|
EPOETIN ALFA-EPBX 2,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$77.53
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$69.78 |
| Rate for Payer: Aetna American Axle |
$50.39
|
| Rate for Payer: Aetna Commercial |
$65.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.39
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$54.27
|
| Rate for Payer: Cofinity Commercial |
$66.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Healthscope Commercial |
$69.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.90
|
| Rate for Payer: PHP Commercial |
$65.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: Priority Health SBD |
$48.84
|
| Rate for Payer: UMR Bronson Commercial |
$34.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.15
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,115.01
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$490.60 |
| Max. Negotiated Rate |
$1,003.51 |
| Rate for Payer: Aetna American Axle |
$724.76
|
| Rate for Payer: Aetna Commercial |
$947.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.76
|
| Rate for Payer: Cash Price |
$892.01
|
| Rate for Payer: Cofinity Commercial |
$780.51
|
| Rate for Payer: Cofinity Commercial |
$958.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.01
|
| Rate for Payer: Healthscope Commercial |
$1,003.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$836.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.76
|
| Rate for Payer: PHP Commercial |
$947.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.76
|
| Rate for Payer: Priority Health SBD |
$702.46
|
| Rate for Payer: UMR Bronson Commercial |
$490.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$836.26
|
|
|
EPOETIN ALFA-EPBX 40,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,115.01
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$1,003.51 |
| Rate for Payer: Aetna American Axle |
$724.76
|
| Rate for Payer: Aetna Commercial |
$947.76
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.14
|
| Rate for Payer: BCN Commercial |
$20.14
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| Rate for Payer: Cash Price |
$892.01
|
| Rate for Payer: Cash Price |
$892.01
|
| Rate for Payer: Cofinity Commercial |
$958.91
|
| Rate for Payer: Cofinity Commercial |
$780.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$780.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$892.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$1,003.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$780.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$836.26
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$947.76
|
| Rate for Payer: Nomi Health Commercial |
$22.41
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$947.76
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.92
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$17.54
|
| Rate for Payer: Priority Health SBD |
$702.46
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Exchange |
$14.28
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$412.55
|
| Rate for Payer: VA VA |
$7.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$836.26
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$155.06
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.23 |
| Max. Negotiated Rate |
$139.55 |
| Rate for Payer: Aetna American Axle |
$100.79
|
| Rate for Payer: Aetna Commercial |
$131.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.79
|
| Rate for Payer: Cash Price |
$124.05
|
| Rate for Payer: Cofinity Commercial |
$108.54
|
| Rate for Payer: Cofinity Commercial |
$133.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.05
|
| Rate for Payer: Healthscope Commercial |
$139.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.80
|
| Rate for Payer: PHP Commercial |
$131.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.79
|
| Rate for Payer: Priority Health SBD |
$97.69
|
| Rate for Payer: UMR Bronson Commercial |
$68.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.30
|
|
|
EPOETIN ALFA-EPBX 4,000 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$155.06
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
186987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$139.55 |
| Rate for Payer: Aetna American Axle |
$100.79
|
| Rate for Payer: Aetna Commercial |
$131.80
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.34
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS MAPPO |
$7.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.14
|
| Rate for Payer: BCN Commercial |
$20.14
|
| Rate for Payer: BCN Medicare Advantage |
$7.47
|
| Rate for Payer: Cash Price |
$124.05
|
| Rate for Payer: Cash Price |
$124.05
|
| Rate for Payer: Cofinity Commercial |
$133.35
|
| Rate for Payer: Cofinity Commercial |
$108.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$139.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.30
|
| Rate for Payer: Mclaren Medicaid |
$4.00
|
| Rate for Payer: Mclaren Medicare |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.84
|
| Rate for Payer: Meridian Medicaid |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.80
|
| Rate for Payer: Nomi Health Commercial |
$22.41
|
| Rate for Payer: PACE Medicare |
$7.10
|
| Rate for Payer: PACE SWMI |
$7.47
|
| Rate for Payer: PHP Commercial |
$131.80
|
| Rate for Payer: PHP Medicare Advantage |
$7.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.92
|
| Rate for Payer: Priority Health Medicare |
$7.47
|
| Rate for Payer: Priority Health Narrow Network |
$17.54
|
| Rate for Payer: Priority Health SBD |
$97.69
|
| Rate for Payer: Railroad Medicare Medicare |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.47
|
| Rate for Payer: UHC Exchange |
$14.28
|
| Rate for Payer: UHC Medicare Advantage |
$7.47
|
| Rate for Payer: UHCCP Medicaid |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$57.37
|
| Rate for Payer: VA VA |
$7.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.30
|
|
|
EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$100.15
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
162203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.07 |
| Max. Negotiated Rate |
$90.14 |
| Rate for Payer: Aetna American Axle |
$65.10
|
| Rate for Payer: Aetna American Axle |
$85.05
|
| Rate for Payer: Aetna Commercial |
$85.13
|
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.05
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cofinity Commercial |
$91.60
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Cofinity Commercial |
$70.10
|
| Rate for Payer: Cofinity Commercial |
$86.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.68
|
| Rate for Payer: Healthscope Commercial |
$90.14
|
| Rate for Payer: Healthscope Commercial |
$117.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.13
|
| Rate for Payer: PHP Commercial |
$111.22
|
| Rate for Payer: PHP Commercial |
$85.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.05
|
| Rate for Payer: Priority Health SBD |
$63.09
|
| Rate for Payer: Priority Health SBD |
$82.44
|
| Rate for Payer: UMR Bronson Commercial |
$44.07
|
| Rate for Payer: UMR Bronson Commercial |
$57.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.14
|
|
|
EPOPROSTENOL 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$100.15
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
162203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$90.14 |
| Rate for Payer: Aetna American Axle |
$65.10
|
| Rate for Payer: Aetna American Axle |
$85.05
|
| Rate for Payer: Aetna Commercial |
$111.22
|
| Rate for Payer: Aetna Commercial |
$85.13
|
| Rate for Payer: Aetna Medicare |
$50.08
|
| Rate for Payer: Aetna Medicare |
$65.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.05
|
| Rate for Payer: BCBS Complete |
$52.34
|
| Rate for Payer: BCBS Complete |
$40.06
|
| Rate for Payer: BCBS Trust/PPO |
$42.74
|
| Rate for Payer: BCBS Trust/PPO |
$42.74
|
| Rate for Payer: BCN Commercial |
$42.74
|
| Rate for Payer: BCN Commercial |
$42.74
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cash Price |
$80.12
|
| Rate for Payer: Cofinity Commercial |
$91.60
|
| Rate for Payer: Cofinity Commercial |
$70.10
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Cofinity Commercial |
$86.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.12
|
| Rate for Payer: Healthscope Commercial |
$117.76
|
| Rate for Payer: Healthscope Commercial |
$90.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.22
|
| Rate for Payer: PHP Commercial |
$85.13
|
| Rate for Payer: PHP Commercial |
$111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.05
|
| Rate for Payer: Priority Health SBD |
$82.44
|
| Rate for Payer: Priority Health SBD |
$63.09
|
| Rate for Payer: UMR Bronson Commercial |
$37.06
|
| Rate for Payer: UMR Bronson Commercial |
$48.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.11
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$200.22
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
155384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.10 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Aetna American Axle |
$130.14
|
| Rate for Payer: Aetna Commercial |
$170.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.14
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$140.15
|
| Rate for Payer: Cofinity Commercial |
$172.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Healthscope Commercial |
$180.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.19
|
| Rate for Payer: PHP Commercial |
$170.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.14
|
| Rate for Payer: Priority Health SBD |
$126.14
|
| Rate for Payer: UMR Bronson Commercial |
$88.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.16
|
|
|
EPOPROSTENOL 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$200.22
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
155384
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.74 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Aetna American Axle |
$130.14
|
| Rate for Payer: Aetna Commercial |
$170.19
|
| Rate for Payer: Aetna Medicare |
$100.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.14
|
| Rate for Payer: BCBS Complete |
$80.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.74
|
| Rate for Payer: BCN Commercial |
$42.74
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cash Price |
$160.18
|
| Rate for Payer: Cofinity Commercial |
$140.15
|
| Rate for Payer: Cofinity Commercial |
$172.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.18
|
| Rate for Payer: Healthscope Commercial |
$180.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.19
|
| Rate for Payer: PHP Commercial |
$170.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.14
|
| Rate for Payer: Priority Health SBD |
$126.14
|
| Rate for Payer: UMR Bronson Commercial |
$74.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.16
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$126.72
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
15897
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.74 |
| Max. Negotiated Rate |
$114.05 |
| Rate for Payer: Aetna American Axle |
$82.37
|
| Rate for Payer: Aetna Commercial |
$107.71
|
| Rate for Payer: Aetna Medicare |
$63.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.37
|
| Rate for Payer: BCBS Complete |
$50.69
|
| Rate for Payer: BCBS Trust/PPO |
$42.74
|
| Rate for Payer: BCN Commercial |
$42.74
|
| Rate for Payer: Cash Price |
$101.38
|
| Rate for Payer: Cash Price |
$101.38
|
| Rate for Payer: Cofinity Commercial |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$88.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.38
|
| Rate for Payer: Healthscope Commercial |
$114.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.71
|
| Rate for Payer: PHP Commercial |
$107.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.37
|
| Rate for Payer: Priority Health SBD |
$79.83
|
| Rate for Payer: UMR Bronson Commercial |
$46.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.04
|
|
|
EPOPROSTENOL (GLYCINE) 0.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$126.72
|
|
|
Service Code
|
HCPCS J1325
|
| Hospital Charge Code |
15897
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.76 |
| Max. Negotiated Rate |
$114.05 |
| Rate for Payer: Aetna American Axle |
$82.37
|
| Rate for Payer: Aetna Commercial |
$107.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.37
|
| Rate for Payer: Cash Price |
$101.38
|
| Rate for Payer: Cofinity Commercial |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$88.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.38
|
| Rate for Payer: Healthscope Commercial |
$114.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.71
|
| Rate for Payer: PHP Commercial |
$107.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.37
|
| Rate for Payer: Priority Health SBD |
$79.83
|
| Rate for Payer: UMR Bronson Commercial |
$55.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.04
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$267.73
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.80 |
| Max. Negotiated Rate |
$240.96 |
| Rate for Payer: Healthscope Commercial |
$240.96
|
| Rate for Payer: Healthscope Commercial |
$232.19
|
| Rate for Payer: Healthscope Commercial |
$260.17
|
| Rate for Payer: Healthscope Commercial |
$967.23
|
| Rate for Payer: Aetna American Axle |
$174.02
|
| Rate for Payer: Aetna American Axle |
$698.56
|
| Rate for Payer: Aetna American Axle |
$1,095.38
|
| Rate for Payer: Aetna American Axle |
$187.90
|
| Rate for Payer: Aetna American Axle |
$167.69
|
| Rate for Payer: Aetna Commercial |
$227.57
|
| Rate for Payer: Aetna Commercial |
$1,432.42
|
| Rate for Payer: Aetna Commercial |
$913.50
|
| Rate for Payer: Aetna Commercial |
$245.72
|
| Rate for Payer: Aetna Commercial |
$219.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.38
|
| Rate for Payer: Cash Price |
$214.18
|
| Rate for Payer: Cash Price |
$231.26
|
| Rate for Payer: Cash Price |
$1,348.16
|
| Rate for Payer: Cash Price |
$206.39
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cofinity Commercial |
$202.36
|
| Rate for Payer: Cofinity Commercial |
$752.29
|
| Rate for Payer: Cofinity Commercial |
$230.25
|
| Rate for Payer: Cofinity Commercial |
$187.41
|
| Rate for Payer: Cofinity Commercial |
$180.59
|
| Rate for Payer: Cofinity Commercial |
$1,179.64
|
| Rate for Payer: Cofinity Commercial |
$1,449.27
|
| Rate for Payer: Cofinity Commercial |
$221.87
|
| Rate for Payer: Cofinity Commercial |
$924.24
|
| Rate for Payer: Cofinity Commercial |
$248.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$752.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,179.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,348.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.39
|
| Rate for Payer: Healthscope Commercial |
$1,516.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$752.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,179.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$806.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,432.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.50
|
| Rate for Payer: PHP Commercial |
$913.50
|
| Rate for Payer: PHP Commercial |
$245.72
|
| Rate for Payer: PHP Commercial |
$219.29
|
| Rate for Payer: PHP Commercial |
$227.57
|
| Rate for Payer: PHP Commercial |
$1,432.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,095.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.56
|
| Rate for Payer: Priority Health SBD |
$182.12
|
| Rate for Payer: Priority Health SBD |
$162.53
|
| Rate for Payer: Priority Health SBD |
$1,061.68
|
| Rate for Payer: Priority Health SBD |
$677.06
|
| Rate for Payer: Priority Health SBD |
$168.67
|
| Rate for Payer: UMR Bronson Commercial |
$472.87
|
| Rate for Payer: UMR Bronson Commercial |
$741.49
|
| Rate for Payer: UMR Bronson Commercial |
$117.80
|
| Rate for Payer: UMR Bronson Commercial |
$127.20
|
| Rate for Payer: UMR Bronson Commercial |
$113.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$806.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.80
|
|
|
EPTIFIBATIDE 0.75 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,685.20
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.23 |
| Max. Negotiated Rate |
$1,516.68 |
| Rate for Payer: Cofinity Commercial |
$1,179.64
|
| Rate for Payer: Cofinity Commercial |
$248.61
|
| Rate for Payer: Cofinity Commercial |
$752.29
|
| Rate for Payer: Cofinity Commercial |
$221.87
|
| Rate for Payer: Cofinity Commercial |
$180.59
|
| Rate for Payer: Cofinity Commercial |
$202.36
|
| Rate for Payer: Cofinity Commercial |
$230.25
|
| Rate for Payer: Cofinity Commercial |
$187.41
|
| Rate for Payer: Cofinity Commercial |
$1,449.27
|
| Rate for Payer: Cofinity Commercial |
$924.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$202.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,179.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$752.29
|
| Rate for Payer: Aetna American Axle |
$1,095.38
|
| Rate for Payer: Aetna American Axle |
$174.02
|
| Rate for Payer: Aetna American Axle |
$167.69
|
| Rate for Payer: Aetna American Axle |
$698.56
|
| Rate for Payer: Aetna American Axle |
$187.90
|
| Rate for Payer: Aetna Commercial |
$1,432.42
|
| Rate for Payer: Aetna Commercial |
$913.50
|
| Rate for Payer: Aetna Commercial |
$245.72
|
| Rate for Payer: Aetna Commercial |
$219.29
|
| Rate for Payer: Aetna Commercial |
$227.57
|
| Rate for Payer: Aetna Medicare |
$129.00
|
| Rate for Payer: Aetna Medicare |
$133.86
|
| Rate for Payer: Aetna Medicare |
$842.60
|
| Rate for Payer: Aetna Medicare |
$537.35
|
| Rate for Payer: Aetna Medicare |
$144.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$698.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.69
|
| Rate for Payer: BCBS Complete |
$674.08
|
| Rate for Payer: BCBS Complete |
$429.88
|
| Rate for Payer: BCBS Complete |
$107.09
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCBS Complete |
$103.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.23
|
| Rate for Payer: BCBS Trust/PPO |
$31.23
|
| Rate for Payer: BCBS Trust/PPO |
$31.23
|
| Rate for Payer: BCBS Trust/PPO |
$31.23
|
| Rate for Payer: BCBS Trust/PPO |
$31.23
|
| Rate for Payer: BCN Commercial |
$31.23
|
| Rate for Payer: BCN Commercial |
$31.23
|
| Rate for Payer: BCN Commercial |
$31.23
|
| Rate for Payer: BCN Commercial |
$31.23
|
| Rate for Payer: BCN Commercial |
$31.23
|
| Rate for Payer: Cash Price |
$1,348.16
|
| Rate for Payer: Cash Price |
$206.39
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cash Price |
$1,348.16
|
| Rate for Payer: Cash Price |
$859.76
|
| Rate for Payer: Cash Price |
$206.39
|
| Rate for Payer: Cash Price |
$231.26
|
| Rate for Payer: Cash Price |
$231.26
|
| Rate for Payer: Cash Price |
$214.18
|
| Rate for Payer: Cash Price |
$214.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,348.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$859.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.18
|
| Rate for Payer: Healthscope Commercial |
$240.96
|
| Rate for Payer: Healthscope Commercial |
$967.23
|
| Rate for Payer: Healthscope Commercial |
$1,516.68
|
| Rate for Payer: Healthscope Commercial |
$232.19
|
| Rate for Payer: Healthscope Commercial |
$260.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$752.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,179.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$806.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,432.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$913.50
|
| Rate for Payer: PHP Commercial |
$245.72
|
| Rate for Payer: PHP Commercial |
$227.57
|
| Rate for Payer: PHP Commercial |
$1,432.42
|
| Rate for Payer: PHP Commercial |
$913.50
|
| Rate for Payer: PHP Commercial |
$219.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,095.38
|
| Rate for Payer: Priority Health SBD |
$1,061.68
|
| Rate for Payer: Priority Health SBD |
$182.12
|
| Rate for Payer: Priority Health SBD |
$168.67
|
| Rate for Payer: Priority Health SBD |
$677.06
|
| Rate for Payer: Priority Health SBD |
$162.53
|
| Rate for Payer: UMR Bronson Commercial |
$397.64
|
| Rate for Payer: UMR Bronson Commercial |
$95.46
|
| Rate for Payer: UMR Bronson Commercial |
$623.52
|
| Rate for Payer: UMR Bronson Commercial |
$99.06
|
| Rate for Payer: UMR Bronson Commercial |
$106.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$806.02
|
|
|
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
|
$86.02
|
|
|
Service Code
|
HCPCS J1327
|
| Hospital Charge Code |
23124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.23 |
| Max. Negotiated Rate |
$77.42 |
| Rate for Payer: Aetna American Axle |
$55.91
|
| Rate for Payer: Aetna American Axle |
$54.03
|
| Rate for Payer: Aetna American Axle |
$215.85
|
| Rate for Payer: Aetna American Axle |
$52.21
|
| 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 Commercial |
$70.66
|
| Rate for Payer: Aetna Medicare |
$41.56
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna Medicare |
$166.04
|
| Rate for Payer: Aetna Medicare |
$43.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: BCBS Complete |
$33.25
|
| Rate for Payer: BCBS Complete |
$132.83
|
| Rate for Payer: BCBS Complete |
$34.41
|
| Rate for Payer: BCBS Complete |
$32.13
|
| Rate for Payer: BCBS Trust/PPO |
$31.23
|
| Rate for Payer: BCBS Trust/PPO |
$31.23
|
| Rate for Payer: BCBS Trust/PPO |
$31.23
|
| Rate for Payer: BCBS Trust/PPO |
$31.23
|
| Rate for Payer: BCN Commercial |
$31.23
|
| Rate for Payer: BCN Commercial |
$31.23
|
| Rate for Payer: BCN Commercial |
$31.23
|
| Rate for Payer: BCN Commercial |
$31.23
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cash Price |
$265.66
|
| Rate for Payer: Cash Price |
$265.66
|
| Rate for Payer: Cash Price |
$66.50
|
| Rate for Payer: Cash Price |
$68.82
|
| Rate for Payer: Cofinity Commercial |
$73.98
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$232.45
|
| Rate for Payer: Cofinity Commercial |
$285.58
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$58.19
|
| Rate for Payer: Cofinity Commercial |
$71.49
|
| Rate for Payer: Cofinity Commercial |
$60.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$232.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| 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 |
$265.66
|
| Rate for Payer: Healthscope Commercial |
$298.86
|
| Rate for Payer: Healthscope Commercial |
$77.42
|
| Rate for Payer: Healthscope Commercial |
$74.82
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.19
|
| 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: Lakeland Regional Health Systems Commercial |
$64.52
|
| 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 |
$60.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.26
|
| Rate for Payer: PHP Commercial |
$73.12
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: PHP Commercial |
$282.26
|
| Rate for Payer: PHP Commercial |
$70.66
|
| 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 Cigna Priority Health |
$54.03
|
| Rate for Payer: Priority Health SBD |
$209.20
|
| Rate for Payer: Priority Health SBD |
$52.37
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: Priority Health SBD |
$54.19
|
| Rate for Payer: UMR Bronson Commercial |
$122.87
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: UMR Bronson Commercial |
$31.83
|
| Rate for Payer: UMR Bronson Commercial |
$29.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.52
|
|
|
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 |
$10.36 |
| 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 |
$20.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,927.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.15
|
| Rate for Payer: BCBS Complete |
$10.87
|
| Rate for Payer: BCBS MAPPO |
$19.32
|
| Rate for Payer: BCBS Trust/PPO |
$52.08
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: BCN Medicare Advantage |
$19.32
|
| 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 |
$19.32
|
| 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 |
$10.36
|
| Rate for Payer: Mclaren Medicare |
$19.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.29
|
| Rate for Payer: Meridian Medicaid |
$10.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,135.77
|
| Rate for Payer: Nomi Health Commercial |
$57.96
|
| Rate for Payer: PACE Medicare |
$18.35
|
| Rate for Payer: PACE SWMI |
$19.32
|
| Rate for Payer: PHP Commercial |
$5,135.77
|
| Rate for Payer: PHP Medicare Advantage |
$19.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,927.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.79
|
| Rate for Payer: Priority Health Medicare |
$19.32
|
| Rate for Payer: Priority Health Narrow Network |
$43.03
|
| Rate for Payer: Priority Health SBD |
$3,806.51
|
| Rate for Payer: Railroad Medicare Medicare |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.32
|
| Rate for Payer: UHC Exchange |
$36.92
|
| Rate for Payer: UHC Medicare Advantage |
$19.32
|
| Rate for Payer: UHCCP Medicaid |
$10.36
|
| Rate for Payer: UMR Bronson Commercial |
$2,235.57
|
| Rate for Payer: VA VA |
$19.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,531.56
|
|
|
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
|
|
|
ERAVACYCLINE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$414.16
|
|
|
Service Code
|
HCPCS J0122
|
| Hospital Charge Code |
195057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.26 |
| 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: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: Cash Price |
$331.33
|
| 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 |
$268.60 |
| 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 |
$208.92
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.92
|
| 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 |
$268.60 |
| 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 |
$208.92
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.92
|
| 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
|
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
|
$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
|
$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 |
$130.24
|
| 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
|
|
