|
GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$631.68
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
93574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$277.94 |
| Max. Negotiated Rate |
$568.51 |
| Rate for Payer: Aetna American Axle |
$410.59
|
| Rate for Payer: Aetna Commercial |
$536.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.59
|
| Rate for Payer: Cash Price |
$505.34
|
| Rate for Payer: Cofinity Advantage |
$442.18
|
| Rate for Payer: Cofinity Commercial |
$543.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.34
|
| Rate for Payer: Healthscope Commercial |
$568.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.76
|
| Rate for Payer: PHP Commercial |
$536.93
|
| Rate for Payer: Priority Health SBD |
$397.96
|
| Rate for Payer: UMR Bronson Commercial |
$277.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.76
|
|
|
GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$631.68
|
|
|
Service Code
|
HCPCS A9581
|
| Hospital Charge Code |
93574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$568.51 |
| Rate for Payer: Aetna American Axle |
$410.59
|
| Rate for Payer: Aetna Commercial |
$536.93
|
| Rate for Payer: Aetna Medicare |
$315.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.59
|
| Rate for Payer: BCBS Complete |
$252.67
|
| Rate for Payer: BCBS Trust/PPO |
$23.09
|
| Rate for Payer: BCN Commercial |
$23.09
|
| Rate for Payer: Cash Price |
$505.34
|
| Rate for Payer: Cash Price |
$505.34
|
| Rate for Payer: Cofinity Advantage |
$442.18
|
| Rate for Payer: Cofinity Commercial |
$543.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.34
|
| Rate for Payer: Healthscope Commercial |
$568.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.76
|
| Rate for Payer: PHP Commercial |
$536.93
|
| Rate for Payer: Priority Health SBD |
$397.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.34
|
| Rate for Payer: UHC Core |
$24.34
|
| Rate for Payer: UHC Exchange |
$24.34
|
| Rate for Payer: UMR Bronson Commercial |
$233.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.76
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
OP
|
$175.11
|
|
|
Service Code
|
NDC 57237004960
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.79 |
| Max. Negotiated Rate |
$157.60 |
| Rate for Payer: Aetna American Axle |
$113.82
|
| Rate for Payer: Aetna Commercial |
$148.84
|
| Rate for Payer: Aetna Medicare |
$87.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.82
|
| Rate for Payer: BCBS Complete |
$70.04
|
| Rate for Payer: Cash Price |
$140.09
|
| Rate for Payer: Cofinity Advantage |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$150.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.09
|
| Rate for Payer: Healthscope Commercial |
$157.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.33
|
| Rate for Payer: PHP Commercial |
$148.84
|
| Rate for Payer: Priority Health SBD |
$110.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.82
|
| Rate for Payer: UHC Core |
$91.23
|
| Rate for Payer: UHC Exchange |
$68.82
|
| Rate for Payer: UMR Bronson Commercial |
$64.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.33
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
IP
|
$163.30
|
|
|
Service Code
|
NDC 24979072204
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$146.97 |
| Rate for Payer: Aetna American Axle |
$106.14
|
| Rate for Payer: Aetna Commercial |
$138.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.14
|
| Rate for Payer: Cash Price |
$130.64
|
| Rate for Payer: Cofinity Advantage |
$114.31
|
| Rate for Payer: Cofinity Commercial |
$140.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.64
|
| Rate for Payer: Healthscope Commercial |
$146.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.47
|
| Rate for Payer: PHP Commercial |
$138.81
|
| Rate for Payer: Priority Health SBD |
$102.88
|
| Rate for Payer: UMR Bronson Commercial |
$71.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.47
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
IP
|
$238.83
|
|
|
Service Code
|
NDC 70436000406
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$214.95 |
| Rate for Payer: Aetna American Axle |
$155.24
|
| Rate for Payer: Aetna Commercial |
$203.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.24
|
| Rate for Payer: Cash Price |
$191.06
|
| Rate for Payer: Cofinity Advantage |
$167.18
|
| Rate for Payer: Cofinity Commercial |
$205.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.06
|
| Rate for Payer: Healthscope Commercial |
$214.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.12
|
| Rate for Payer: PHP Commercial |
$203.01
|
| Rate for Payer: Priority Health SBD |
$150.46
|
| Rate for Payer: UMR Bronson Commercial |
$105.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.12
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
IP
|
$175.11
|
|
|
Service Code
|
NDC 57237004960
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.05 |
| Max. Negotiated Rate |
$157.60 |
| Rate for Payer: Aetna American Axle |
$113.82
|
| Rate for Payer: Aetna Commercial |
$148.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.82
|
| Rate for Payer: Cash Price |
$140.09
|
| Rate for Payer: Cofinity Advantage |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$150.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.09
|
| Rate for Payer: Healthscope Commercial |
$157.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.33
|
| Rate for Payer: PHP Commercial |
$148.84
|
| Rate for Payer: Priority Health SBD |
$110.32
|
| Rate for Payer: UMR Bronson Commercial |
$77.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.33
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
OP
|
$238.83
|
|
|
Service Code
|
NDC 70436000406
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.37 |
| Max. Negotiated Rate |
$214.95 |
| Rate for Payer: Aetna American Axle |
$155.24
|
| Rate for Payer: Aetna Commercial |
$203.01
|
| Rate for Payer: Aetna Medicare |
$119.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.24
|
| Rate for Payer: BCBS Complete |
$95.53
|
| Rate for Payer: Cash Price |
$191.06
|
| Rate for Payer: Cofinity Advantage |
$167.18
|
| Rate for Payer: Cofinity Commercial |
$205.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.06
|
| Rate for Payer: Healthscope Commercial |
$214.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.12
|
| Rate for Payer: PHP Commercial |
$203.01
|
| Rate for Payer: Priority Health SBD |
$150.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.24
|
| Rate for Payer: UHC Core |
$124.43
|
| Rate for Payer: UHC Exchange |
$93.86
|
| Rate for Payer: UMR Bronson Commercial |
$88.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.12
|
|
|
GALANTAMINE 4 MG TABLET
|
Facility
|
OP
|
$163.30
|
|
|
Service Code
|
NDC 24979072204
|
| Hospital Charge Code |
29806
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.42 |
| Max. Negotiated Rate |
$146.97 |
| Rate for Payer: Aetna American Axle |
$106.14
|
| Rate for Payer: Aetna Commercial |
$138.81
|
| Rate for Payer: Aetna Medicare |
$81.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.14
|
| Rate for Payer: BCBS Complete |
$65.32
|
| Rate for Payer: Cash Price |
$130.64
|
| Rate for Payer: Cofinity Advantage |
$114.31
|
| Rate for Payer: Cofinity Commercial |
$140.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.64
|
| Rate for Payer: Healthscope Commercial |
$146.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.47
|
| Rate for Payer: PHP Commercial |
$138.81
|
| Rate for Payer: Priority Health SBD |
$102.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.14
|
| Rate for Payer: UHC Core |
$85.08
|
| Rate for Payer: UHC Exchange |
$64.18
|
| Rate for Payer: UMR Bronson Commercial |
$60.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.47
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$154.08
|
|
|
Service Code
|
NDC 47335083583
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$138.67 |
| Rate for Payer: Aetna American Axle |
$100.15
|
| Rate for Payer: Aetna Commercial |
$130.97
|
| Rate for Payer: Aetna Medicare |
$77.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.15
|
| Rate for Payer: BCBS Complete |
$61.63
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cofinity Advantage |
$107.86
|
| Rate for Payer: Cofinity Commercial |
$132.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.26
|
| Rate for Payer: Healthscope Commercial |
$138.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.56
|
| Rate for Payer: PHP Commercial |
$130.97
|
| Rate for Payer: Priority Health SBD |
$97.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.15
|
| Rate for Payer: UHC Core |
$80.28
|
| Rate for Payer: UHC Exchange |
$60.55
|
| Rate for Payer: UMR Bronson Commercial |
$57.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.56
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$200.88
|
|
|
Service Code
|
NDC 65862074430
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.33 |
| Max. Negotiated Rate |
$180.79 |
| Rate for Payer: Aetna American Axle |
$130.57
|
| Rate for Payer: Aetna Commercial |
$170.75
|
| Rate for Payer: Aetna Medicare |
$100.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.57
|
| Rate for Payer: BCBS Complete |
$80.35
|
| Rate for Payer: Cash Price |
$160.70
|
| Rate for Payer: Cofinity Advantage |
$140.62
|
| Rate for Payer: Cofinity Commercial |
$172.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.70
|
| Rate for Payer: Healthscope Commercial |
$180.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.66
|
| Rate for Payer: PHP Commercial |
$170.75
|
| Rate for Payer: Priority Health SBD |
$126.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.57
|
| Rate for Payer: UHC Core |
$104.66
|
| Rate for Payer: UHC Exchange |
$78.95
|
| Rate for Payer: UMR Bronson Commercial |
$74.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.66
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$154.08
|
|
|
Service Code
|
NDC 47335083583
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$138.67 |
| Rate for Payer: Aetna American Axle |
$100.15
|
| Rate for Payer: Aetna Commercial |
$130.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.15
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cofinity Advantage |
$107.86
|
| Rate for Payer: Cofinity Commercial |
$132.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.26
|
| Rate for Payer: Healthscope Commercial |
$138.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.56
|
| Rate for Payer: PHP Commercial |
$130.97
|
| Rate for Payer: Priority Health SBD |
$97.07
|
| Rate for Payer: UMR Bronson Commercial |
$67.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.56
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$200.88
|
|
|
Service Code
|
NDC 65862074430
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.39 |
| Max. Negotiated Rate |
$180.79 |
| Rate for Payer: Aetna American Axle |
$130.57
|
| Rate for Payer: Aetna Commercial |
$170.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.57
|
| Rate for Payer: Cash Price |
$160.70
|
| Rate for Payer: Cofinity Advantage |
$140.62
|
| Rate for Payer: Cofinity Commercial |
$172.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.70
|
| Rate for Payer: Healthscope Commercial |
$180.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.66
|
| Rate for Payer: PHP Commercial |
$170.75
|
| Rate for Payer: Priority Health SBD |
$126.55
|
| Rate for Payer: UMR Bronson Commercial |
$88.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.66
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$487.52
|
|
|
Service Code
|
NDC 00378810593
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.51 |
| Max. Negotiated Rate |
$438.77 |
| Rate for Payer: Aetna American Axle |
$316.89
|
| Rate for Payer: Aetna Commercial |
$414.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.89
|
| Rate for Payer: Cash Price |
$390.02
|
| Rate for Payer: Cofinity Advantage |
$341.26
|
| Rate for Payer: Cofinity Commercial |
$419.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.02
|
| Rate for Payer: Healthscope Commercial |
$438.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$365.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$365.64
|
| Rate for Payer: PHP Commercial |
$414.39
|
| Rate for Payer: Priority Health SBD |
$307.14
|
| Rate for Payer: UMR Bronson Commercial |
$214.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$365.64
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$487.52
|
|
|
Service Code
|
NDC 00378810593
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.38 |
| Max. Negotiated Rate |
$438.77 |
| Rate for Payer: Aetna American Axle |
$316.89
|
| Rate for Payer: Aetna Commercial |
$414.39
|
| Rate for Payer: Aetna Medicare |
$243.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.89
|
| Rate for Payer: BCBS Complete |
$195.01
|
| Rate for Payer: Cash Price |
$390.02
|
| Rate for Payer: Cofinity Advantage |
$341.26
|
| Rate for Payer: Cofinity Commercial |
$419.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.02
|
| Rate for Payer: Healthscope Commercial |
$438.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$365.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$390.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$365.64
|
| Rate for Payer: PHP Commercial |
$414.39
|
| Rate for Payer: Priority Health SBD |
$307.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.89
|
| Rate for Payer: UHC Core |
$254.00
|
| Rate for Payer: UHC Exchange |
$191.60
|
| Rate for Payer: UMR Bronson Commercial |
$180.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$365.64
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
OP
|
$528.14
|
|
|
Service Code
|
NDC 10147089103
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.41 |
| Max. Negotiated Rate |
$475.33 |
| Rate for Payer: Aetna American Axle |
$343.29
|
| Rate for Payer: Aetna Commercial |
$448.92
|
| Rate for Payer: Aetna Medicare |
$264.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.29
|
| Rate for Payer: BCBS Complete |
$211.26
|
| Rate for Payer: Cash Price |
$422.51
|
| Rate for Payer: Cofinity Advantage |
$369.70
|
| Rate for Payer: Cofinity Commercial |
$454.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.51
|
| Rate for Payer: Healthscope Commercial |
$475.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.11
|
| Rate for Payer: PHP Commercial |
$448.92
|
| Rate for Payer: Priority Health SBD |
$332.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.29
|
| Rate for Payer: UHC Core |
$275.16
|
| Rate for Payer: UHC Exchange |
$207.56
|
| Rate for Payer: UMR Bronson Commercial |
$195.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.11
|
|
|
GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE
|
Facility
|
IP
|
$528.14
|
|
|
Service Code
|
NDC 10147089103
|
| Hospital Charge Code |
41138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$475.33 |
| Rate for Payer: Aetna American Axle |
$343.29
|
| Rate for Payer: Aetna Commercial |
$448.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.29
|
| Rate for Payer: Cash Price |
$422.51
|
| Rate for Payer: Cofinity Advantage |
$369.70
|
| Rate for Payer: Cofinity Commercial |
$454.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.51
|
| Rate for Payer: Healthscope Commercial |
$475.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.11
|
| Rate for Payer: PHP Commercial |
$448.92
|
| Rate for Payer: Priority Health SBD |
$332.73
|
| Rate for Payer: UMR Bronson Commercial |
$232.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.11
|
|
|
GAMMAKED 10 GRAM/100 ML (10 %) INJECTION SOLUTION
|
Facility
|
OP
|
$4,485.32
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
153286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$4,036.79 |
| Rate for Payer: Aetna American Axle |
$2,915.46
|
| Rate for Payer: Aetna Commercial |
$3,812.52
|
| Rate for Payer: Aetna Medicare |
$51.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,915.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.16
|
| Rate for Payer: BCBS Complete |
$27.31
|
| Rate for Payer: BCBS MAPPO |
$49.73
|
| Rate for Payer: BCBS Trust/PPO |
$159.13
|
| Rate for Payer: BCN Commercial |
$159.13
|
| Rate for Payer: BCN Medicare Advantage |
$49.73
|
| Rate for Payer: Cash Price |
$3,588.26
|
| Rate for Payer: Cash Price |
$3,588.26
|
| Rate for Payer: Cofinity Advantage |
$3,139.72
|
| Rate for Payer: Cofinity Commercial |
$3,857.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,588.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.73
|
| Rate for Payer: Healthscope Commercial |
$4,036.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,139.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,363.99
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,812.52
|
| Rate for Payer: Nomi Health Commercial |
$149.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,363.99
|
| Rate for Payer: PACE Medicare |
$47.24
|
| Rate for Payer: PACE SWMI |
$49.73
|
| Rate for Payer: PHP Commercial |
$3,812.52
|
| Rate for Payer: PHP Medicare Advantage |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.42
|
| Rate for Payer: Priority Health Medicare |
$49.73
|
| Rate for Payer: Priority Health SBD |
$2,825.75
|
| Rate for Payer: Priority Health Tiered Network |
$123.54
|
| Rate for Payer: Railroad Medicare Medicare |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.98
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.73
|
| Rate for Payer: UHC Exchange |
$80.98
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,659.57
|
| Rate for Payer: VA VA |
$49.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,363.99
|
|
|
GAMMAKED 10 GRAM/100 ML (10 %) INJECTION SOLUTION
|
Facility
|
IP
|
$4,485.32
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
153286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,973.54 |
| Max. Negotiated Rate |
$4,036.79 |
| Rate for Payer: Aetna American Axle |
$2,915.46
|
| Rate for Payer: Aetna Commercial |
$3,812.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,915.46
|
| Rate for Payer: Cash Price |
$3,588.26
|
| Rate for Payer: Cofinity Advantage |
$3,139.72
|
| Rate for Payer: Cofinity Commercial |
$3,857.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,588.26
|
| Rate for Payer: Healthscope Commercial |
$4,036.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,139.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,363.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,812.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,363.99
|
| Rate for Payer: PHP Commercial |
$3,812.52
|
| Rate for Payer: Priority Health SBD |
$2,825.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,973.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,363.99
|
|
|
GAMMAKED 20 GRAM/200 ML (10 %) INJECTION SOLUTION
|
Facility
|
OP
|
$8,970.63
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
153287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$8,073.57 |
| Rate for Payer: Aetna American Axle |
$5,830.91
|
| Rate for Payer: Aetna Commercial |
$7,625.04
|
| Rate for Payer: Aetna Medicare |
$51.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,830.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.16
|
| Rate for Payer: BCBS Complete |
$27.31
|
| Rate for Payer: BCBS MAPPO |
$49.73
|
| Rate for Payer: BCBS Trust/PPO |
$159.13
|
| Rate for Payer: BCN Commercial |
$159.13
|
| Rate for Payer: BCN Medicare Advantage |
$49.73
|
| Rate for Payer: Cash Price |
$7,176.50
|
| Rate for Payer: Cash Price |
$7,176.50
|
| Rate for Payer: Cofinity Advantage |
$6,279.44
|
| Rate for Payer: Cofinity Commercial |
$7,714.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,176.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.73
|
| Rate for Payer: Healthscope Commercial |
$8,073.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,279.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,727.97
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,625.04
|
| Rate for Payer: Nomi Health Commercial |
$149.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,727.97
|
| Rate for Payer: PACE Medicare |
$47.24
|
| Rate for Payer: PACE SWMI |
$49.73
|
| Rate for Payer: PHP Commercial |
$7,625.04
|
| Rate for Payer: PHP Medicare Advantage |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.42
|
| Rate for Payer: Priority Health Medicare |
$49.73
|
| Rate for Payer: Priority Health SBD |
$5,651.50
|
| Rate for Payer: Priority Health Tiered Network |
$123.54
|
| Rate for Payer: Railroad Medicare Medicare |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.98
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.73
|
| Rate for Payer: UHC Exchange |
$80.98
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UMR Bronson Commercial |
$3,319.13
|
| Rate for Payer: VA VA |
$49.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,727.97
|
|
|
GAMMAKED 5 GRAM/50 ML (10 %) INJECTION SOLUTION
|
Facility
|
OP
|
$2,242.66
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
153285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$2,018.39 |
| Rate for Payer: Aetna American Axle |
$1,457.73
|
| Rate for Payer: Aetna Commercial |
$1,906.26
|
| Rate for Payer: Aetna Medicare |
$51.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,457.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.16
|
| Rate for Payer: BCBS Complete |
$27.31
|
| Rate for Payer: BCBS MAPPO |
$49.73
|
| Rate for Payer: BCBS Trust/PPO |
$159.13
|
| Rate for Payer: BCN Commercial |
$159.13
|
| Rate for Payer: BCN Medicare Advantage |
$49.73
|
| Rate for Payer: Cash Price |
$1,794.13
|
| Rate for Payer: Cash Price |
$1,794.13
|
| Rate for Payer: Cofinity Advantage |
$1,569.86
|
| Rate for Payer: Cofinity Commercial |
$1,928.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.73
|
| Rate for Payer: Healthscope Commercial |
$2,018.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,569.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,681.99
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.26
|
| Rate for Payer: Nomi Health Commercial |
$149.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,681.99
|
| Rate for Payer: PACE Medicare |
$47.24
|
| Rate for Payer: PACE SWMI |
$49.73
|
| Rate for Payer: PHP Commercial |
$1,906.26
|
| Rate for Payer: PHP Medicare Advantage |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.42
|
| Rate for Payer: Priority Health Medicare |
$49.73
|
| Rate for Payer: Priority Health SBD |
$1,412.88
|
| Rate for Payer: Priority Health Tiered Network |
$123.54
|
| Rate for Payer: Railroad Medicare Medicare |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.98
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.73
|
| Rate for Payer: UHC Exchange |
$80.98
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UMR Bronson Commercial |
$829.78
|
| Rate for Payer: VA VA |
$49.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,681.99
|
|
|
GAMMAKED 5 GRAM/50 ML (10 %) INJECTION SOLUTION
|
Facility
|
IP
|
$2,242.66
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
153285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$986.77 |
| Max. Negotiated Rate |
$2,018.39 |
| Rate for Payer: Aetna American Axle |
$1,457.73
|
| Rate for Payer: Aetna Commercial |
$1,906.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,457.73
|
| Rate for Payer: Cash Price |
$1,794.13
|
| Rate for Payer: Cofinity Advantage |
$1,569.86
|
| Rate for Payer: Cofinity Commercial |
$1,928.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,794.13
|
| Rate for Payer: Healthscope Commercial |
$2,018.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,569.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,681.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,906.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,681.99
|
| Rate for Payer: PHP Commercial |
$1,906.26
|
| Rate for Payer: Priority Health SBD |
$1,412.88
|
| Rate for Payer: UMR Bronson Commercial |
$986.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,681.99
|
|
|
GAMUNEX-C 10 GRAM/100 ML (10 %) INJECTION SOLUTION
|
Facility
|
IP
|
$4,544.30
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107780
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,999.49 |
| Max. Negotiated Rate |
$4,089.87 |
| Rate for Payer: Aetna American Axle |
$2,953.80
|
| Rate for Payer: Aetna Commercial |
$3,862.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,953.80
|
| Rate for Payer: Cash Price |
$3,635.44
|
| Rate for Payer: Cofinity Advantage |
$3,181.01
|
| Rate for Payer: Cofinity Commercial |
$3,908.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,635.44
|
| Rate for Payer: Healthscope Commercial |
$4,089.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,181.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,408.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,862.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,408.22
|
| Rate for Payer: PHP Commercial |
$3,862.66
|
| Rate for Payer: Priority Health SBD |
$2,862.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,999.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,408.22
|
|
|
GAMUNEX-C 10 GRAM/100 ML (10 %) INJECTION SOLUTION
|
Facility
|
OP
|
$4,544.30
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107780
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$4,089.87 |
| Rate for Payer: Aetna American Axle |
$2,953.80
|
| Rate for Payer: Aetna Commercial |
$3,862.66
|
| Rate for Payer: Aetna Medicare |
$51.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,953.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.16
|
| Rate for Payer: BCBS Complete |
$27.31
|
| Rate for Payer: BCBS MAPPO |
$49.73
|
| Rate for Payer: BCBS Trust/PPO |
$159.13
|
| Rate for Payer: BCN Commercial |
$159.13
|
| Rate for Payer: BCN Medicare Advantage |
$49.73
|
| Rate for Payer: Cash Price |
$3,635.44
|
| Rate for Payer: Cash Price |
$3,635.44
|
| Rate for Payer: Cofinity Advantage |
$3,181.01
|
| Rate for Payer: Cofinity Commercial |
$3,908.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,635.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.73
|
| Rate for Payer: Healthscope Commercial |
$4,089.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,181.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,408.22
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,862.66
|
| Rate for Payer: Nomi Health Commercial |
$149.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,408.22
|
| Rate for Payer: PACE Medicare |
$47.24
|
| Rate for Payer: PACE SWMI |
$49.73
|
| Rate for Payer: PHP Commercial |
$3,862.66
|
| Rate for Payer: PHP Medicare Advantage |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.42
|
| Rate for Payer: Priority Health Medicare |
$49.73
|
| Rate for Payer: Priority Health SBD |
$2,862.91
|
| Rate for Payer: Priority Health Tiered Network |
$123.54
|
| Rate for Payer: Railroad Medicare Medicare |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.98
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.73
|
| Rate for Payer: UHC Exchange |
$80.98
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,681.39
|
| Rate for Payer: VA VA |
$49.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,408.22
|
|
|
GAMUNEX-C 2.5 GRAM/25 ML (10 %) INJECTION SOLUTION
|
Facility
|
OP
|
$1,136.08
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$1,022.47 |
| Rate for Payer: Aetna American Axle |
$738.45
|
| Rate for Payer: Aetna Commercial |
$965.67
|
| Rate for Payer: Aetna Medicare |
$51.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.16
|
| Rate for Payer: BCBS Complete |
$27.31
|
| Rate for Payer: BCBS MAPPO |
$49.73
|
| Rate for Payer: BCBS Trust/PPO |
$159.13
|
| Rate for Payer: BCN Commercial |
$159.13
|
| Rate for Payer: BCN Medicare Advantage |
$49.73
|
| Rate for Payer: Cash Price |
$908.86
|
| Rate for Payer: Cash Price |
$908.86
|
| Rate for Payer: Cofinity Advantage |
$795.26
|
| Rate for Payer: Cofinity Commercial |
$977.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.73
|
| Rate for Payer: Healthscope Commercial |
$1,022.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$795.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$852.06
|
| Rate for Payer: Mclaren Medicaid |
$49.73
|
| Rate for Payer: Mclaren Medicare |
$49.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.22
|
| Rate for Payer: Meridian Medicaid |
$52.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.67
|
| Rate for Payer: Nomi Health Commercial |
$149.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.06
|
| Rate for Payer: PACE Medicare |
$47.24
|
| Rate for Payer: PACE SWMI |
$49.73
|
| Rate for Payer: PHP Commercial |
$965.67
|
| Rate for Payer: PHP Medicare Advantage |
$49.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$154.42
|
| Rate for Payer: Priority Health Medicare |
$49.73
|
| Rate for Payer: Priority Health SBD |
$715.73
|
| Rate for Payer: Priority Health Tiered Network |
$123.54
|
| Rate for Payer: Railroad Medicare Medicare |
$49.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.98
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.73
|
| Rate for Payer: UHC Exchange |
$80.98
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UMR Bronson Commercial |
$420.35
|
| Rate for Payer: VA VA |
$49.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$852.06
|
|
|
GAMUNEX-C 2.5 GRAM/25 ML (10 %) INJECTION SOLUTION
|
Facility
|
IP
|
$1,136.08
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
107777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$499.88 |
| Max. Negotiated Rate |
$1,022.47 |
| Rate for Payer: Aetna American Axle |
$738.45
|
| Rate for Payer: Aetna Commercial |
$965.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.45
|
| Rate for Payer: Cash Price |
$908.86
|
| Rate for Payer: Cofinity Advantage |
$795.26
|
| Rate for Payer: Cofinity Commercial |
$977.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$908.86
|
| Rate for Payer: Healthscope Commercial |
$1,022.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$795.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$852.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$965.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.06
|
| Rate for Payer: PHP Commercial |
$965.67
|
| Rate for Payer: Priority Health SBD |
$715.73
|
| Rate for Payer: UMR Bronson Commercial |
$499.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$852.06
|
|
