|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$83.13
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$74.82 |
| Rate for Payer: Aetna American Axle |
$54.03
|
| Rate for Payer: Aetna American Axle |
$52.21
|
| Rate for Payer: Aetna American Axle |
$215.85
|
| Rate for Payer: Aetna American Axle |
$55.91
|
| Rate for Payer: Aetna Commercial |
$70.66
|
| Rate for Payer: Aetna Commercial |
$73.12
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Commercial |
$282.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.03
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$265.66
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cofinity Commercial |
$232.45
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Cofinity Commercial |
$60.21
|
| Rate for Payer: Cofinity Commercial |
$58.19
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$71.49
|
| Rate for Payer: Cofinity Commercial |
$285.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$74.82
|
| Rate for Payer: Healthscope Commercial |
$298.86
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.66
|
| Rate for Payer: PHP Commercial |
$70.66
|
| Rate for Payer: PHP Commercial |
$73.12
|
| Rate for Payer: PHP Commercial |
$282.26
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.85
|
| Rate for Payer: Priority Health SBD |
$54.19
|
| Rate for Payer: Priority Health SBD |
$209.20
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: Priority Health SBD |
$52.37
|
| Rate for Payer: UMR Bronson Commercial |
$36.58
|
| Rate for Payer: UMR Bronson Commercial |
$37.85
|
| Rate for Payer: UMR Bronson Commercial |
$35.35
|
| Rate for Payer: UMR Bronson Commercial |
$146.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.35
|
|
|
EPTIFIBATIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$80.33
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna American Axle |
$52.21
|
| Rate for Payer: Aetna American Axle |
$55.91
|
| Rate for Payer: Aetna American Axle |
$215.85
|
| Rate for Payer: Aetna American Axle |
$54.03
|
| Rate for Payer: Aetna Commercial |
$73.12
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Commercial |
$70.66
|
| Rate for Payer: Aetna Commercial |
$282.26
|
| Rate for Payer: Aetna Medicare |
$41.56
|
| Rate for Payer: Aetna Medicare |
$166.03
|
| Rate for Payer: Aetna Medicare |
$43.01
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.85
|
| Rate for Payer: BCBS Complete |
$132.83
|
| Rate for Payer: BCBS Complete |
$34.41
|
| Rate for Payer: BCBS Complete |
$33.25
|
| Rate for Payer: BCBS Complete |
$32.13
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$265.66
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Cofinity Commercial |
$232.45
|
| Rate for Payer: Cofinity Commercial |
$71.49
|
| Rate for Payer: Cofinity Commercial |
$58.19
|
| Rate for Payer: Cofinity Commercial |
$60.21
|
| Rate for Payer: Cofinity Commercial |
$285.58
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$74.82
|
| Rate for Payer: Healthscope Commercial |
$298.86
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.66
|
| Rate for Payer: PHP Commercial |
$70.66
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: PHP Commercial |
$73.12
|
| Rate for Payer: PHP Commercial |
$282.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.85
|
| Rate for Payer: Priority Health SBD |
$52.37
|
| Rate for Payer: Priority Health SBD |
$54.19
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: Priority Health SBD |
$209.20
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: UMR Bronson Commercial |
$29.72
|
| Rate for Payer: UMR Bronson Commercial |
$31.83
|
| Rate for Payer: UMR Bronson Commercial |
$122.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,042.08
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,658.52 |
| Max. Negotiated Rate |
$5,437.87 |
| Rate for Payer: Aetna American Axle |
$3,927.35
|
| Rate for Payer: Aetna Commercial |
$5,135.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,927.35
|
| Rate for Payer: Cash Price |
$4,833.66
|
| Rate for Payer: Cofinity Commercial |
$4,229.46
|
| Rate for Payer: Cofinity Commercial |
$5,196.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,229.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,833.66
|
| Rate for Payer: Healthscope Commercial |
$5,437.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,229.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,531.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,135.77
|
| Rate for Payer: PHP Commercial |
$5,135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,927.35
|
| Rate for Payer: Priority Health SBD |
$3,806.51
|
| Rate for Payer: UMR Bronson Commercial |
$2,658.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,531.56
|
|
|
EPTINEZUMAB-JJMR 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,042.08
|
|
|
Service Code
|
HCPCS J3032
|
| Hospital Charge Code |
193002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$5,437.87 |
| Rate for Payer: Aetna American Axle |
$3,927.35
|
| Rate for Payer: Aetna Commercial |
$5,135.77
|
| Rate for Payer: Aetna Medicare |
$20.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,927.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.96
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: BCBS MAPPO |
$19.97
|
| Rate for Payer: BCN Medicare Advantage |
$19.97
|
| Rate for Payer: Cash Price |
$4,833.66
|
| Rate for Payer: Cash Price |
$4,833.66
|
| Rate for Payer: Cofinity Commercial |
$5,196.19
|
| Rate for Payer: Cofinity Commercial |
$4,229.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,229.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,833.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.97
|
| Rate for Payer: Healthscope Commercial |
$5,437.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,229.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,531.56
|
| Rate for Payer: Mclaren Medicaid |
$10.70
|
| Rate for Payer: Mclaren Medicare |
$19.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.97
|
| Rate for Payer: Meridian Medicaid |
$11.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,135.77
|
| Rate for Payer: PACE Medicare |
$18.97
|
| Rate for Payer: PACE SWMI |
$19.97
|
| Rate for Payer: PHP Commercial |
$5,135.77
|
| Rate for Payer: PHP Medicare Advantage |
$19.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,927.35
|
| Rate for Payer: Priority Health Medicare |
$19.97
|
| Rate for Payer: Priority Health SBD |
$3,806.51
|
| Rate for Payer: Railroad Medicare Medicare |
$19.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.97
|
| Rate for Payer: UHC Exchange |
$38.16
|
| Rate for Payer: UHC Medicare Advantage |
$19.97
|
| Rate for Payer: UHCCP Medicaid |
$10.70
|
| Rate for Payer: UMR Bronson Commercial |
$2,235.57
|
| Rate for Payer: VA VA |
$19.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,531.56
|
|
|
ERAVACYCLINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$414.16
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
195057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$372.74 |
| Rate for Payer: Aetna American Axle |
$269.20
|
| Rate for Payer: Aetna Commercial |
$352.04
|
| Rate for Payer: Aetna Medicare |
$207.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.20
|
| Rate for Payer: BCBS Complete |
$165.66
|
| Rate for Payer: Cash Price |
$331.33
|
| Rate for Payer: Cofinity Commercial |
$289.91
|
| Rate for Payer: Cofinity Commercial |
$356.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.33
|
| Rate for Payer: Healthscope Commercial |
$372.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.04
|
| Rate for Payer: PHP Commercial |
$352.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.20
|
| Rate for Payer: Priority Health SBD |
$260.92
|
| Rate for Payer: UMR Bronson Commercial |
$153.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.62
|
|
|
ERAVACYCLINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$414.16
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
195057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.23 |
| Max. Negotiated Rate |
$372.74 |
| Rate for Payer: Aetna American Axle |
$269.20
|
| Rate for Payer: Aetna Commercial |
$352.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.20
|
| Rate for Payer: Cash Price |
$331.33
|
| Rate for Payer: Cofinity Commercial |
$289.91
|
| Rate for Payer: Cofinity Commercial |
$356.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.33
|
| Rate for Payer: Healthscope Commercial |
$372.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.04
|
| Rate for Payer: PHP Commercial |
$352.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.20
|
| Rate for Payer: Priority Health SBD |
$260.92
|
| Rate for Payer: UMR Bronson Commercial |
$182.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.62
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.32 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna American Axle |
$193.99
|
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.99
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$208.91
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.99
|
| Rate for Payer: Priority Health SBD |
$188.02
|
| Rate for Payer: UMR Bronson Commercial |
$131.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 64380073706
|
| Hospital Charge Code |
2863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.43 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna American Axle |
$193.99
|
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna Medicare |
$149.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.99
|
| Rate for Payer: BCBS Complete |
$119.38
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$208.91
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.99
|
| Rate for Payer: Priority Health SBD |
$188.02
|
| Rate for Payer: UMR Bronson Commercial |
$110.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$266.19
|
|
|
Service Code
|
NDC 69367028302
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.49 |
| Max. Negotiated Rate |
$239.57 |
| Rate for Payer: Aetna American Axle |
$173.02
|
| Rate for Payer: Aetna Commercial |
$226.26
|
| Rate for Payer: Aetna Medicare |
$133.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.02
|
| Rate for Payer: BCBS Complete |
$106.48
|
| Rate for Payer: Cash Price |
$212.95
|
| Rate for Payer: Cofinity Commercial |
$186.33
|
| Rate for Payer: Cofinity Commercial |
$228.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.95
|
| Rate for Payer: Healthscope Commercial |
$239.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.26
|
| Rate for Payer: PHP Commercial |
$226.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.02
|
| Rate for Payer: Priority Health SBD |
$167.70
|
| Rate for Payer: UMR Bronson Commercial |
$98.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.64
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 09900001965
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.18
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$266.19
|
|
|
Service Code
|
NDC 69367028302
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.12 |
| Max. Negotiated Rate |
$239.57 |
| Rate for Payer: Aetna American Axle |
$173.02
|
| Rate for Payer: Aetna Commercial |
$226.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.02
|
| Rate for Payer: Cash Price |
$212.95
|
| Rate for Payer: Cofinity Commercial |
$186.33
|
| Rate for Payer: Cofinity Commercial |
$228.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.95
|
| Rate for Payer: Healthscope Commercial |
$239.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.26
|
| Rate for Payer: PHP Commercial |
$226.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.02
|
| Rate for Payer: Priority Health SBD |
$167.70
|
| Rate for Payer: UMR Bronson Commercial |
$117.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.64
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$277.59
|
|
|
Service Code
|
NDC 47781064726
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.14 |
| Max. Negotiated Rate |
$249.83 |
| Rate for Payer: Aetna American Axle |
$180.43
|
| Rate for Payer: Aetna Commercial |
$235.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.43
|
| Rate for Payer: Cash Price |
$222.07
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Cofinity Commercial |
$238.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.07
|
| Rate for Payer: Healthscope Commercial |
$249.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.95
|
| Rate for Payer: PHP Commercial |
$235.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.43
|
| Rate for Payer: Priority Health SBD |
$174.88
|
| Rate for Payer: UMR Bronson Commercial |
$122.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.19
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$260.49
|
|
|
Service Code
|
NDC 75834001060
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$234.44 |
| Rate for Payer: Aetna American Axle |
$169.32
|
| Rate for Payer: Aetna Commercial |
$221.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.32
|
| Rate for Payer: Cash Price |
$208.39
|
| Rate for Payer: Cofinity Commercial |
$182.34
|
| Rate for Payer: Cofinity Commercial |
$224.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.39
|
| Rate for Payer: Healthscope Commercial |
$234.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.42
|
| Rate for Payer: PHP Commercial |
$221.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.32
|
| Rate for Payer: Priority Health SBD |
$164.11
|
| Rate for Payer: UMR Bronson Commercial |
$114.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.37
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$260.49
|
|
|
Service Code
|
NDC 75834001060
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.38 |
| Max. Negotiated Rate |
$234.44 |
| Rate for Payer: Aetna American Axle |
$169.32
|
| Rate for Payer: Aetna Commercial |
$221.42
|
| Rate for Payer: Aetna Medicare |
$130.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.32
|
| Rate for Payer: BCBS Complete |
$104.20
|
| Rate for Payer: Cash Price |
$208.39
|
| Rate for Payer: Cofinity Commercial |
$182.34
|
| Rate for Payer: Cofinity Commercial |
$224.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.39
|
| Rate for Payer: Healthscope Commercial |
$234.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.42
|
| Rate for Payer: PHP Commercial |
$221.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.32
|
| Rate for Payer: Priority Health SBD |
$164.11
|
| Rate for Payer: UMR Bronson Commercial |
$96.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.37
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$255.46
|
|
|
Service Code
|
NDC 39328035760
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.52 |
| Max. Negotiated Rate |
$229.91 |
| Rate for Payer: Aetna American Axle |
$166.05
|
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Aetna Medicare |
$127.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.05
|
| Rate for Payer: BCBS Complete |
$102.18
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cofinity Commercial |
$178.82
|
| Rate for Payer: Cofinity Commercial |
$219.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.37
|
| Rate for Payer: Healthscope Commercial |
$229.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.14
|
| Rate for Payer: PHP Commercial |
$217.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.05
|
| Rate for Payer: Priority Health SBD |
$160.94
|
| Rate for Payer: UMR Bronson Commercial |
$94.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.59
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$277.59
|
|
|
Service Code
|
NDC 47781064726
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.71 |
| Max. Negotiated Rate |
$249.83 |
| Rate for Payer: Aetna American Axle |
$180.43
|
| Rate for Payer: Aetna Commercial |
$235.95
|
| Rate for Payer: Aetna Medicare |
$138.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.43
|
| Rate for Payer: BCBS Complete |
$111.04
|
| Rate for Payer: Cash Price |
$222.07
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Cofinity Commercial |
$238.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.07
|
| Rate for Payer: Healthscope Commercial |
$249.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.95
|
| Rate for Payer: PHP Commercial |
$235.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.43
|
| Rate for Payer: Priority Health SBD |
$174.88
|
| Rate for Payer: UMR Bronson Commercial |
$102.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.19
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
IP
|
$255.46
|
|
|
Service Code
|
NDC 39328035760
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$229.91 |
| Rate for Payer: Aetna American Axle |
$166.05
|
| Rate for Payer: Aetna Commercial |
$217.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.05
|
| Rate for Payer: Cash Price |
$204.37
|
| Rate for Payer: Cofinity Commercial |
$178.82
|
| Rate for Payer: Cofinity Commercial |
$219.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.37
|
| Rate for Payer: Healthscope Commercial |
$229.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.14
|
| Rate for Payer: PHP Commercial |
$217.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.05
|
| Rate for Payer: Priority Health SBD |
$160.94
|
| Rate for Payer: UMR Bronson Commercial |
$112.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.59
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 09900001965
|
| Hospital Charge Code |
9943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.18
|
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,330.90
|
|
|
Service Code
|
HCPCS J9179
|
| Hospital Charge Code |
106773
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$5,697.81 |
| Rate for Payer: Aetna American Axle |
$4,115.09
|
| Rate for Payer: Aetna Commercial |
$5,381.27
|
| Rate for Payer: Aetna Medicare |
$92.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,115.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.67
|
| Rate for Payer: BCBS Complete |
$50.28
|
| Rate for Payer: BCBS MAPPO |
$89.34
|
| Rate for Payer: BCN Medicare Advantage |
$89.34
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cash Price |
$5,064.72
|
| Rate for Payer: Cofinity Commercial |
$4,431.63
|
| Rate for Payer: Cofinity Commercial |
$5,444.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,431.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,064.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.34
|
| Rate for Payer: Healthscope Commercial |
$5,697.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,431.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,748.18
|
| Rate for Payer: Mclaren Medicaid |
$47.89
|
| Rate for Payer: Mclaren Medicare |
$89.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.81
|
| Rate for Payer: Meridian Medicaid |
$50.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,381.27
|
| Rate for Payer: PACE Medicare |
$84.87
|
| Rate for Payer: PACE SWMI |
$89.34
|
| Rate for Payer: PHP Commercial |
$5,381.27
|
| Rate for Payer: PHP Medicare Advantage |
$89.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,115.09
|
| Rate for Payer: Priority Health Medicare |
$89.34
|
| Rate for Payer: Priority Health SBD |
$3,988.47
|
| Rate for Payer: Railroad Medicare Medicare |
$89.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.34
|
| Rate for Payer: UHC Exchange |
$170.74
|
| Rate for Payer: UHC Medicare Advantage |
$89.34
|
| Rate for Payer: UHCCP Medicaid |
$47.89
|
| Rate for Payer: UMR Bronson Commercial |
$2,342.43
|
| Rate for Payer: VA VA |
$89.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,748.18
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
IP
|
$206.93
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: UMR Bronson Commercial |
$91.05
|
| Rate for Payer: UMR Bronson Commercial |
$186.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM IM SOLR CUSTOM
|
Facility
|
OP
|
$206.93
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
150756
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$186.24 |
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Medicare |
$103.47
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$82.77
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: UMR Bronson Commercial |
$76.56
|
| Rate for Payer: UMR Bronson Commercial |
$156.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna American Axle |
$69.24
|
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna American Axle |
$53.51
|
| Rate for Payer: Aetna American Axle |
$65.91
|
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$69.98
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$212.00
|
| Rate for Payer: Aetna Medicare |
$53.27
|
| Rate for Payer: Aetna Medicare |
$41.16
|
| Rate for Payer: Aetna Medicare |
$103.47
|
| Rate for Payer: Aetna Medicare |
$50.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: BCBS Complete |
$32.93
|
| Rate for Payer: BCBS Complete |
$40.56
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS Complete |
$82.77
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: Cash Price |
$65.86
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cofinity Commercial |
$57.63
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$70.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Healthscope Commercial |
$74.10
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.98
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$69.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Priority Health SBD |
$51.87
|
| Rate for Payer: UMR Bronson Commercial |
$30.46
|
| Rate for Payer: UMR Bronson Commercial |
$156.88
|
| Rate for Payer: UMR Bronson Commercial |
$39.42
|
| Rate for Payer: UMR Bronson Commercial |
$37.52
|
| Rate for Payer: UMR Bronson Commercial |
$76.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.56 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna American Axle |
$275.60
|
| Rate for Payer: Aetna American Axle |
$65.91
|
| Rate for Payer: Aetna American Axle |
$69.24
|
| Rate for Payer: Aetna American Axle |
$53.51
|
| Rate for Payer: Aetna American Axle |
$134.50
|
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Commercial |
$86.19
|
| Rate for Payer: Aetna Commercial |
$69.98
|
| Rate for Payer: Aetna Commercial |
$175.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$65.86
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cash Price |
$165.54
|
| Rate for Payer: Cash Price |
$81.12
|
| Rate for Payer: Cofinity Commercial |
$57.63
|
| Rate for Payer: Cofinity Commercial |
$70.98
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$144.85
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$70.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.54
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Healthscope Commercial |
$186.24
|
| Rate for Payer: Healthscope Commercial |
$74.10
|
| Rate for Payer: Healthscope Commercial |
$91.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$86.19
|
| Rate for Payer: PHP Commercial |
$69.98
|
| Rate for Payer: PHP Commercial |
$175.89
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.91
|
| Rate for Payer: Priority Health SBD |
$51.87
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: Priority Health SBD |
$63.88
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.87
|
| Rate for Payer: UMR Bronson Commercial |
$186.56
|
| Rate for Payer: UMR Bronson Commercial |
$36.23
|
| Rate for Payer: UMR Bronson Commercial |
$91.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.00
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna American Axle |
$69.24
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna Medicare |
$53.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: BCBS Complete |
$42.61
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: UMR Bronson Commercial |
$39.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
|
|
ERTAPENEM 1 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$106.53
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
301714
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.87 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna American Axle |
$69.24
|
| Rate for Payer: Aetna Commercial |
$90.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.24
|
| Rate for Payer: Cash Price |
$85.22
|
| Rate for Payer: Cofinity Commercial |
$74.57
|
| Rate for Payer: Cofinity Commercial |
$91.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.22
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.55
|
| Rate for Payer: PHP Commercial |
$90.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.24
|
| Rate for Payer: Priority Health SBD |
$67.11
|
| Rate for Payer: UMR Bronson Commercial |
$46.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.90
|
|
