|
DIVALPROEX ER 250 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,149.96
|
|
|
Service Code
|
NDC 00074382611
|
| Hospital Charge Code |
34418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$505.98 |
| Max. Negotiated Rate |
$1,034.96 |
| Rate for Payer: Aetna American Axle |
$747.47
|
| Rate for Payer: Aetna Commercial |
$977.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.47
|
| Rate for Payer: Cash Price |
$919.97
|
| Rate for Payer: Cofinity Commercial |
$804.97
|
| Rate for Payer: Cofinity Commercial |
$988.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$804.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.97
|
| Rate for Payer: Healthscope Commercial |
$1,034.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$804.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$862.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.47
|
| Rate for Payer: PHP Commercial |
$977.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.47
|
| Rate for Payer: Priority Health SBD |
$724.47
|
| Rate for Payer: UMR Bronson Commercial |
$505.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$862.47
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$611.52
|
|
|
Service Code
|
NDC 00904718261
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.26 |
| Max. Negotiated Rate |
$550.37 |
| Rate for Payer: Aetna American Axle |
$397.49
|
| Rate for Payer: Aetna Commercial |
$519.79
|
| Rate for Payer: Aetna Medicare |
$305.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.49
|
| Rate for Payer: BCBS Complete |
$244.61
|
| Rate for Payer: Cash Price |
$489.22
|
| Rate for Payer: Cofinity Commercial |
$428.06
|
| Rate for Payer: Cofinity Commercial |
$525.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.22
|
| Rate for Payer: Healthscope Commercial |
$550.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.79
|
| Rate for Payer: PHP Commercial |
$519.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.49
|
| Rate for Payer: Priority Health SBD |
$385.26
|
| Rate for Payer: UMR Bronson Commercial |
$226.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.64
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$596.15
|
|
|
Service Code
|
NDC 00904636445
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.31 |
| Max. Negotiated Rate |
$536.53 |
| Rate for Payer: Aetna American Axle |
$387.50
|
| Rate for Payer: Aetna Commercial |
$506.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.50
|
| Rate for Payer: Cash Price |
$476.92
|
| Rate for Payer: Cofinity Commercial |
$417.31
|
| Rate for Payer: Cofinity Commercial |
$512.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$417.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.92
|
| Rate for Payer: Healthscope Commercial |
$536.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.73
|
| Rate for Payer: PHP Commercial |
$506.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.50
|
| Rate for Payer: Priority Health SBD |
$375.57
|
| Rate for Payer: UMR Bronson Commercial |
$262.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.11
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$8.61
|
|
|
Service Code
|
NDC 51079076701
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna American Axle |
$5.60
|
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.60
|
| Rate for Payer: Cash Price |
$6.89
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$7.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.32
|
| Rate for Payer: PHP Commercial |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health SBD |
$5.42
|
| Rate for Payer: UMR Bronson Commercial |
$3.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.46
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$611.52
|
|
|
Service Code
|
NDC 00904718261
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.07 |
| Max. Negotiated Rate |
$550.37 |
| Rate for Payer: Aetna American Axle |
$397.49
|
| Rate for Payer: Aetna Commercial |
$519.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.49
|
| Rate for Payer: Cash Price |
$489.22
|
| Rate for Payer: Cofinity Commercial |
$428.06
|
| Rate for Payer: Cofinity Commercial |
$525.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.22
|
| Rate for Payer: Healthscope Commercial |
$550.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.79
|
| Rate for Payer: PHP Commercial |
$519.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.49
|
| Rate for Payer: Priority Health SBD |
$385.26
|
| Rate for Payer: UMR Bronson Commercial |
$269.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.64
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$622.08
|
|
|
Service Code
|
NDC 00904718245
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.72 |
| Max. Negotiated Rate |
$559.87 |
| Rate for Payer: Aetna American Axle |
$404.35
|
| Rate for Payer: Aetna Commercial |
$528.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.35
|
| Rate for Payer: Cash Price |
$497.66
|
| Rate for Payer: Cofinity Commercial |
$435.46
|
| Rate for Payer: Cofinity Commercial |
$534.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.66
|
| Rate for Payer: Healthscope Commercial |
$559.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.77
|
| Rate for Payer: PHP Commercial |
$528.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.35
|
| Rate for Payer: Priority Health SBD |
$391.91
|
| Rate for Payer: UMR Bronson Commercial |
$273.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.56
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$596.15
|
|
|
Service Code
|
NDC 00904636445
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.58 |
| Max. Negotiated Rate |
$536.53 |
| Rate for Payer: Aetna American Axle |
$387.50
|
| Rate for Payer: Aetna Commercial |
$506.73
|
| Rate for Payer: Aetna Medicare |
$298.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.50
|
| Rate for Payer: BCBS Complete |
$238.46
|
| Rate for Payer: Cash Price |
$476.92
|
| Rate for Payer: Cofinity Commercial |
$417.31
|
| Rate for Payer: Cofinity Commercial |
$512.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$417.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.92
|
| Rate for Payer: Healthscope Commercial |
$536.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.73
|
| Rate for Payer: PHP Commercial |
$506.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.50
|
| Rate for Payer: Priority Health SBD |
$375.57
|
| Rate for Payer: UMR Bronson Commercial |
$220.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.11
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$688.50
|
|
|
Service Code
|
NDC 51079076708
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$302.94 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Aetna American Axle |
$447.52
|
| Rate for Payer: Aetna Commercial |
$585.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.52
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Commercial |
$481.95
|
| Rate for Payer: Cofinity Commercial |
$592.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Healthscope Commercial |
$619.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.23
|
| Rate for Payer: PHP Commercial |
$585.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.52
|
| Rate for Payer: Priority Health SBD |
$433.75
|
| Rate for Payer: UMR Bronson Commercial |
$302.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.38
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$622.08
|
|
|
Service Code
|
NDC 00904718245
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.17 |
| Max. Negotiated Rate |
$559.87 |
| Rate for Payer: Aetna American Axle |
$404.35
|
| Rate for Payer: Aetna Commercial |
$528.77
|
| Rate for Payer: Aetna Medicare |
$311.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.35
|
| Rate for Payer: BCBS Complete |
$248.83
|
| Rate for Payer: Cash Price |
$497.66
|
| Rate for Payer: Cofinity Commercial |
$435.46
|
| Rate for Payer: Cofinity Commercial |
$534.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$435.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$497.66
|
| Rate for Payer: Healthscope Commercial |
$559.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$435.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$466.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$528.77
|
| Rate for Payer: PHP Commercial |
$528.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.35
|
| Rate for Payer: Priority Health SBD |
$391.91
|
| Rate for Payer: UMR Bronson Commercial |
$230.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$466.56
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$688.50
|
|
|
Service Code
|
NDC 51079076708
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.75 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Aetna American Axle |
$447.52
|
| Rate for Payer: Aetna Commercial |
$585.23
|
| Rate for Payer: Aetna Medicare |
$344.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.52
|
| Rate for Payer: BCBS Complete |
$275.40
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Commercial |
$481.95
|
| Rate for Payer: Cofinity Commercial |
$592.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Healthscope Commercial |
$619.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.23
|
| Rate for Payer: PHP Commercial |
$585.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.52
|
| Rate for Payer: Priority Health SBD |
$433.75
|
| Rate for Payer: UMR Bronson Commercial |
$254.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.38
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$8.61
|
|
|
Service Code
|
NDC 51079076701
|
| Hospital Charge Code |
81426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna American Axle |
$5.60
|
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Aetna Medicare |
$4.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.60
|
| Rate for Payer: BCBS Complete |
$3.44
|
| Rate for Payer: Cash Price |
$6.89
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Cofinity Commercial |
$7.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$7.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.32
|
| Rate for Payer: PHP Commercial |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health SBD |
$5.42
|
| Rate for Payer: UMR Bronson Commercial |
$3.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.46
|
|
|
DIVISION OF PLANTAR FASCIA AND MUSCLE (EG, STEINDLER STRIPPING) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.33
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
9892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$28.20 |
| Rate for Payer: Aetna American Axle |
$20.36
|
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna American Axle |
$17.59
|
| Rate for Payer: Aetna Commercial |
$26.63
|
| Rate for Payer: Aetna Commercial |
$23.00
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Medicare |
$15.66
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Aetna Medicare |
$10.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS Complete |
$10.82
|
| Rate for Payer: BCBS Complete |
$12.53
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cash Price |
$21.65
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$23.27
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$26.94
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$18.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$24.35
|
| Rate for Payer: Healthscope Commercial |
$28.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.63
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: PHP Commercial |
$23.00
|
| Rate for Payer: PHP Commercial |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$17.05
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: Priority Health SBD |
$19.74
|
| Rate for Payer: UMR Bronson Commercial |
$11.59
|
| Rate for Payer: UMR Bronson Commercial |
$8.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.50
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
9892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$19.45 |
| Rate for Payer: Aetna American Axle |
$14.05
|
| Rate for Payer: Aetna American Axle |
$17.59
|
| Rate for Payer: Aetna American Axle |
$20.36
|
| Rate for Payer: Aetna Commercial |
$23.00
|
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Aetna Commercial |
$26.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.59
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cash Price |
$21.65
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Cofinity Commercial |
$23.27
|
| Rate for Payer: Cofinity Commercial |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$26.94
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.65
|
| Rate for Payer: Healthscope Commercial |
$24.35
|
| Rate for Payer: Healthscope Commercial |
$19.45
|
| Rate for Payer: Healthscope Commercial |
$28.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.00
|
| Rate for Payer: PHP Commercial |
$26.63
|
| Rate for Payer: PHP Commercial |
$23.00
|
| Rate for Payer: PHP Commercial |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.05
|
| Rate for Payer: Priority Health SBD |
$19.74
|
| Rate for Payer: Priority Health SBD |
$17.05
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UMR Bronson Commercial |
$9.51
|
| Rate for Payer: UMR Bronson Commercial |
$13.79
|
| Rate for Payer: UMR Bronson Commercial |
$11.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.30
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
OP
|
$66.56
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: Aetna American Axle |
$43.26
|
| Rate for Payer: Aetna American Axle |
$57.02
|
| Rate for Payer: Aetna Commercial |
$56.58
|
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna Medicare |
$33.28
|
| Rate for Payer: Aetna Medicare |
$43.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$57.24
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Cofinity Commercial |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$59.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$56.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: Priority Health SBD |
$41.93
|
| Rate for Payer: UMR Bronson Commercial |
$24.63
|
| Rate for Payer: UMR Bronson Commercial |
$32.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.92
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$66.56
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
15981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.29 |
| Max. Negotiated Rate |
$59.90 |
| Rate for Payer: Aetna American Axle |
$43.26
|
| Rate for Payer: Aetna American Axle |
$57.02
|
| Rate for Payer: Aetna Commercial |
$56.58
|
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$61.41
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Cofinity Commercial |
$57.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$59.90
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.58
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$56.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health SBD |
$41.93
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: UMR Bronson Commercial |
$29.29
|
| Rate for Payer: UMR Bronson Commercial |
$38.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.80
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
IP
|
$80.33
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna American Axle |
$52.21
|
| Rate for Payer: Aetna American Axle |
$62.65
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Commercial |
$81.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.65
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: PHP Commercial |
$81.93
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.65
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: Priority Health SBD |
$60.73
|
| Rate for Payer: UMR Bronson Commercial |
$35.35
|
| Rate for Payer: UMR Bronson Commercial |
$42.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.29
|
|
|
DOBUTAMINE 500 MG/250 ML (2,000 MCG/ML) IN 5 % DEXTROSE IV
|
Facility
|
OP
|
$80.33
|
|
|
Service Code
|
HCPCS J1250
|
| Hospital Charge Code |
18315
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna American Axle |
$52.21
|
| Rate for Payer: Aetna American Axle |
$62.65
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Commercial |
$81.93
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna Medicare |
$48.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.65
|
| Rate for Payer: BCBS Complete |
$38.56
|
| Rate for Payer: BCBS Complete |
$32.13
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.93
|
| Rate for Payer: PHP Commercial |
$81.93
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.65
|
| Rate for Payer: Priority Health SBD |
$60.73
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: UMR Bronson Commercial |
$29.72
|
| Rate for Payer: UMR Bronson Commercial |
$35.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
|
|
DOCETAXEL 160 MG/16 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$645.14
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
152336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$238.70 |
| Max. Negotiated Rate |
$580.63 |
| Rate for Payer: Aetna American Axle |
$419.34
|
| Rate for Payer: Aetna American Axle |
$435.60
|
| Rate for Payer: Aetna Commercial |
$548.37
|
| Rate for Payer: Aetna Commercial |
$569.63
|
| Rate for Payer: Aetna Medicare |
$322.57
|
| Rate for Payer: Aetna Medicare |
$335.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.60
|
| Rate for Payer: BCBS Complete |
$268.06
|
| Rate for Payer: BCBS Complete |
$258.06
|
| Rate for Payer: Cash Price |
$516.11
|
| Rate for Payer: Cash Price |
$536.12
|
| Rate for Payer: Cofinity Commercial |
$554.82
|
| Rate for Payer: Cofinity Commercial |
$451.60
|
| Rate for Payer: Cofinity Commercial |
$469.11
|
| Rate for Payer: Cofinity Commercial |
$576.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$451.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.12
|
| Rate for Payer: Healthscope Commercial |
$603.13
|
| Rate for Payer: Healthscope Commercial |
$580.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$451.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$469.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$483.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.63
|
| Rate for Payer: PHP Commercial |
$569.63
|
| Rate for Payer: PHP Commercial |
$548.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.60
|
| Rate for Payer: Priority Health SBD |
$422.19
|
| Rate for Payer: Priority Health SBD |
$406.44
|
| Rate for Payer: UMR Bronson Commercial |
$238.70
|
| Rate for Payer: UMR Bronson Commercial |
$247.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$483.86
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$346.45
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
161671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.19 |
| Max. Negotiated Rate |
$311.81 |
| Rate for Payer: Aetna American Axle |
$225.19
|
| Rate for Payer: Aetna American Axle |
$581.78
|
| Rate for Payer: Aetna American Axle |
$1,249.06
|
| Rate for Payer: Aetna American Axle |
$468.98
|
| Rate for Payer: Aetna Commercial |
$760.78
|
| Rate for Payer: Aetna Commercial |
$294.48
|
| Rate for Payer: Aetna Commercial |
$613.27
|
| Rate for Payer: Aetna Commercial |
$1,633.39
|
| Rate for Payer: Aetna Medicare |
$360.75
|
| Rate for Payer: Aetna Medicare |
$960.82
|
| Rate for Payer: Aetna Medicare |
$447.52
|
| Rate for Payer: Aetna Medicare |
$173.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.06
|
| Rate for Payer: BCBS Complete |
$768.65
|
| Rate for Payer: BCBS Complete |
$358.02
|
| Rate for Payer: BCBS Complete |
$288.60
|
| Rate for Payer: BCBS Complete |
$138.58
|
| Rate for Payer: Cash Price |
$277.16
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cash Price |
$716.03
|
| Rate for Payer: Cofinity Commercial |
$297.95
|
| Rate for Payer: Cofinity Commercial |
$769.73
|
| Rate for Payer: Cofinity Commercial |
$1,345.14
|
| Rate for Payer: Cofinity Commercial |
$620.49
|
| Rate for Payer: Cofinity Commercial |
$505.05
|
| Rate for Payer: Cofinity Commercial |
$626.53
|
| Rate for Payer: Cofinity Commercial |
$1,652.60
|
| Rate for Payer: Cofinity Commercial |
$242.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$242.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$505.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$577.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.16
|
| Rate for Payer: Healthscope Commercial |
$649.35
|
| Rate for Payer: Healthscope Commercial |
$1,729.47
|
| Rate for Payer: Healthscope Commercial |
$311.81
|
| Rate for Payer: Healthscope Commercial |
$805.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$505.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,441.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$541.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.27
|
| Rate for Payer: PHP Commercial |
$613.27
|
| Rate for Payer: PHP Commercial |
$294.48
|
| Rate for Payer: PHP Commercial |
$760.78
|
| Rate for Payer: PHP Commercial |
$1,633.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.06
|
| Rate for Payer: Priority Health SBD |
$454.55
|
| Rate for Payer: Priority Health SBD |
$563.88
|
| Rate for Payer: Priority Health SBD |
$218.26
|
| Rate for Payer: Priority Health SBD |
$1,210.63
|
| Rate for Payer: UMR Bronson Commercial |
$266.95
|
| Rate for Payer: UMR Bronson Commercial |
$128.19
|
| Rate for Payer: UMR Bronson Commercial |
$331.16
|
| Rate for Payer: UMR Bronson Commercial |
$711.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,441.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$541.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.84
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,921.63
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
161671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$845.52 |
| Max. Negotiated Rate |
$1,729.47 |
| Rate for Payer: Aetna American Axle |
$1,249.06
|
| Rate for Payer: Aetna American Axle |
$581.78
|
| Rate for Payer: Aetna Commercial |
$1,633.39
|
| Rate for Payer: Aetna Commercial |
$760.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.78
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cash Price |
$716.03
|
| Rate for Payer: Cofinity Commercial |
$769.73
|
| Rate for Payer: Cofinity Commercial |
$626.53
|
| Rate for Payer: Cofinity Commercial |
$1,345.14
|
| Rate for Payer: Cofinity Commercial |
$1,652.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.03
|
| Rate for Payer: Healthscope Commercial |
$1,729.47
|
| Rate for Payer: Healthscope Commercial |
$805.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$626.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,441.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.39
|
| Rate for Payer: PHP Commercial |
$760.78
|
| Rate for Payer: PHP Commercial |
$1,633.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.78
|
| Rate for Payer: Priority Health SBD |
$1,210.63
|
| Rate for Payer: Priority Health SBD |
$563.88
|
| Rate for Payer: UMR Bronson Commercial |
$845.52
|
| Rate for Payer: UMR Bronson Commercial |
$393.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,441.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.28
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$352.40
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
106443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.06 |
| Max. Negotiated Rate |
$317.16 |
| Rate for Payer: Aetna American Axle |
$229.06
|
| Rate for Payer: Aetna Commercial |
$299.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.06
|
| Rate for Payer: Cash Price |
$281.92
|
| Rate for Payer: Cofinity Commercial |
$246.68
|
| Rate for Payer: Cofinity Commercial |
$303.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.92
|
| Rate for Payer: Healthscope Commercial |
$317.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.54
|
| Rate for Payer: PHP Commercial |
$299.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.06
|
| Rate for Payer: Priority Health SBD |
$222.01
|
| Rate for Payer: UMR Bronson Commercial |
$155.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.30
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$280.65
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
106443
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.84 |
| Max. Negotiated Rate |
$252.59 |
| Rate for Payer: Aetna American Axle |
$182.42
|
| Rate for Payer: Aetna American Axle |
$229.06
|
| Rate for Payer: Aetna Commercial |
$238.55
|
| Rate for Payer: Aetna Commercial |
$299.54
|
| Rate for Payer: Aetna Medicare |
$140.32
|
| Rate for Payer: Aetna Medicare |
$176.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.06
|
| Rate for Payer: BCBS Complete |
$112.26
|
| Rate for Payer: BCBS Complete |
$140.96
|
| Rate for Payer: Cash Price |
$224.52
|
| Rate for Payer: Cash Price |
$281.92
|
| Rate for Payer: Cofinity Commercial |
$241.36
|
| Rate for Payer: Cofinity Commercial |
$196.46
|
| Rate for Payer: Cofinity Commercial |
$303.06
|
| Rate for Payer: Cofinity Commercial |
$246.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.52
|
| Rate for Payer: Healthscope Commercial |
$252.59
|
| Rate for Payer: Healthscope Commercial |
$317.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.55
|
| Rate for Payer: PHP Commercial |
$299.54
|
| Rate for Payer: PHP Commercial |
$238.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.06
|
| Rate for Payer: Priority Health SBD |
$222.01
|
| Rate for Payer: Priority Health SBD |
$176.81
|
| Rate for Payer: UMR Bronson Commercial |
$103.84
|
| Rate for Payer: UMR Bronson Commercial |
$130.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.30
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$499.25
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
120029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.67 |
| Max. Negotiated Rate |
$449.32 |
| Rate for Payer: Aetna American Axle |
$324.51
|
| Rate for Payer: Aetna American Axle |
$1,249.06
|
| Rate for Payer: Aetna American Axle |
$538.19
|
| Rate for Payer: Aetna Commercial |
$424.36
|
| Rate for Payer: Aetna Commercial |
$1,633.39
|
| Rate for Payer: Aetna Commercial |
$703.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.06
|
| Rate for Payer: Cash Price |
$662.39
|
| Rate for Payer: Cash Price |
$399.40
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cofinity Commercial |
$1,652.60
|
| Rate for Payer: Cofinity Commercial |
$1,345.14
|
| Rate for Payer: Cofinity Commercial |
$349.48
|
| Rate for Payer: Cofinity Commercial |
$429.36
|
| Rate for Payer: Cofinity Commercial |
$579.59
|
| Rate for Payer: Cofinity Commercial |
$712.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$579.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.30
|
| Rate for Payer: Healthscope Commercial |
$745.19
|
| Rate for Payer: Healthscope Commercial |
$1,729.47
|
| Rate for Payer: Healthscope Commercial |
$449.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$620.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,441.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.79
|
| Rate for Payer: PHP Commercial |
$1,633.39
|
| Rate for Payer: PHP Commercial |
$703.79
|
| Rate for Payer: PHP Commercial |
$424.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.19
|
| Rate for Payer: Priority Health SBD |
$314.53
|
| Rate for Payer: Priority Health SBD |
$1,210.63
|
| Rate for Payer: Priority Health SBD |
$521.63
|
| Rate for Payer: UMR Bronson Commercial |
$364.32
|
| Rate for Payer: UMR Bronson Commercial |
$219.67
|
| Rate for Payer: UMR Bronson Commercial |
$845.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,441.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$620.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.44
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$333.66
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
120029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.45 |
| Max. Negotiated Rate |
$300.29 |
| Rate for Payer: Aetna American Axle |
$216.88
|
| Rate for Payer: Aetna American Axle |
$414.14
|
| Rate for Payer: Aetna American Axle |
$538.19
|
| Rate for Payer: Aetna American Axle |
$1,249.06
|
| Rate for Payer: Aetna American Axle |
$324.51
|
| Rate for Payer: Aetna Commercial |
$1,633.39
|
| Rate for Payer: Aetna Commercial |
$703.79
|
| Rate for Payer: Aetna Commercial |
$424.36
|
| Rate for Payer: Aetna Commercial |
$541.57
|
| Rate for Payer: Aetna Commercial |
$283.61
|
| Rate for Payer: Aetna Medicare |
$318.57
|
| Rate for Payer: Aetna Medicare |
$166.83
|
| Rate for Payer: Aetna Medicare |
$414.00
|
| Rate for Payer: Aetna Medicare |
$249.62
|
| Rate for Payer: Aetna Medicare |
$960.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.14
|
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: BCBS Complete |
$768.65
|
| Rate for Payer: BCBS Complete |
$254.86
|
| Rate for Payer: BCBS Complete |
$199.70
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: Cash Price |
$662.39
|
| Rate for Payer: Cash Price |
$1,537.30
|
| Rate for Payer: Cash Price |
$266.93
|
| Rate for Payer: Cash Price |
$509.71
|
| Rate for Payer: Cash Price |
$399.40
|
| Rate for Payer: Cofinity Commercial |
$579.59
|
| Rate for Payer: Cofinity Commercial |
$286.95
|
| Rate for Payer: Cofinity Commercial |
$547.94
|
| Rate for Payer: Cofinity Commercial |
$1,345.14
|
| Rate for Payer: Cofinity Commercial |
$429.36
|
| Rate for Payer: Cofinity Commercial |
$349.48
|
| Rate for Payer: Cofinity Commercial |
$446.00
|
| Rate for Payer: Cofinity Commercial |
$1,652.60
|
| Rate for Payer: Cofinity Commercial |
$233.56
|
| Rate for Payer: Cofinity Commercial |
$712.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$446.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$579.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.40
|
| Rate for Payer: Healthscope Commercial |
$1,729.47
|
| Rate for Payer: Healthscope Commercial |
$449.32
|
| Rate for Payer: Healthscope Commercial |
$745.19
|
| Rate for Payer: Healthscope Commercial |
$573.43
|
| Rate for Payer: Healthscope Commercial |
$300.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$446.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$620.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,441.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.79
|
| Rate for Payer: PHP Commercial |
$541.57
|
| Rate for Payer: PHP Commercial |
$424.36
|
| Rate for Payer: PHP Commercial |
$1,633.39
|
| Rate for Payer: PHP Commercial |
$283.61
|
| Rate for Payer: PHP Commercial |
$703.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.88
|
| Rate for Payer: Priority Health SBD |
$210.21
|
| Rate for Payer: Priority Health SBD |
$1,210.63
|
| Rate for Payer: Priority Health SBD |
$314.53
|
| Rate for Payer: Priority Health SBD |
$401.40
|
| Rate for Payer: Priority Health SBD |
$521.63
|
| Rate for Payer: UMR Bronson Commercial |
$306.36
|
| Rate for Payer: UMR Bronson Commercial |
$235.74
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$711.00
|
| Rate for Payer: UMR Bronson Commercial |
$184.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$620.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,441.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.44
|
|
