|
DUODERM CGF DRESSING EXTRA THIN 4X4
|
Facility
|
IP
|
$6.95
|
|
|
Service Code
|
NDC 68455010691
|
| Hospital Charge Code |
150728
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Aetna American Axle |
$4.52
|
| Rate for Payer: Aetna Commercial |
$5.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.52
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$4.87
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$6.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.91
|
| Rate for Payer: PHP Commercial |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.52
|
| Rate for Payer: Priority Health SBD |
$4.38
|
| Rate for Payer: UMR Bronson Commercial |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.21
|
|
|
DUPILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$6,229.65
|
|
|
Service Code
|
NDC 00024591800
|
| Hospital Charge Code |
188703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,304.97 |
| Max. Negotiated Rate |
$5,606.69 |
| Rate for Payer: Aetna American Axle |
$4,049.27
|
| Rate for Payer: Aetna Commercial |
$5,295.20
|
| Rate for Payer: Aetna Medicare |
$3,114.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,049.27
|
| Rate for Payer: BCBS Complete |
$2,491.86
|
| Rate for Payer: Cash Price |
$4,983.72
|
| Rate for Payer: Cofinity Commercial |
$4,360.76
|
| Rate for Payer: Cofinity Commercial |
$5,357.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,360.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,983.72
|
| Rate for Payer: Healthscope Commercial |
$5,606.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,360.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,672.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,295.20
|
| Rate for Payer: PHP Commercial |
$5,295.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,049.27
|
| Rate for Payer: Priority Health SBD |
$3,924.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,304.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,672.24
|
|
|
DUPILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$6,229.65
|
|
|
Service Code
|
NDC 00024591801
|
| Hospital Charge Code |
188703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,741.05 |
| Max. Negotiated Rate |
$5,606.69 |
| Rate for Payer: Aetna American Axle |
$4,049.27
|
| Rate for Payer: Aetna Commercial |
$5,295.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,049.27
|
| Rate for Payer: Cash Price |
$4,983.72
|
| Rate for Payer: Cofinity Commercial |
$4,360.76
|
| Rate for Payer: Cofinity Commercial |
$5,357.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,360.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,983.72
|
| Rate for Payer: Healthscope Commercial |
$5,606.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,360.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,672.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,295.20
|
| Rate for Payer: PHP Commercial |
$5,295.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,049.27
|
| Rate for Payer: Priority Health SBD |
$3,924.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,741.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,672.24
|
|
|
DUPILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$6,229.65
|
|
|
Service Code
|
NDC 00024591801
|
| Hospital Charge Code |
188703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,304.97 |
| Max. Negotiated Rate |
$5,606.69 |
| Rate for Payer: Aetna American Axle |
$4,049.27
|
| Rate for Payer: Aetna Commercial |
$5,295.20
|
| Rate for Payer: Aetna Medicare |
$3,114.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,049.27
|
| Rate for Payer: BCBS Complete |
$2,491.86
|
| Rate for Payer: Cash Price |
$4,983.72
|
| Rate for Payer: Cofinity Commercial |
$4,360.76
|
| Rate for Payer: Cofinity Commercial |
$5,357.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,360.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,983.72
|
| Rate for Payer: Healthscope Commercial |
$5,606.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,360.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,672.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,295.20
|
| Rate for Payer: PHP Commercial |
$5,295.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,049.27
|
| Rate for Payer: Priority Health SBD |
$3,924.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,304.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,672.24
|
|
|
DUPILUMAB 200 MG/1.14 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$6,229.65
|
|
|
Service Code
|
NDC 00024591800
|
| Hospital Charge Code |
188703
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,741.05 |
| Max. Negotiated Rate |
$5,606.69 |
| Rate for Payer: Aetna American Axle |
$4,049.27
|
| Rate for Payer: Aetna Commercial |
$5,295.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,049.27
|
| Rate for Payer: Cash Price |
$4,983.72
|
| Rate for Payer: Cofinity Commercial |
$4,360.76
|
| Rate for Payer: Cofinity Commercial |
$5,357.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,360.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,983.72
|
| Rate for Payer: Healthscope Commercial |
$5,606.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,360.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,672.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,295.20
|
| Rate for Payer: PHP Commercial |
$5,295.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,049.27
|
| Rate for Payer: Priority Health SBD |
$3,924.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,741.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,672.24
|
|
|
DUPILUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$6,229.66
|
|
|
Service Code
|
NDC 00024591401
|
| Hospital Charge Code |
182455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,741.05 |
| Max. Negotiated Rate |
$5,606.69 |
| Rate for Payer: Aetna American Axle |
$4,049.28
|
| Rate for Payer: Aetna Commercial |
$5,295.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,049.28
|
| Rate for Payer: Cash Price |
$4,983.73
|
| Rate for Payer: Cofinity Commercial |
$4,360.76
|
| Rate for Payer: Cofinity Commercial |
$5,357.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,360.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,983.73
|
| Rate for Payer: Healthscope Commercial |
$5,606.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,360.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,672.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,295.21
|
| Rate for Payer: PHP Commercial |
$5,295.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,049.28
|
| Rate for Payer: Priority Health SBD |
$3,924.69
|
| Rate for Payer: UMR Bronson Commercial |
$2,741.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,672.24
|
|
|
DUPILUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$6,229.66
|
|
|
Service Code
|
NDC 00024591400
|
| Hospital Charge Code |
182455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,304.97 |
| Max. Negotiated Rate |
$5,606.69 |
| Rate for Payer: Aetna American Axle |
$4,049.28
|
| Rate for Payer: Aetna Commercial |
$5,295.21
|
| Rate for Payer: Aetna Medicare |
$3,114.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,049.28
|
| Rate for Payer: BCBS Complete |
$2,491.86
|
| Rate for Payer: Cash Price |
$4,983.73
|
| Rate for Payer: Cofinity Commercial |
$4,360.76
|
| Rate for Payer: Cofinity Commercial |
$5,357.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,360.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,983.73
|
| Rate for Payer: Healthscope Commercial |
$5,606.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,360.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,672.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,295.21
|
| Rate for Payer: PHP Commercial |
$5,295.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,049.28
|
| Rate for Payer: Priority Health SBD |
$3,924.69
|
| Rate for Payer: UMR Bronson Commercial |
$2,304.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,672.24
|
|
|
DUPILUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$6,229.66
|
|
|
Service Code
|
NDC 00024591400
|
| Hospital Charge Code |
182455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,741.05 |
| Max. Negotiated Rate |
$5,606.69 |
| Rate for Payer: Aetna American Axle |
$4,049.28
|
| Rate for Payer: Aetna Commercial |
$5,295.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,049.28
|
| Rate for Payer: Cash Price |
$4,983.73
|
| Rate for Payer: Cofinity Commercial |
$4,360.76
|
| Rate for Payer: Cofinity Commercial |
$5,357.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,360.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,983.73
|
| Rate for Payer: Healthscope Commercial |
$5,606.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,360.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,672.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,295.21
|
| Rate for Payer: PHP Commercial |
$5,295.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,049.28
|
| Rate for Payer: Priority Health SBD |
$3,924.69
|
| Rate for Payer: UMR Bronson Commercial |
$2,741.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,672.24
|
|
|
DUPILUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$6,229.66
|
|
|
Service Code
|
NDC 00024591401
|
| Hospital Charge Code |
182455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,304.97 |
| Max. Negotiated Rate |
$5,606.69 |
| Rate for Payer: Aetna American Axle |
$4,049.28
|
| Rate for Payer: Aetna Commercial |
$5,295.21
|
| Rate for Payer: Aetna Medicare |
$3,114.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,049.28
|
| Rate for Payer: BCBS Complete |
$2,491.86
|
| Rate for Payer: Cash Price |
$4,983.73
|
| Rate for Payer: Cofinity Commercial |
$4,360.76
|
| Rate for Payer: Cofinity Commercial |
$5,357.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,360.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,983.73
|
| Rate for Payer: Healthscope Commercial |
$5,606.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,360.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,672.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,295.21
|
| Rate for Payer: PHP Commercial |
$5,295.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,049.28
|
| Rate for Payer: Priority Health SBD |
$3,924.69
|
| Rate for Payer: UMR Bronson Commercial |
$2,304.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,672.24
|
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$4,537.20
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
183305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$4,083.48 |
| Rate for Payer: Aetna American Axle |
$2,949.18
|
| Rate for Payer: Aetna American Axle |
$12,288.20
|
| Rate for Payer: Aetna Commercial |
$16,069.19
|
| Rate for Payer: Aetna Commercial |
$3,856.62
|
| Rate for Payer: Aetna Medicare |
$88.52
|
| Rate for Payer: Aetna Medicare |
$88.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,949.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,288.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.40
|
| Rate for Payer: BCBS Complete |
$47.91
|
| Rate for Payer: BCBS Complete |
$47.91
|
| Rate for Payer: BCBS MAPPO |
$85.12
|
| Rate for Payer: BCBS MAPPO |
$85.12
|
| Rate for Payer: BCN Medicare Advantage |
$85.12
|
| Rate for Payer: BCN Medicare Advantage |
$85.12
|
| Rate for Payer: Cash Price |
$15,123.94
|
| Rate for Payer: Cash Price |
$3,629.76
|
| Rate for Payer: Cash Price |
$3,629.76
|
| Rate for Payer: Cash Price |
$15,123.94
|
| Rate for Payer: Cofinity Commercial |
$13,233.45
|
| Rate for Payer: Cofinity Commercial |
$16,258.24
|
| Rate for Payer: Cofinity Commercial |
$3,176.04
|
| Rate for Payer: Cofinity Commercial |
$3,901.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,233.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,176.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,629.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,123.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.12
|
| Rate for Payer: Healthscope Commercial |
$4,083.48
|
| Rate for Payer: Healthscope Commercial |
$17,014.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,176.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,233.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,178.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,402.90
|
| Rate for Payer: Mclaren Medicaid |
$45.62
|
| Rate for Payer: Mclaren Medicaid |
$45.62
|
| Rate for Payer: Mclaren Medicare |
$85.12
|
| Rate for Payer: Mclaren Medicare |
$85.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.38
|
| Rate for Payer: Meridian Medicaid |
$47.91
|
| Rate for Payer: Meridian Medicaid |
$47.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,856.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,069.19
|
| Rate for Payer: PACE Medicare |
$80.86
|
| Rate for Payer: PACE Medicare |
$80.86
|
| Rate for Payer: PACE SWMI |
$85.12
|
| Rate for Payer: PACE SWMI |
$85.12
|
| Rate for Payer: PHP Commercial |
$16,069.19
|
| Rate for Payer: PHP Commercial |
$3,856.62
|
| Rate for Payer: PHP Medicare Advantage |
$85.12
|
| Rate for Payer: PHP Medicare Advantage |
$85.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,288.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,949.18
|
| Rate for Payer: Priority Health Medicare |
$85.12
|
| Rate for Payer: Priority Health Medicare |
$85.12
|
| Rate for Payer: Priority Health SBD |
$11,910.11
|
| Rate for Payer: Priority Health SBD |
$2,858.44
|
| Rate for Payer: Railroad Medicare Medicare |
$85.12
|
| Rate for Payer: Railroad Medicare Medicare |
$85.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.12
|
| Rate for Payer: UHC Exchange |
$162.67
|
| Rate for Payer: UHC Exchange |
$162.67
|
| Rate for Payer: UHC Medicare Advantage |
$85.12
|
| Rate for Payer: UHC Medicare Advantage |
$85.12
|
| Rate for Payer: UHCCP Medicaid |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$45.62
|
| Rate for Payer: UMR Bronson Commercial |
$6,994.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,678.76
|
| Rate for Payer: VA VA |
$85.12
|
| Rate for Payer: VA VA |
$85.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,402.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,178.70
|
|
|
DURVALUMAB 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18,904.93
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
183305
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,318.17 |
| Max. Negotiated Rate |
$17,014.44 |
| Rate for Payer: Aetna American Axle |
$12,288.20
|
| Rate for Payer: Aetna American Axle |
$2,949.18
|
| Rate for Payer: Aetna Commercial |
$16,069.19
|
| Rate for Payer: Aetna Commercial |
$3,856.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,288.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,949.18
|
| Rate for Payer: Cash Price |
$15,123.94
|
| Rate for Payer: Cash Price |
$3,629.76
|
| Rate for Payer: Cofinity Commercial |
$3,901.99
|
| Rate for Payer: Cofinity Commercial |
$3,176.04
|
| Rate for Payer: Cofinity Commercial |
$13,233.45
|
| Rate for Payer: Cofinity Commercial |
$16,258.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,233.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,176.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,123.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,629.76
|
| Rate for Payer: Healthscope Commercial |
$17,014.44
|
| Rate for Payer: Healthscope Commercial |
$4,083.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,233.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,176.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,178.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,402.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,856.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,069.19
|
| Rate for Payer: PHP Commercial |
$3,856.62
|
| Rate for Payer: PHP Commercial |
$16,069.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,288.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,949.18
|
| Rate for Payer: Priority Health SBD |
$11,910.11
|
| Rate for Payer: Priority Health SBD |
$2,858.44
|
| Rate for Payer: UMR Bronson Commercial |
$8,318.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,996.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,178.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,402.90
|
|
|
DUTASTERIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$860.92
|
|
|
Service Code
|
NDC 00173071215
|
| Hospital Charge Code |
34089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$774.83 |
| Rate for Payer: Aetna American Axle |
$559.60
|
| Rate for Payer: Aetna Commercial |
$731.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.60
|
| Rate for Payer: Cash Price |
$688.74
|
| Rate for Payer: Cofinity Commercial |
$602.64
|
| Rate for Payer: Cofinity Commercial |
$740.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$602.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.74
|
| Rate for Payer: Healthscope Commercial |
$774.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.78
|
| Rate for Payer: PHP Commercial |
$731.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.60
|
| Rate for Payer: Priority Health SBD |
$542.38
|
| Rate for Payer: UMR Bronson Commercial |
$378.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.69
|
|
|
DUTASTERIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$2,582.75
|
|
|
Service Code
|
NDC 00173071204
|
| Hospital Charge Code |
34089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,136.41 |
| Max. Negotiated Rate |
$2,324.47 |
| Rate for Payer: Aetna American Axle |
$1,678.79
|
| Rate for Payer: Aetna Commercial |
$2,195.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,678.79
|
| Rate for Payer: Cash Price |
$2,066.20
|
| Rate for Payer: Cofinity Commercial |
$1,807.92
|
| Rate for Payer: Cofinity Commercial |
$2,221.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,807.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,066.20
|
| Rate for Payer: Healthscope Commercial |
$2,324.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,807.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,937.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,195.34
|
| Rate for Payer: PHP Commercial |
$2,195.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,678.79
|
| Rate for Payer: Priority Health SBD |
$1,627.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,136.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,937.06
|
|
|
DUTASTERIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$365.90
|
|
|
Service Code
|
NDC 31722013190
|
| Hospital Charge Code |
34089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$329.31 |
| Rate for Payer: Aetna American Axle |
$237.84
|
| Rate for Payer: Aetna Commercial |
$311.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.84
|
| Rate for Payer: Cash Price |
$292.72
|
| Rate for Payer: Cofinity Commercial |
$256.13
|
| Rate for Payer: Cofinity Commercial |
$314.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.72
|
| Rate for Payer: Healthscope Commercial |
$329.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.01
|
| Rate for Payer: PHP Commercial |
$311.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.84
|
| Rate for Payer: Priority Health SBD |
$230.52
|
| Rate for Payer: UMR Bronson Commercial |
$161.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.43
|
|
|
DUTASTERIDE 0.5 MG CAPSULE
|
Facility
|
OP
|
$365.90
|
|
|
Service Code
|
NDC 31722013190
|
| Hospital Charge Code |
34089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.38 |
| Max. Negotiated Rate |
$329.31 |
| Rate for Payer: Aetna American Axle |
$237.84
|
| Rate for Payer: Aetna Commercial |
$311.01
|
| Rate for Payer: Aetna Medicare |
$182.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.84
|
| Rate for Payer: BCBS Complete |
$146.36
|
| Rate for Payer: Cash Price |
$292.72
|
| Rate for Payer: Cofinity Commercial |
$256.13
|
| Rate for Payer: Cofinity Commercial |
$314.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.72
|
| Rate for Payer: Healthscope Commercial |
$329.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.01
|
| Rate for Payer: PHP Commercial |
$311.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.84
|
| Rate for Payer: Priority Health SBD |
$230.52
|
| Rate for Payer: UMR Bronson Commercial |
$135.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.43
|
|
|
DUTASTERIDE 0.5 MG CAPSULE
|
Facility
|
OP
|
$860.92
|
|
|
Service Code
|
NDC 00173071215
|
| Hospital Charge Code |
34089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.54 |
| Max. Negotiated Rate |
$774.83 |
| Rate for Payer: Aetna American Axle |
$559.60
|
| Rate for Payer: Aetna Commercial |
$731.78
|
| Rate for Payer: Aetna Medicare |
$430.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.60
|
| Rate for Payer: BCBS Complete |
$344.37
|
| Rate for Payer: Cash Price |
$688.74
|
| Rate for Payer: Cofinity Commercial |
$602.64
|
| Rate for Payer: Cofinity Commercial |
$740.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$602.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.74
|
| Rate for Payer: Healthscope Commercial |
$774.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.78
|
| Rate for Payer: PHP Commercial |
$731.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.60
|
| Rate for Payer: Priority Health SBD |
$542.38
|
| Rate for Payer: UMR Bronson Commercial |
$318.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.69
|
|
|
DUTASTERIDE 0.5 MG CAPSULE
|
Facility
|
OP
|
$57.57
|
|
|
Service Code
|
NDC 31722013130
|
| Hospital Charge Code |
34089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna American Axle |
$37.42
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna Medicare |
$28.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.42
|
| Rate for Payer: BCBS Complete |
$23.03
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$40.30
|
| Rate for Payer: Cofinity Commercial |
$49.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$51.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.42
|
| Rate for Payer: Priority Health SBD |
$36.27
|
| Rate for Payer: UMR Bronson Commercial |
$21.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
DUTASTERIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$57.57
|
|
|
Service Code
|
NDC 31722013130
|
| Hospital Charge Code |
34089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna American Axle |
$37.42
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.42
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$40.30
|
| Rate for Payer: Cofinity Commercial |
$49.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$51.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.42
|
| Rate for Payer: Priority Health SBD |
$36.27
|
| Rate for Payer: UMR Bronson Commercial |
$25.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
DUTASTERIDE 0.5 MG CAPSULE
|
Facility
|
OP
|
$2,582.75
|
|
|
Service Code
|
NDC 00173071204
|
| Hospital Charge Code |
34089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$955.62 |
| Max. Negotiated Rate |
$2,324.47 |
| Rate for Payer: Aetna American Axle |
$1,678.79
|
| Rate for Payer: Aetna Commercial |
$2,195.34
|
| Rate for Payer: Aetna Medicare |
$1,291.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,678.79
|
| Rate for Payer: BCBS Complete |
$1,033.10
|
| Rate for Payer: Cash Price |
$2,066.20
|
| Rate for Payer: Cofinity Commercial |
$1,807.92
|
| Rate for Payer: Cofinity Commercial |
$2,221.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,807.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,066.20
|
| Rate for Payer: Healthscope Commercial |
$2,324.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,807.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,937.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,195.34
|
| Rate for Payer: PHP Commercial |
$2,195.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,678.79
|
| Rate for Payer: Priority Health SBD |
$1,627.13
|
| Rate for Payer: UMR Bronson Commercial |
$955.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,937.06
|
|
|
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL-TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT
|
Facility
|
OP
|
$1,505.27
|
|
|
Service Code
|
CPT 93312
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$286.63 |
| Max. Negotiated Rate |
$1,505.27 |
| Rate for Payer: Aetna Medicare |
$556.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.75
|
| Rate for Payer: Mclaren Medicaid |
$286.63
|
| Rate for Payer: Mclaren Medicare |
$534.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Meridian Medicaid |
$300.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.96
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.63
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,505.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$1,021.96
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: VA VA |
$534.75
|
|
|
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL-TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT
|
Facility
|
OP
|
$1,505.27
|
|
|
Service Code
|
CPT 93312
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$286.63 |
| Max. Negotiated Rate |
$1,505.27 |
| Rate for Payer: Aetna Medicare |
$556.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.44
|
| Rate for Payer: BCBS Complete |
$300.96
|
| Rate for Payer: BCBS MAPPO |
$534.75
|
| Rate for Payer: BCN Medicare Advantage |
$534.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.75
|
| Rate for Payer: Mclaren Medicaid |
$286.63
|
| Rate for Payer: Mclaren Medicare |
$534.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$561.49
|
| Rate for Payer: Meridian Medicaid |
$300.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.96
|
| Rate for Payer: PACE Medicare |
$508.01
|
| Rate for Payer: PACE SWMI |
$534.75
|
| Rate for Payer: PHP Medicare Advantage |
$534.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.63
|
| Rate for Payer: Priority Health Medicare |
$534.75
|
| Rate for Payer: Railroad Medicare Medicare |
$534.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,505.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.75
|
| Rate for Payer: UHC Exchange |
$1,021.96
|
| Rate for Payer: UHC Medicare Advantage |
$534.75
|
| Rate for Payer: UHCCP Medicaid |
$286.63
|
| Rate for Payer: VA VA |
$534.75
|
|
|
ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,959.78
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
81696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,275.12 |
| Max. Negotiated Rate |
$15,263.80 |
| Rate for Payer: Aetna American Axle |
$11,023.86
|
| Rate for Payer: Aetna Commercial |
$14,415.81
|
| Rate for Payer: Aetna Medicare |
$8,479.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,023.86
|
| Rate for Payer: BCBS Complete |
$6,783.91
|
| Rate for Payer: Cash Price |
$13,567.82
|
| Rate for Payer: Cofinity Commercial |
$11,871.85
|
| Rate for Payer: Cofinity Commercial |
$14,585.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,871.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,567.82
|
| Rate for Payer: Healthscope Commercial |
$15,263.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,871.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,719.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,415.81
|
| Rate for Payer: PHP Commercial |
$14,415.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,023.86
|
| Rate for Payer: Priority Health SBD |
$10,684.66
|
| Rate for Payer: UMR Bronson Commercial |
$6,275.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,719.83
|
|
|
ECULIZUMAB 300 MG/30 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16,959.78
|
|
|
Service Code
|
HCPCS J1300
|
| Hospital Charge Code |
81696
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,462.30 |
| Max. Negotiated Rate |
$15,263.80 |
| Rate for Payer: Aetna American Axle |
$11,023.86
|
| Rate for Payer: Aetna Commercial |
$14,415.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,023.86
|
| Rate for Payer: Cash Price |
$13,567.82
|
| Rate for Payer: Cofinity Commercial |
$11,871.85
|
| Rate for Payer: Cofinity Commercial |
$14,585.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,871.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,567.82
|
| Rate for Payer: Healthscope Commercial |
$15,263.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,871.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,719.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,415.81
|
| Rate for Payer: PHP Commercial |
$14,415.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,023.86
|
| Rate for Payer: Priority Health SBD |
$10,684.66
|
| Rate for Payer: UMR Bronson Commercial |
$7,462.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,719.83
|
|
|
EDARAVONE 30 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,737.60
|
|
|
Service Code
|
HCPCS J1301
|
| Hospital Charge Code |
183348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.25 |
| Max. Negotiated Rate |
$1,563.84 |
| Rate for Payer: Aetna American Axle |
$1,129.44
|
| Rate for Payer: Aetna Commercial |
$1,476.96
|
| Rate for Payer: Aetna Medicare |
$21.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.24
|
| Rate for Payer: BCBS Complete |
$11.81
|
| Rate for Payer: BCBS MAPPO |
$20.99
|
| Rate for Payer: BCN Medicare Advantage |
$20.99
|
| Rate for Payer: Cash Price |
$1,390.08
|
| Rate for Payer: Cash Price |
$1,390.08
|
| Rate for Payer: Cofinity Commercial |
$1,494.34
|
| Rate for Payer: Cofinity Commercial |
$1,216.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,216.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.99
|
| Rate for Payer: Healthscope Commercial |
$1,563.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,216.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,303.20
|
| Rate for Payer: Mclaren Medicaid |
$11.25
|
| Rate for Payer: Mclaren Medicare |
$20.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.04
|
| Rate for Payer: Meridian Medicaid |
$11.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.96
|
| Rate for Payer: PACE Medicare |
$19.94
|
| Rate for Payer: PACE SWMI |
$20.99
|
| Rate for Payer: PHP Commercial |
$1,476.96
|
| Rate for Payer: PHP Medicare Advantage |
$20.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.44
|
| Rate for Payer: Priority Health Medicare |
$20.99
|
| Rate for Payer: Priority Health SBD |
$1,094.69
|
| Rate for Payer: Railroad Medicare Medicare |
$20.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.99
|
| Rate for Payer: UHC Exchange |
$40.11
|
| Rate for Payer: UHC Medicare Advantage |
$20.99
|
| Rate for Payer: UHCCP Medicaid |
$11.25
|
| Rate for Payer: UMR Bronson Commercial |
$642.91
|
| Rate for Payer: VA VA |
$20.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,303.20
|
|
|
EDARAVONE 30 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,737.60
|
|
|
Service Code
|
HCPCS J1301
|
| Hospital Charge Code |
183348
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$764.54 |
| Max. Negotiated Rate |
$1,563.84 |
| Rate for Payer: Aetna American Axle |
$1,129.44
|
| Rate for Payer: Aetna Commercial |
$1,476.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.44
|
| Rate for Payer: Cash Price |
$1,390.08
|
| Rate for Payer: Cofinity Commercial |
$1,216.32
|
| Rate for Payer: Cofinity Commercial |
$1,494.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,216.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.08
|
| Rate for Payer: Healthscope Commercial |
$1,563.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,216.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,303.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.96
|
| Rate for Payer: PHP Commercial |
$1,476.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.44
|
| Rate for Payer: Priority Health SBD |
$1,094.69
|
| Rate for Payer: UMR Bronson Commercial |
$764.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,303.20
|
|
