Rate for Payer: Priority Health SBD |
$41.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.11
|
| Rate for Payer: UHC Core |
$15.11
|
| Rate for Payer: UHC Exchange |
$15.11
|
| Rate for Payer: UMR Bronson Commercial |
$24.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.38
|
|
