|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$25.85
|
|
|
Service Code
|
NDC 00904759060
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$23.27 |
| Rate for Payer: Aetna American Axle |
$16.80
|
| Rate for Payer: Aetna Commercial |
$21.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.80
|
| Rate for Payer: Cash Price |
$20.68
|
| Rate for Payer: Cofinity Advantage |
$18.09
|
| Rate for Payer: Cofinity Commercial |
$22.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.68
|
| Rate for Payer: Healthscope Commercial |
$23.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.39
|
| Rate for Payer: PHP Commercial |
$21.97
|
| Rate for Payer: Priority Health SBD |
$16.29
|
| Rate for Payer: UMR Bronson Commercial |
$11.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.39
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,000.31
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$900.28 |
| Rate for Payer: Aetna American Axle |
$650.20
|
| Rate for Payer: Aetna American Axle |
$363.68
|
| Rate for Payer: Aetna Commercial |
$850.26
|
| Rate for Payer: Aetna Commercial |
$475.58
|
| Rate for Payer: Aetna Medicare |
$0.24
|
| Rate for Payer: Aetna Medicare |
$0.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$363.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.29
|
| Rate for Payer: BCBS Complete |
$0.13
|
| Rate for Payer: BCBS Complete |
$0.13
|
| Rate for Payer: BCBS MAPPO |
$0.23
|
| Rate for Payer: BCBS MAPPO |
$0.23
|
| Rate for Payer: BCBS Trust/PPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$1.15
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: BCN Medicare Advantage |
$0.23
|
| Rate for Payer: BCN Medicare Advantage |
$0.23
|
| Rate for Payer: Cash Price |
$447.61
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cash Price |
$447.61
|
| Rate for Payer: Cofinity Advantage |
$391.66
|
| Rate for Payer: Cofinity Advantage |
$700.22
|
| Rate for Payer: Cofinity Commercial |
$860.27
|
| Rate for Payer: Cofinity Commercial |
$481.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$447.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$900.28
|
| Rate for Payer: Healthscope Commercial |
$503.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$700.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$391.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$419.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.23
|
| Rate for Payer: Mclaren Medicaid |
$0.23
|
| Rate for Payer: Mclaren Medicaid |
$0.23
|
| Rate for Payer: Mclaren Medicare |
$0.23
|
| Rate for Payer: Mclaren Medicare |
$0.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.24
|
| Rate for Payer: Meridian Medicaid |
$0.24
|
| Rate for Payer: Meridian Medicaid |
$0.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$475.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.26
|
| Rate for Payer: Nomi Health Commercial |
$0.69
|
| Rate for Payer: Nomi Health Commercial |
$0.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$750.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$419.63
|
| Rate for Payer: PACE Medicare |
$0.22
|
| Rate for Payer: PACE Medicare |
$0.22
|
| Rate for Payer: PACE SWMI |
$0.23
|
| Rate for Payer: PACE SWMI |
$0.23
|
| Rate for Payer: PHP Commercial |
$850.26
|
| Rate for Payer: PHP Commercial |
$475.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.23
|
| Rate for Payer: PHP Medicare Advantage |
$0.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1.01
|
| Rate for Payer: Priority Health Medicare |
$0.23
|
| Rate for Payer: Priority Health Medicare |
$0.23
|
| Rate for Payer: Priority Health SBD |
$352.49
|
| Rate for Payer: Priority Health SBD |
$630.20
|
| Rate for Payer: Priority Health Tiered Network |
$0.81
|
| Rate for Payer: Priority Health Tiered Network |
$0.81
|
| Rate for Payer: Railroad Medicare Medicare |
$0.23
|
| Rate for Payer: Railroad Medicare Medicare |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHC Medicaid |
$0.12
|
| Rate for Payer: UHC Medicaid |
$0.12
|
| Rate for Payer: UHCCP Medicaid |
$0.12
|
| Rate for Payer: UHCCP Medicaid |
$0.12
|
| Rate for Payer: UMR Bronson Commercial |
$370.11
|
| Rate for Payer: UMR Bronson Commercial |
$207.02
|
| Rate for Payer: VA VA |
$0.23
|
| Rate for Payer: VA VA |
$0.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$419.63
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,000.31
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$440.14 |
| Max. Negotiated Rate |
$900.28 |
| Rate for Payer: Aetna American Axle |
$650.20
|
| Rate for Payer: Aetna Commercial |
$850.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.20
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cofinity Advantage |
$700.22
|
| Rate for Payer: Cofinity Commercial |
$860.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.25
|
| Rate for Payer: Healthscope Commercial |
$900.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$700.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$750.23
|
| Rate for Payer: PHP Commercial |
$850.26
|
| Rate for Payer: Priority Health SBD |
$630.20
|
| Rate for Payer: UMR Bronson Commercial |
$440.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.23
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$11,509.65
|
|
|
Service Code
|
APR-DRG 7224
|
| Min. Negotiated Rate |
$10,961.57 |
| Max. Negotiated Rate |
$11,509.65 |
| Rate for Payer: BCBS Complete |
$11,509.65
|
| Rate for Payer: Mclaren Medicaid |
$10,961.57
|
| Rate for Payer: Meridian Medicaid |
$11,509.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,961.57
|
| Rate for Payer: UHC Medicaid |
$10,961.57
|
| Rate for Payer: UHCCP Medicaid |
$10,961.57
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$2,781.47
|
|
|
Service Code
|
APR-DRG 7221
|
| Min. Negotiated Rate |
$2,649.02 |
| Max. Negotiated Rate |
$2,781.47 |
| Rate for Payer: BCBS Complete |
$2,781.47
|
| Rate for Payer: Mclaren Medicaid |
$2,649.02
|
| Rate for Payer: Meridian Medicaid |
$2,781.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,649.02
|
| Rate for Payer: UHC Medicaid |
$2,649.02
|
| Rate for Payer: UHCCP Medicaid |
$2,649.02
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$3,362.58
|
|
|
Service Code
|
APR-DRG 7222
|
| Min. Negotiated Rate |
$3,202.46 |
| Max. Negotiated Rate |
$3,362.58 |
| Rate for Payer: BCBS Complete |
$3,362.58
|
| Rate for Payer: Mclaren Medicaid |
$3,202.46
|
| Rate for Payer: Meridian Medicaid |
$3,362.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,202.46
|
| Rate for Payer: UHC Medicaid |
$3,202.46
|
| Rate for Payer: UHCCP Medicaid |
$3,202.46
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$5,282.67
|
|
|
Service Code
|
APR-DRG 7223
|
| Min. Negotiated Rate |
$5,031.12 |
| Max. Negotiated Rate |
$5,282.67 |
| Rate for Payer: BCBS Complete |
$5,282.67
|
| Rate for Payer: Mclaren Medicaid |
$5,031.12
|
| Rate for Payer: Meridian Medicaid |
$5,282.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,031.12
|
| Rate for Payer: UHC Medicaid |
$5,031.12
|
| Rate for Payer: UHCCP Medicaid |
$5,031.12
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$16,154.91
|
|
|
Service Code
|
MSDRG 864
|
| Min. Negotiated Rate |
$7,615.71 |
| Max. Negotiated Rate |
$16,154.91 |
| Rate for Payer: Aetna Medicare |
$8,337.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,020.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,020.67
|
| Rate for Payer: BCBS MAPPO |
$8,016.54
|
| Rate for Payer: BCBS Trust/PPO |
$16,154.91
|
| Rate for Payer: BCN Commercial |
$16,154.91
|
| Rate for Payer: BCN Medicare Advantage |
$8,016.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,016.54
|
| Rate for Payer: Mclaren Medicare |
$8,016.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,417.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,219.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,818.19
|
| Rate for Payer: Nomi Health Commercial |
$11,451.33
|
| Rate for Payer: PACE Medicare |
$7,615.71
|
| Rate for Payer: PACE SWMI |
$8,016.54
|
| Rate for Payer: PHP Medicare Advantage |
$8,016.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,311.62
|
| Rate for Payer: Priority Health Medicare |
$8,016.54
|
| Rate for Payer: Priority Health Tiered Network |
$11,449.30
|
| Rate for Payer: Railroad Medicare Medicare |
$8,016.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,469.51
|
| Rate for Payer: UHC Core |
$12,105.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,016.54
|
| Rate for Payer: UHC Exchange |
$9,886.31
|
| Rate for Payer: VA VA |
$8,016.54
|
|
|
FIBERSOURCE HN BOLUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
161567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$2.47
|
| Rate for Payer: UHC Exchange |
$1.87
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
FIBERSOURCE HN BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
161567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 43900018555
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.09
|
| Rate for Payer: UHC Core |
$2.47
|
| Rate for Payer: UHC Exchange |
$1.87
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.24
|
| Rate for Payer: UHC Core |
$5.00
|
| Rate for Payer: UHC Exchange |
$3.77
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.24
|
| Rate for Payer: UHC Core |
$5.00
|
| Rate for Payer: UHC Exchange |
$3.77
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIBERSOURCE HN INTERMITTENT FEED
|
Facility
|
IP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
200076
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UMR Bronson Commercial |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIBERSOURCE HN INTERMITTENT FEED
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
NDC 43900018588
|
| Hospital Charge Code |
200076
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna American Axle |
$6.24
|
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.24
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: Cash Price |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.68
|
| Rate for Payer: Healthscope Commercial |
$8.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.20
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: Priority Health SBD |
$6.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.24
|
| Rate for Payer: UHC Core |
$5.00
|
| Rate for Payer: UHC Exchange |
$3.77
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.20
|
|
|
FIDAXOMICIN 200 MG TABLET
|
Facility
|
IP
|
$8,776.11
|
|
|
Service Code
|
NDC 52015008001
|
| Hospital Charge Code |
152861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,861.49 |
| Max. Negotiated Rate |
$7,898.50 |
| Rate for Payer: Aetna American Axle |
$5,704.47
|
| Rate for Payer: Aetna Commercial |
$7,459.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,704.47
|
| Rate for Payer: Cash Price |
$7,020.89
|
| Rate for Payer: Cofinity Advantage |
$6,143.28
|
| Rate for Payer: Cofinity Commercial |
$7,547.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,020.89
|
| Rate for Payer: Healthscope Commercial |
$7,898.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,143.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,582.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,459.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,582.08
|
| Rate for Payer: PHP Commercial |
$7,459.69
|
| Rate for Payer: Priority Health SBD |
$5,528.95
|
| Rate for Payer: UMR Bronson Commercial |
$3,861.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,582.08
|
|
|
FIDAXOMICIN 200 MG TABLET
|
Facility
|
OP
|
$8,776.11
|
|
|
Service Code
|
NDC 52015008001
|
| Hospital Charge Code |
152861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,247.16 |
| Max. Negotiated Rate |
$7,898.50 |
| Rate for Payer: Aetna American Axle |
$5,704.47
|
| Rate for Payer: Aetna Commercial |
$7,459.69
|
| Rate for Payer: Aetna Medicare |
$4,388.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,704.47
|
| Rate for Payer: BCBS Complete |
$3,510.44
|
| Rate for Payer: Cash Price |
$7,020.89
|
| Rate for Payer: Cofinity Advantage |
$6,143.28
|
| Rate for Payer: Cofinity Commercial |
$7,547.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,020.89
|
| Rate for Payer: Healthscope Commercial |
$7,898.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,143.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,582.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,020.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,459.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,582.08
|
| Rate for Payer: PHP Commercial |
$7,459.69
|
| Rate for Payer: Priority Health SBD |
$5,528.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,704.47
|
| Rate for Payer: UHC Core |
$4,572.35
|
| Rate for Payer: UHC Exchange |
$3,449.01
|
| Rate for Payer: UMR Bronson Commercial |
$3,247.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,582.08
|
|
|
FILGRASTIM 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$1,041.16
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
28863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$937.04 |
| Rate for Payer: Aetna American Axle |
$676.75
|
| Rate for Payer: Aetna Commercial |
$884.99
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.27
|
| Rate for Payer: BCBS Complete |
$0.56
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: Cash Price |
$832.93
|
| Rate for Payer: Cash Price |
$832.93
|
| Rate for Payer: Cofinity Advantage |
$728.81
|
| Rate for Payer: Cofinity Commercial |
$895.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$937.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.87
|
| Rate for Payer: Mclaren Medicaid |
$1.02
|
| Rate for Payer: Mclaren Medicare |
$1.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: Meridian Medicaid |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.99
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.87
|
| Rate for Payer: PACE Medicare |
$0.97
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PHP Commercial |
$884.99
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$1.02
|
| Rate for Payer: Priority Health SBD |
$655.93
|
| Rate for Payer: Priority Health Tiered Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.65
|
| Rate for Payer: UHC Core |
$1.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.02
|
| Rate for Payer: UHC Exchange |
$1.65
|
| Rate for Payer: UHC Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$385.23
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.87
|
|
|
FILGRASTIM 300 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,458.07
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
10036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$641.55 |
| Max. Negotiated Rate |
$1,312.26 |
| Rate for Payer: Aetna American Axle |
$947.75
|
| Rate for Payer: Aetna Commercial |
$1,239.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.75
|
| Rate for Payer: Cash Price |
$1,166.46
|
| Rate for Payer: Cofinity Advantage |
$1,020.65
|
| Rate for Payer: Cofinity Commercial |
$1,253.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.46
|
| Rate for Payer: Healthscope Commercial |
$1,312.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,020.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,093.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.55
|
| Rate for Payer: PHP Commercial |
$1,239.36
|
| Rate for Payer: Priority Health SBD |
$918.58
|
| Rate for Payer: UMR Bronson Commercial |
$641.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,093.55
|
|
|
FILGRASTIM 300 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,458.07
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
10036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1,312.26 |
| Rate for Payer: Aetna American Axle |
$947.75
|
| Rate for Payer: Aetna Commercial |
$1,239.36
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.27
|
| Rate for Payer: BCBS Complete |
$0.56
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: Cash Price |
$1,166.46
|
| Rate for Payer: Cash Price |
$1,166.46
|
| Rate for Payer: Cofinity Advantage |
$1,020.65
|
| Rate for Payer: Cofinity Commercial |
$1,253.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$1,312.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,020.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,093.55
|
| Rate for Payer: Mclaren Medicaid |
$1.02
|
| Rate for Payer: Mclaren Medicare |
$1.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: Meridian Medicaid |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.36
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.55
|
| Rate for Payer: PACE Medicare |
$0.97
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PHP Commercial |
$1,239.36
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$1.02
|
| Rate for Payer: Priority Health SBD |
$918.58
|
| Rate for Payer: Priority Health Tiered Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.65
|
| Rate for Payer: UHC Core |
$1.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.02
|
| Rate for Payer: UHC Exchange |
$1.65
|
| Rate for Payer: UHC Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$539.49
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,093.55
|
|
|
FILGRASTIM 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
OP
|
$1,658.05
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
112198
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1,492.24 |
| Rate for Payer: Aetna American Axle |
$1,077.73
|
| Rate for Payer: Aetna Commercial |
$1,409.34
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.27
|
| Rate for Payer: BCBS Complete |
$0.56
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.15
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: Cash Price |
$1,326.44
|
| Rate for Payer: Cash Price |
$1,326.44
|
| Rate for Payer: Cofinity Advantage |
$1,160.63
|
| Rate for Payer: Cofinity Commercial |
$1,425.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,326.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$1,492.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,160.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,243.54
|
| Rate for Payer: Mclaren Medicaid |
$1.02
|
| Rate for Payer: Mclaren Medicare |
$1.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: Meridian Medicaid |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,409.34
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,243.54
|
| Rate for Payer: PACE Medicare |
$0.97
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PHP Commercial |
$1,409.34
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$1.02
|
| Rate for Payer: Priority Health SBD |
$1,044.57
|
| Rate for Payer: Priority Health Tiered Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.65
|
| Rate for Payer: UHC Core |
$1.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.02
|
| Rate for Payer: UHC Exchange |
$1.65
|
| Rate for Payer: UHC Medicaid |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$613.48
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,243.54
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJECTION SOLUTION
|
Facility
|
IP
|
$2,194.70
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
112757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$965.67 |
| Max. Negotiated Rate |
$1,975.23 |
| Rate for Payer: Aetna American Axle |
$1,426.56
|
| Rate for Payer: Aetna Commercial |
$1,865.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,426.56
|
| Rate for Payer: Cash Price |
$1,755.76
|
| Rate for Payer: Cofinity Advantage |
$1,536.29
|
| Rate for Payer: Cofinity Commercial |
$1,887.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,755.76
|
| Rate for Payer: Healthscope Commercial |
$1,975.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,536.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,646.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,865.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,646.03
|
| Rate for Payer: PHP Commercial |
$1,865.49
|
| Rate for Payer: Priority Health SBD |
$1,382.66
|
| Rate for Payer: UMR Bronson Commercial |
$965.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,646.03
|
|
