|
ELOTUZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,916.72
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
176616
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,603.36 |
| Max. Negotiated Rate |
$5,325.05 |
| Rate for Payer: Aetna American Axle |
$3,845.87
|
| Rate for Payer: Aetna Commercial |
$5,029.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,845.87
|
| Rate for Payer: Cash Price |
$4,733.38
|
| Rate for Payer: Cofinity Commercial |
$4,141.70
|
| Rate for Payer: Cofinity Commercial |
$5,088.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,141.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,733.38
|
| Rate for Payer: Healthscope Commercial |
$5,325.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,141.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,437.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,029.21
|
| Rate for Payer: PHP Commercial |
$5,029.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,845.87
|
| Rate for Payer: Priority Health SBD |
$3,727.53
|
| Rate for Payer: UMR Bronson Commercial |
$2,603.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,437.54
|
|
|
ELOTUZUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,888.87
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
176617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,471.10 |
| Max. Negotiated Rate |
$7,099.98 |
| Rate for Payer: Aetna American Axle |
$5,127.77
|
| Rate for Payer: Aetna Commercial |
$6,705.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,127.77
|
| Rate for Payer: Cash Price |
$6,311.10
|
| Rate for Payer: Cofinity Commercial |
$5,522.21
|
| Rate for Payer: Cofinity Commercial |
$6,784.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,522.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,311.10
|
| Rate for Payer: Healthscope Commercial |
$7,099.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,522.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,916.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,705.54
|
| Rate for Payer: PHP Commercial |
$6,705.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,127.77
|
| Rate for Payer: Priority Health SBD |
$4,969.99
|
| Rate for Payer: UMR Bronson Commercial |
$3,471.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,916.65
|
|
|
ELOTUZUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,888.87
|
|
|
Service Code
|
HCPCS J9176
|
| Hospital Charge Code |
176617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$7,099.98 |
| Rate for Payer: Aetna American Axle |
$5,127.77
|
| Rate for Payer: Aetna Commercial |
$6,705.54
|
| Rate for Payer: Aetna Medicare |
$8.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,127.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.86
|
| Rate for Payer: BCBS Complete |
$4.44
|
| Rate for Payer: BCBS MAPPO |
$7.89
|
| Rate for Payer: BCN Medicare Advantage |
$7.89
|
| Rate for Payer: Cash Price |
$6,311.10
|
| Rate for Payer: Cash Price |
$6,311.10
|
| Rate for Payer: Cofinity Commercial |
$6,784.43
|
| Rate for Payer: Cofinity Commercial |
$5,522.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,522.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,311.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.89
|
| Rate for Payer: Healthscope Commercial |
$7,099.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,522.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,916.65
|
| Rate for Payer: Mclaren Medicaid |
$4.23
|
| Rate for Payer: Mclaren Medicare |
$7.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.28
|
| Rate for Payer: Meridian Medicaid |
$4.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,705.54
|
| Rate for Payer: PACE Medicare |
$7.50
|
| Rate for Payer: PACE SWMI |
$7.89
|
| Rate for Payer: PHP Commercial |
$6,705.54
|
| Rate for Payer: PHP Medicare Advantage |
$7.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,127.77
|
| Rate for Payer: Priority Health Medicare |
$7.89
|
| Rate for Payer: Priority Health SBD |
$4,969.99
|
| Rate for Payer: Railroad Medicare Medicare |
$7.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.89
|
| Rate for Payer: UHC Exchange |
$15.08
|
| Rate for Payer: UHC Medicare Advantage |
$7.89
|
| Rate for Payer: UHCCP Medicaid |
$4.23
|
| Rate for Payer: UMR Bronson Commercial |
$2,918.88
|
| Rate for Payer: VA VA |
$7.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,916.65
|
|
|
ELRANATAMAB-BCMM 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$35,776.82
|
|
|
Service Code
|
HCPCS J1323
|
| Hospital Charge Code |
205012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,741.80 |
| Max. Negotiated Rate |
$32,199.14 |
| Rate for Payer: Aetna American Axle |
$23,254.93
|
| Rate for Payer: Aetna American Axle |
$40,167.61
|
| Rate for Payer: Aetna Commercial |
$30,410.30
|
| Rate for Payer: Aetna Commercial |
$52,526.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23,254.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,167.61
|
| Rate for Payer: Cash Price |
$28,621.46
|
| Rate for Payer: Cash Price |
$49,437.06
|
| Rate for Payer: Cofinity Commercial |
$53,144.84
|
| Rate for Payer: Cofinity Commercial |
$43,257.43
|
| Rate for Payer: Cofinity Commercial |
$25,043.77
|
| Rate for Payer: Cofinity Commercial |
$30,768.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$25,043.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$43,257.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28,621.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49,437.06
|
| Rate for Payer: Healthscope Commercial |
$32,199.14
|
| Rate for Payer: Healthscope Commercial |
$55,616.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25,043.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43,257.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26,832.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46,347.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52,526.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,410.30
|
| Rate for Payer: PHP Commercial |
$52,526.88
|
| Rate for Payer: PHP Commercial |
$30,410.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23,254.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40,167.61
|
| Rate for Payer: Priority Health SBD |
$22,539.40
|
| Rate for Payer: Priority Health SBD |
$38,931.69
|
| Rate for Payer: UMR Bronson Commercial |
$15,741.80
|
| Rate for Payer: UMR Bronson Commercial |
$27,190.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26,832.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46,347.25
|
|
|
ELRANATAMAB-BCMM 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$61,796.33
|
|
|
Service Code
|
HCPCS J1323
|
| Hospital Charge Code |
205012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.66 |
| Max. Negotiated Rate |
$55,616.70 |
| Rate for Payer: Aetna American Axle |
$40,167.61
|
| Rate for Payer: Aetna American Axle |
$23,254.93
|
| Rate for Payer: Aetna Commercial |
$30,410.30
|
| Rate for Payer: Aetna Commercial |
$52,526.88
|
| Rate for Payer: Aetna Medicare |
$191.43
|
| Rate for Payer: Aetna Medicare |
$191.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,167.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23,254.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$230.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$230.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$230.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$230.09
|
| Rate for Payer: BCBS Complete |
$103.59
|
| Rate for Payer: BCBS Complete |
$103.59
|
| Rate for Payer: BCBS MAPPO |
$184.07
|
| Rate for Payer: BCBS MAPPO |
$184.07
|
| Rate for Payer: BCN Medicare Advantage |
$184.07
|
| Rate for Payer: BCN Medicare Advantage |
$184.07
|
| Rate for Payer: Cash Price |
$28,621.46
|
| Rate for Payer: Cash Price |
$49,437.06
|
| Rate for Payer: Cash Price |
$49,437.06
|
| Rate for Payer: Cash Price |
$28,621.46
|
| Rate for Payer: Cofinity Commercial |
$25,043.77
|
| Rate for Payer: Cofinity Commercial |
$30,768.07
|
| Rate for Payer: Cofinity Commercial |
$43,257.43
|
| Rate for Payer: Cofinity Commercial |
$53,144.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$25,043.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$43,257.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49,437.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28,621.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.07
|
| Rate for Payer: Healthscope Commercial |
$55,616.70
|
| Rate for Payer: Healthscope Commercial |
$32,199.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43,257.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25,043.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26,832.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46,347.25
|
| Rate for Payer: Mclaren Medicaid |
$98.66
|
| Rate for Payer: Mclaren Medicaid |
$98.66
|
| Rate for Payer: Mclaren Medicare |
$184.07
|
| Rate for Payer: Mclaren Medicare |
$184.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.27
|
| Rate for Payer: Meridian Medicaid |
$103.59
|
| Rate for Payer: Meridian Medicaid |
$103.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52,526.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,410.30
|
| Rate for Payer: PACE Medicare |
$174.87
|
| Rate for Payer: PACE Medicare |
$174.87
|
| Rate for Payer: PACE SWMI |
$184.07
|
| Rate for Payer: PACE SWMI |
$184.07
|
| Rate for Payer: PHP Commercial |
$30,410.30
|
| Rate for Payer: PHP Commercial |
$52,526.88
|
| Rate for Payer: PHP Medicare Advantage |
$184.07
|
| Rate for Payer: PHP Medicare Advantage |
$184.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23,254.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40,167.61
|
| Rate for Payer: Priority Health Medicare |
$184.07
|
| Rate for Payer: Priority Health Medicare |
$184.07
|
| Rate for Payer: Priority Health SBD |
$22,539.40
|
| Rate for Payer: Priority Health SBD |
$38,931.69
|
| Rate for Payer: Railroad Medicare Medicare |
$184.07
|
| Rate for Payer: Railroad Medicare Medicare |
$184.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.07
|
| Rate for Payer: UHC Exchange |
$351.78
|
| Rate for Payer: UHC Exchange |
$351.78
|
| Rate for Payer: UHC Medicare Advantage |
$184.07
|
| Rate for Payer: UHC Medicare Advantage |
$184.07
|
| Rate for Payer: UHCCP Medicaid |
$98.66
|
| Rate for Payer: UHCCP Medicaid |
$98.66
|
| Rate for Payer: UMR Bronson Commercial |
$13,237.42
|
| Rate for Payer: UMR Bronson Commercial |
$22,864.64
|
| Rate for Payer: VA VA |
$184.07
|
| Rate for Payer: VA VA |
$184.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46,347.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26,832.62
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$893.81
|
|
|
Service Code
|
NDC 00078069719
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$393.28 |
| Max. Negotiated Rate |
$804.43 |
| Rate for Payer: Aetna American Axle |
$580.98
|
| Rate for Payer: Aetna Commercial |
$759.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.98
|
| Rate for Payer: Cash Price |
$715.05
|
| Rate for Payer: Cofinity Commercial |
$625.67
|
| Rate for Payer: Cofinity Commercial |
$768.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.05
|
| Rate for Payer: Healthscope Commercial |
$804.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.74
|
| Rate for Payer: PHP Commercial |
$759.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.98
|
| Rate for Payer: Priority Health SBD |
$563.10
|
| Rate for Payer: UMR Bronson Commercial |
$393.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.36
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$26,814.05
|
|
|
Service Code
|
NDC 00078069761
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,798.18 |
| Max. Negotiated Rate |
$24,132.65 |
| Rate for Payer: Aetna American Axle |
$17,429.13
|
| Rate for Payer: Aetna Commercial |
$22,791.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,429.13
|
| Rate for Payer: Cash Price |
$21,451.24
|
| Rate for Payer: Cofinity Commercial |
$18,769.83
|
| Rate for Payer: Cofinity Commercial |
$23,060.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,769.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,451.24
|
| Rate for Payer: Healthscope Commercial |
$24,132.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,769.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,110.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,791.94
|
| Rate for Payer: PHP Commercial |
$22,791.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,429.13
|
| Rate for Payer: Priority Health SBD |
$16,892.85
|
| Rate for Payer: UMR Bronson Commercial |
$11,798.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,110.54
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
OP
|
$26,814.05
|
|
|
Service Code
|
NDC 00078069723
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,921.20 |
| Max. Negotiated Rate |
$24,132.65 |
| Rate for Payer: Aetna American Axle |
$17,429.13
|
| Rate for Payer: Aetna Commercial |
$22,791.94
|
| Rate for Payer: Aetna Medicare |
$13,407.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,429.13
|
| Rate for Payer: BCBS Complete |
$10,725.62
|
| Rate for Payer: Cash Price |
$21,451.24
|
| Rate for Payer: Cofinity Commercial |
$18,769.83
|
| Rate for Payer: Cofinity Commercial |
$23,060.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,769.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,451.24
|
| Rate for Payer: Healthscope Commercial |
$24,132.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,769.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,110.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,791.94
|
| Rate for Payer: PHP Commercial |
$22,791.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,429.13
|
| Rate for Payer: Priority Health SBD |
$16,892.85
|
| Rate for Payer: UMR Bronson Commercial |
$9,921.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,110.54
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
OP
|
$26,814.05
|
|
|
Service Code
|
NDC 00078069761
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,921.20 |
| Max. Negotiated Rate |
$24,132.65 |
| Rate for Payer: Aetna American Axle |
$17,429.13
|
| Rate for Payer: Aetna Commercial |
$22,791.94
|
| Rate for Payer: Aetna Medicare |
$13,407.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,429.13
|
| Rate for Payer: BCBS Complete |
$10,725.62
|
| Rate for Payer: Cash Price |
$21,451.24
|
| Rate for Payer: Cofinity Commercial |
$18,769.83
|
| Rate for Payer: Cofinity Commercial |
$23,060.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,769.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,451.24
|
| Rate for Payer: Healthscope Commercial |
$24,132.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,769.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,110.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,791.94
|
| Rate for Payer: PHP Commercial |
$22,791.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,429.13
|
| Rate for Payer: Priority Health SBD |
$16,892.85
|
| Rate for Payer: UMR Bronson Commercial |
$9,921.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,110.54
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
IP
|
$26,814.05
|
|
|
Service Code
|
NDC 00078069723
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,798.18 |
| Max. Negotiated Rate |
$24,132.65 |
| Rate for Payer: Aetna American Axle |
$17,429.13
|
| Rate for Payer: Aetna Commercial |
$22,791.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,429.13
|
| Rate for Payer: Cash Price |
$21,451.24
|
| Rate for Payer: Cofinity Commercial |
$18,769.83
|
| Rate for Payer: Cofinity Commercial |
$23,060.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,769.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,451.24
|
| Rate for Payer: Healthscope Commercial |
$24,132.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,769.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,110.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,791.94
|
| Rate for Payer: PHP Commercial |
$22,791.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,429.13
|
| Rate for Payer: Priority Health SBD |
$16,892.85
|
| Rate for Payer: UMR Bronson Commercial |
$11,798.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,110.54
|
|
|
ELTROMBOPAG OLAMINE 25 MG ORAL POWDER PACKET
|
Facility
|
OP
|
$893.81
|
|
|
Service Code
|
NDC 00078069719
|
| Hospital Charge Code |
193346
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.71 |
| Max. Negotiated Rate |
$804.43 |
| Rate for Payer: Aetna American Axle |
$580.98
|
| Rate for Payer: Aetna Commercial |
$759.74
|
| Rate for Payer: Aetna Medicare |
$446.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.98
|
| Rate for Payer: BCBS Complete |
$357.52
|
| Rate for Payer: Cash Price |
$715.05
|
| Rate for Payer: Cofinity Commercial |
$625.67
|
| Rate for Payer: Cofinity Commercial |
$768.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.05
|
| Rate for Payer: Healthscope Commercial |
$804.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.74
|
| Rate for Payer: PHP Commercial |
$759.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.98
|
| Rate for Payer: Priority Health SBD |
$563.10
|
| Rate for Payer: UMR Bronson Commercial |
$330.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.36
|
|
|
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; AXILLARY, BRACHIAL, INNOMINATE, SUBCLAVIAN ARTERY, BY ARM INCISION
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 34101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; FEMOROPOPLITEAL, AORTOILIAC ARTERY, BY LEG INCISION
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 34201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; RADIAL OR ULNAR ARTERY, BY ARM INCISION
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 34111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES A MEDICALLY APPROPRIATE HISTORY AND/OR EXAMINATION AND MODERATE LEVEL OF MEDICAL DECISION MAKING
|
Facility
|
OP
|
$1,169.00
|
|
|
Service Code
|
CPT 99284
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$1,169.00 |
| Rate for Payer: Aetna Medicare |
$431.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$519.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$519.11
|
| Rate for Payer: BCBS Complete |
$233.73
|
| Rate for Payer: BCBS MAPPO |
$415.29
|
| Rate for Payer: BCN Medicare Advantage |
$415.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.29
|
| Rate for Payer: Mclaren Medicaid |
$222.60
|
| Rate for Payer: Mclaren Medicare |
$415.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.05
|
| Rate for Payer: Meridian Medicaid |
$233.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$477.58
|
| Rate for Payer: PACE Medicare |
$394.53
|
| Rate for Payer: PACE SWMI |
$415.29
|
| Rate for Payer: PHP Medicare Advantage |
$415.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.60
|
| Rate for Payer: Priority Health Medicare |
$415.29
|
| Rate for Payer: Railroad Medicare Medicare |
$415.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,169.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.29
|
| Rate for Payer: UHC Exchange |
$793.66
|
| Rate for Payer: UHC Medicare Advantage |
$415.29
|
| Rate for Payer: UHCCP Medicaid |
$222.60
|
| Rate for Payer: VA VA |
$415.29
|
|
|
EMOLLIENT TOPICAL CREAM
|
Facility
|
OP
|
$23.29
|
|
|
Service Code
|
NDC 00225052053
|
| Hospital Charge Code |
77778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: Aetna American Axle |
$15.14
|
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Medicare |
$11.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.14
|
| Rate for Payer: BCBS Complete |
$9.32
|
| Rate for Payer: Cash Price |
$18.63
|
| Rate for Payer: Cofinity Commercial |
$16.30
|
| Rate for Payer: Cofinity Commercial |
$20.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$20.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.80
|
| Rate for Payer: PHP Commercial |
$19.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.14
|
| Rate for Payer: Priority Health SBD |
$14.67
|
| Rate for Payer: UMR Bronson Commercial |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.47
|
|
|
EMOLLIENT TOPICAL CREAM
|
Facility
|
IP
|
$23.29
|
|
|
Service Code
|
NDC 00225052053
|
| Hospital Charge Code |
77778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: Aetna American Axle |
$15.14
|
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.14
|
| Rate for Payer: Cash Price |
$18.63
|
| Rate for Payer: Cofinity Commercial |
$16.30
|
| Rate for Payer: Cofinity Commercial |
$20.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$20.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.80
|
| Rate for Payer: PHP Commercial |
$19.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.14
|
| Rate for Payer: Priority Health SBD |
$14.67
|
| Rate for Payer: UMR Bronson Commercial |
$10.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.47
|
|
|
EMPAGLIFLOZIN 10 MG TABLET
|
Facility
|
OP
|
$1,429.46
|
|
|
Service Code
|
NDC 00597015230
|
| Hospital Charge Code |
171967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$528.90 |
| Max. Negotiated Rate |
$1,286.51 |
| Rate for Payer: Aetna American Axle |
$929.15
|
| Rate for Payer: Aetna Commercial |
$1,215.04
|
| Rate for Payer: Aetna Medicare |
$714.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.15
|
| Rate for Payer: BCBS Complete |
$571.78
|
| Rate for Payer: Cash Price |
$1,143.57
|
| Rate for Payer: Cofinity Commercial |
$1,000.62
|
| Rate for Payer: Cofinity Commercial |
$1,229.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,000.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.57
|
| Rate for Payer: Healthscope Commercial |
$1,286.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,000.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.04
|
| Rate for Payer: PHP Commercial |
$1,215.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.15
|
| Rate for Payer: Priority Health SBD |
$900.56
|
| Rate for Payer: UMR Bronson Commercial |
$528.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.10
|
|
|
EMPAGLIFLOZIN 10 MG TABLET
|
Facility
|
IP
|
$4,288.38
|
|
|
Service Code
|
NDC 00597015290
|
| Hospital Charge Code |
171967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,886.89 |
| Max. Negotiated Rate |
$3,859.54 |
| Rate for Payer: Aetna American Axle |
$2,787.45
|
| Rate for Payer: Aetna Commercial |
$3,645.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,787.45
|
| Rate for Payer: Cash Price |
$3,430.70
|
| Rate for Payer: Cofinity Commercial |
$3,001.87
|
| Rate for Payer: Cofinity Commercial |
$3,688.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,001.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,430.70
|
| Rate for Payer: Healthscope Commercial |
$3,859.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,001.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,216.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,645.12
|
| Rate for Payer: PHP Commercial |
$3,645.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,787.45
|
| Rate for Payer: Priority Health SBD |
$2,701.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,886.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,216.28
|
|
|
EMPAGLIFLOZIN 10 MG TABLET
|
Facility
|
IP
|
$1,429.46
|
|
|
Service Code
|
NDC 00597015230
|
| Hospital Charge Code |
171967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$628.96 |
| Max. Negotiated Rate |
$1,286.51 |
| Rate for Payer: Aetna American Axle |
$929.15
|
| Rate for Payer: Aetna Commercial |
$1,215.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.15
|
| Rate for Payer: Cash Price |
$1,143.57
|
| Rate for Payer: Cofinity Commercial |
$1,000.62
|
| Rate for Payer: Cofinity Commercial |
$1,229.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,000.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.57
|
| Rate for Payer: Healthscope Commercial |
$1,286.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,000.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.04
|
| Rate for Payer: PHP Commercial |
$1,215.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.15
|
| Rate for Payer: Priority Health SBD |
$900.56
|
| Rate for Payer: UMR Bronson Commercial |
$628.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.10
|
|
|
EMPAGLIFLOZIN 10 MG TABLET
|
Facility
|
OP
|
$4,288.38
|
|
|
Service Code
|
NDC 00597015290
|
| Hospital Charge Code |
171967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,586.70 |
| Max. Negotiated Rate |
$3,859.54 |
| Rate for Payer: Aetna American Axle |
$2,787.45
|
| Rate for Payer: Aetna Commercial |
$3,645.12
|
| Rate for Payer: Aetna Medicare |
$2,144.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,787.45
|
| Rate for Payer: BCBS Complete |
$1,715.35
|
| Rate for Payer: Cash Price |
$3,430.70
|
| Rate for Payer: Cofinity Commercial |
$3,001.87
|
| Rate for Payer: Cofinity Commercial |
$3,688.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,001.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,430.70
|
| Rate for Payer: Healthscope Commercial |
$3,859.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,001.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,216.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,645.12
|
| Rate for Payer: PHP Commercial |
$3,645.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,787.45
|
| Rate for Payer: Priority Health SBD |
$2,701.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,586.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,216.28
|
|
|
EMPAGLIFLOZIN 25 MG TABLET
|
Facility
|
OP
|
$1,429.46
|
|
|
Service Code
|
NDC 00597015330
|
| Hospital Charge Code |
171966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$528.90 |
| Max. Negotiated Rate |
$1,286.51 |
| Rate for Payer: Aetna American Axle |
$929.15
|
| Rate for Payer: Aetna Commercial |
$1,215.04
|
| Rate for Payer: Aetna Medicare |
$714.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.15
|
| Rate for Payer: BCBS Complete |
$571.78
|
| Rate for Payer: Cash Price |
$1,143.57
|
| Rate for Payer: Cofinity Commercial |
$1,000.62
|
| Rate for Payer: Cofinity Commercial |
$1,229.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,000.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.57
|
| Rate for Payer: Healthscope Commercial |
$1,286.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,000.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.04
|
| Rate for Payer: PHP Commercial |
$1,215.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.15
|
| Rate for Payer: Priority Health SBD |
$900.56
|
| Rate for Payer: UMR Bronson Commercial |
$528.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.10
|
|
|
EMPAGLIFLOZIN 25 MG TABLET
|
Facility
|
IP
|
$1,429.46
|
|
|
Service Code
|
NDC 00597015330
|
| Hospital Charge Code |
171966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$628.96 |
| Max. Negotiated Rate |
$1,286.51 |
| Rate for Payer: Aetna American Axle |
$929.15
|
| Rate for Payer: Aetna Commercial |
$1,215.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$929.15
|
| Rate for Payer: Cash Price |
$1,143.57
|
| Rate for Payer: Cofinity Commercial |
$1,000.62
|
| Rate for Payer: Cofinity Commercial |
$1,229.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,000.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.57
|
| Rate for Payer: Healthscope Commercial |
$1,286.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,000.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.04
|
| Rate for Payer: PHP Commercial |
$1,215.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.15
|
| Rate for Payer: Priority Health SBD |
$900.56
|
| Rate for Payer: UMR Bronson Commercial |
$628.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.10
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
OP
|
$50.99
|
|
|
Service Code
|
NDC 00264975706
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$45.89 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.34
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.79
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.79
|
| Rate for Payer: Healthscope Commercial |
$45.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.34
|
| Rate for Payer: PHP Commercial |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.24
|
|
|
EMPTY CONTAINER BOTTLE
|
Facility
|
IP
|
$50.99
|
|
|
Service Code
|
NDC 00264975706
|
| Hospital Charge Code |
113131
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.89 |
| Rate for Payer: Aetna American Axle |
$33.14
|
| Rate for Payer: Aetna Commercial |
$43.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.79
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.79
|
| Rate for Payer: Healthscope Commercial |
$45.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.34
|
| Rate for Payer: PHP Commercial |
$43.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.24
|
|
