|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
NDC 65219044501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna American Axle |
$11.98
|
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Medicare |
$9.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.98
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$12.90
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: Priority Health SBD |
$11.61
|
| Rate for Payer: UMR Bronson Commercial |
$6.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.24
|
|
|
Service Code
|
NDC 00517078010
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna American Axle |
$20.31
|
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna Medicare |
$15.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.31
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$21.87
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$28.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.55
|
| Rate for Payer: PHP Commercial |
$26.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.31
|
| Rate for Payer: Priority Health SBD |
$19.68
|
| Rate for Payer: UMR Bronson Commercial |
$11.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.43
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: Aetna American Axle |
$14.90
|
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.90
|
| Rate for Payer: Priority Health SBD |
$14.44
|
| Rate for Payer: UMR Bronson Commercial |
$8.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.19
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.01
|
|
|
Service Code
|
NDC 23155016031
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$20.71 |
| Rate for Payer: Aetna American Axle |
$14.96
|
| Rate for Payer: Aetna Commercial |
$19.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.96
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Cofinity Commercial |
$19.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.41
|
| Rate for Payer: Healthscope Commercial |
$20.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.56
|
| Rate for Payer: PHP Commercial |
$19.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.96
|
| Rate for Payer: Priority Health SBD |
$14.50
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.26
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.01
|
|
|
Service Code
|
NDC 23155016041
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$20.71 |
| Rate for Payer: Aetna American Axle |
$14.96
|
| Rate for Payer: Aetna Commercial |
$19.56
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.96
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: Cash Price |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Cofinity Commercial |
$19.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.41
|
| Rate for Payer: Healthscope Commercial |
$20.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.56
|
| Rate for Payer: PHP Commercial |
$19.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.96
|
| Rate for Payer: Priority Health SBD |
$14.50
|
| Rate for Payer: UMR Bronson Commercial |
$8.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.26
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$66.44
|
|
|
Service Code
|
NDC 00409806201
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna American Axle |
$43.19
|
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.19
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cofinity Commercial |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$57.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.15
|
| Rate for Payer: Healthscope Commercial |
$59.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: PHP Commercial |
$56.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.19
|
| Rate for Payer: Priority Health SBD |
$41.86
|
| Rate for Payer: UMR Bronson Commercial |
$29.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.83
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna American Axle |
$14.90
|
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.90
|
| Rate for Payer: Priority Health SBD |
$14.44
|
| Rate for Payer: UMR Bronson Commercial |
$10.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.19
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$31.24
|
|
|
Service Code
|
NDC 00517078010
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna American Axle |
$20.31
|
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.31
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$21.87
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$28.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.55
|
| Rate for Payer: PHP Commercial |
$26.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.31
|
| Rate for Payer: Priority Health SBD |
$19.68
|
| Rate for Payer: UMR Bronson Commercial |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.43
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.92
|
|
|
Service Code
|
NDC 00409669501
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$20.63 |
| Rate for Payer: Aetna American Axle |
$14.90
|
| Rate for Payer: Aetna Commercial |
$19.48
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: Cash Price |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Cofinity Commercial |
$19.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$20.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: PHP Commercial |
$19.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.90
|
| Rate for Payer: Priority Health SBD |
$14.44
|
| Rate for Payer: UMR Bronson Commercial |
$8.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.19
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
OP
|
$66.44
|
|
|
Service Code
|
NDC 00409806201
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna American Axle |
$43.19
|
| Rate for Payer: Aetna Commercial |
$56.47
|
| Rate for Payer: Aetna Medicare |
$33.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.19
|
| Rate for Payer: BCBS Complete |
$26.58
|
| Rate for Payer: Cash Price |
$53.15
|
| Rate for Payer: Cofinity Commercial |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$57.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.15
|
| Rate for Payer: Healthscope Commercial |
$59.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.47
|
| Rate for Payer: PHP Commercial |
$56.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.19
|
| Rate for Payer: Priority Health SBD |
$41.86
|
| Rate for Payer: UMR Bronson Commercial |
$24.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.83
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
OP
|
$31.24
|
|
|
Service Code
|
NDC 00517078010
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna American Axle |
$20.31
|
| Rate for Payer: Aetna Commercial |
$26.55
|
| Rate for Payer: Aetna Medicare |
$15.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.31
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$21.87
|
| Rate for Payer: Cofinity Commercial |
$26.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$28.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.55
|
| Rate for Payer: PHP Commercial |
$26.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.31
|
| Rate for Payer: Priority Health SBD |
$19.68
|
| Rate for Payer: UMR Bronson Commercial |
$11.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.43
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$372.59
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
10000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$335.33 |
| Rate for Payer: Aetna American Axle |
$242.18
|
| Rate for Payer: Aetna American Axle |
$563.37
|
| Rate for Payer: Aetna American Axle |
$127.52
|
| Rate for Payer: Aetna American Axle |
$153.56
|
| Rate for Payer: Aetna American Axle |
$312.98
|
| Rate for Payer: Aetna American Axle |
$77.17
|
| Rate for Payer: Aetna American Axle |
$116.06
|
| Rate for Payer: Aetna American Axle |
$230.69
|
| Rate for Payer: Aetna American Axle |
$405.85
|
| Rate for Payer: Aetna Commercial |
$301.67
|
| Rate for Payer: Aetna Commercial |
$530.72
|
| Rate for Payer: Aetna Commercial |
$200.81
|
| Rate for Payer: Aetna Commercial |
$409.28
|
| Rate for Payer: Aetna Commercial |
$736.72
|
| Rate for Payer: Aetna Commercial |
$316.70
|
| Rate for Payer: Aetna Commercial |
$166.76
|
| Rate for Payer: Aetna Commercial |
$100.91
|
| Rate for Payer: Aetna Commercial |
$151.78
|
| Rate for Payer: Aetna Medicare |
$240.75
|
| Rate for Payer: Aetna Medicare |
$118.12
|
| Rate for Payer: Aetna Medicare |
$89.28
|
| Rate for Payer: Aetna Medicare |
$59.36
|
| Rate for Payer: Aetna Medicare |
$177.46
|
| Rate for Payer: Aetna Medicare |
$98.10
|
| Rate for Payer: Aetna Medicare |
$433.36
|
| Rate for Payer: Aetna Medicare |
$186.30
|
| Rate for Payer: Aetna Medicare |
$312.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.17
|
| Rate for Payer: BCBS Complete |
$149.04
|
| Rate for Payer: BCBS Complete |
$94.50
|
| Rate for Payer: BCBS Complete |
$192.60
|
| Rate for Payer: BCBS Complete |
$141.96
|
| Rate for Payer: BCBS Complete |
$346.69
|
| Rate for Payer: BCBS Complete |
$249.75
|
| Rate for Payer: BCBS Complete |
$78.48
|
| Rate for Payer: BCBS Complete |
$47.49
|
| Rate for Payer: BCBS Complete |
$71.42
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$298.07
|
| Rate for Payer: Cash Price |
$142.85
|
| Rate for Payer: Cash Price |
$156.95
|
| Rate for Payer: Cash Price |
$94.98
|
| Rate for Payer: Cash Price |
$142.85
|
| Rate for Payer: Cash Price |
$94.98
|
| Rate for Payer: Cash Price |
$156.95
|
| Rate for Payer: Cash Price |
$693.38
|
| Rate for Payer: Cash Price |
$693.38
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$298.07
|
| Rate for Payer: Cash Price |
$283.93
|
| Rate for Payer: Cash Price |
$283.93
|
| Rate for Payer: Cofinity Commercial |
$320.43
|
| Rate for Payer: Cofinity Commercial |
$260.81
|
| Rate for Payer: Cofinity Commercial |
$305.22
|
| Rate for Payer: Cofinity Commercial |
$414.09
|
| Rate for Payer: Cofinity Commercial |
$437.07
|
| Rate for Payer: Cofinity Commercial |
$536.97
|
| Rate for Payer: Cofinity Commercial |
$606.71
|
| Rate for Payer: Cofinity Commercial |
$745.39
|
| Rate for Payer: Cofinity Commercial |
$168.72
|
| Rate for Payer: Cofinity Commercial |
$248.44
|
| Rate for Payer: Cofinity Commercial |
$137.33
|
| Rate for Payer: Cofinity Commercial |
$124.99
|
| Rate for Payer: Cofinity Commercial |
$83.10
|
| Rate for Payer: Cofinity Commercial |
$102.10
|
| Rate for Payer: Cofinity Commercial |
$203.18
|
| Rate for Payer: Cofinity Commercial |
$153.56
|
| Rate for Payer: Cofinity Commercial |
$165.38
|
| Rate for Payer: Cofinity Commercial |
$337.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$437.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$606.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$693.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$499.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.98
|
| Rate for Payer: Healthscope Commercial |
$433.35
|
| Rate for Payer: Healthscope Commercial |
$780.06
|
| Rate for Payer: Healthscope Commercial |
$335.33
|
| Rate for Payer: Healthscope Commercial |
$212.62
|
| Rate for Payer: Healthscope Commercial |
$561.94
|
| Rate for Payer: Healthscope Commercial |
$160.70
|
| Rate for Payer: Healthscope Commercial |
$176.57
|
| Rate for Payer: Healthscope Commercial |
$106.85
|
| Rate for Payer: Healthscope Commercial |
$319.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$606.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$437.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$650.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$468.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$736.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.28
|
| Rate for Payer: PHP Commercial |
$200.81
|
| Rate for Payer: PHP Commercial |
$736.72
|
| Rate for Payer: PHP Commercial |
$409.28
|
| Rate for Payer: PHP Commercial |
$301.67
|
| Rate for Payer: PHP Commercial |
$530.72
|
| Rate for Payer: PHP Commercial |
$151.78
|
| Rate for Payer: PHP Commercial |
$100.91
|
| Rate for Payer: PHP Commercial |
$166.76
|
| Rate for Payer: PHP Commercial |
$316.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$405.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.17
|
| Rate for Payer: Priority Health SBD |
$223.59
|
| Rate for Payer: Priority Health SBD |
$148.84
|
| Rate for Payer: Priority Health SBD |
$234.73
|
| Rate for Payer: Priority Health SBD |
$74.79
|
| Rate for Payer: Priority Health SBD |
$123.60
|
| Rate for Payer: Priority Health SBD |
$546.04
|
| Rate for Payer: Priority Health SBD |
$303.34
|
| Rate for Payer: Priority Health SBD |
$112.49
|
| Rate for Payer: Priority Health SBD |
$393.36
|
| Rate for Payer: UMR Bronson Commercial |
$231.02
|
| Rate for Payer: UMR Bronson Commercial |
$178.16
|
| Rate for Payer: UMR Bronson Commercial |
$72.59
|
| Rate for Payer: UMR Bronson Commercial |
$43.93
|
| Rate for Payer: UMR Bronson Commercial |
$137.86
|
| Rate for Payer: UMR Bronson Commercial |
$87.41
|
| Rate for Payer: UMR Bronson Commercial |
$320.69
|
| Rate for Payer: UMR Bronson Commercial |
$66.07
|
| Rate for Payer: UMR Bronson Commercial |
$131.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$650.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$468.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.18
|
|
|
ETOPOSIDE 20 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$196.19
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
10000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$176.57 |
| Rate for Payer: Aetna American Axle |
$127.52
|
| Rate for Payer: Aetna American Axle |
$116.06
|
| Rate for Payer: Aetna American Axle |
$242.18
|
| Rate for Payer: Aetna American Axle |
$312.98
|
| Rate for Payer: Aetna American Axle |
$230.69
|
| Rate for Payer: Aetna American Axle |
$153.56
|
| Rate for Payer: Aetna American Axle |
$563.37
|
| Rate for Payer: Aetna American Axle |
$77.17
|
| Rate for Payer: Aetna Commercial |
$301.67
|
| Rate for Payer: Aetna Commercial |
$200.81
|
| Rate for Payer: Aetna Commercial |
$151.78
|
| Rate for Payer: Aetna Commercial |
$100.91
|
| Rate for Payer: Aetna Commercial |
$166.76
|
| Rate for Payer: Aetna Commercial |
$736.72
|
| Rate for Payer: Aetna Commercial |
$409.28
|
| Rate for Payer: Aetna Commercial |
$316.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.18
|
| Rate for Payer: Cash Price |
$283.93
|
| Rate for Payer: Cash Price |
$298.07
|
| Rate for Payer: Cash Price |
$693.38
|
| Rate for Payer: Cash Price |
$142.85
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$94.98
|
| Rate for Payer: Cash Price |
$385.20
|
| Rate for Payer: Cash Price |
$156.95
|
| Rate for Payer: Cofinity Commercial |
$168.72
|
| Rate for Payer: Cofinity Commercial |
$102.10
|
| Rate for Payer: Cofinity Commercial |
$83.10
|
| Rate for Payer: Cofinity Commercial |
$124.99
|
| Rate for Payer: Cofinity Commercial |
$153.56
|
| Rate for Payer: Cofinity Commercial |
$137.33
|
| Rate for Payer: Cofinity Commercial |
$165.38
|
| Rate for Payer: Cofinity Commercial |
$203.18
|
| Rate for Payer: Cofinity Commercial |
$248.44
|
| Rate for Payer: Cofinity Commercial |
$305.22
|
| Rate for Payer: Cofinity Commercial |
$260.81
|
| Rate for Payer: Cofinity Commercial |
$320.43
|
| Rate for Payer: Cofinity Commercial |
$337.05
|
| Rate for Payer: Cofinity Commercial |
$414.09
|
| Rate for Payer: Cofinity Commercial |
$606.71
|
| Rate for Payer: Cofinity Commercial |
$745.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$606.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$260.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$693.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.98
|
| Rate for Payer: Healthscope Commercial |
$319.42
|
| Rate for Payer: Healthscope Commercial |
$176.57
|
| Rate for Payer: Healthscope Commercial |
$160.70
|
| Rate for Payer: Healthscope Commercial |
$212.62
|
| Rate for Payer: Healthscope Commercial |
$106.85
|
| Rate for Payer: Healthscope Commercial |
$780.06
|
| Rate for Payer: Healthscope Commercial |
$433.35
|
| Rate for Payer: Healthscope Commercial |
$335.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$606.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$650.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$736.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.81
|
| Rate for Payer: PHP Commercial |
$166.76
|
| Rate for Payer: PHP Commercial |
$316.70
|
| Rate for Payer: PHP Commercial |
$736.72
|
| Rate for Payer: PHP Commercial |
$200.81
|
| Rate for Payer: PHP Commercial |
$100.91
|
| Rate for Payer: PHP Commercial |
$409.28
|
| Rate for Payer: PHP Commercial |
$151.78
|
| Rate for Payer: PHP Commercial |
$301.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.17
|
| Rate for Payer: Priority Health SBD |
$223.59
|
| Rate for Payer: Priority Health SBD |
$123.60
|
| Rate for Payer: Priority Health SBD |
$234.73
|
| Rate for Payer: Priority Health SBD |
$148.84
|
| Rate for Payer: Priority Health SBD |
$546.04
|
| Rate for Payer: Priority Health SBD |
$303.34
|
| Rate for Payer: Priority Health SBD |
$74.79
|
| Rate for Payer: Priority Health SBD |
$112.49
|
| Rate for Payer: UMR Bronson Commercial |
$211.86
|
| Rate for Payer: UMR Bronson Commercial |
$381.36
|
| Rate for Payer: UMR Bronson Commercial |
$86.32
|
| Rate for Payer: UMR Bronson Commercial |
$156.16
|
| Rate for Payer: UMR Bronson Commercial |
$78.57
|
| Rate for Payer: UMR Bronson Commercial |
$52.24
|
| Rate for Payer: UMR Bronson Commercial |
$163.94
|
| Rate for Payer: UMR Bronson Commercial |
$103.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$650.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.18
|
|
|
ETOPOSIDE PHOSPHATE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$830.45
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
17451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$747.40 |
| Rate for Payer: Aetna American Axle |
$539.79
|
| Rate for Payer: Aetna Commercial |
$705.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.79
|
| Rate for Payer: Cash Price |
$664.36
|
| Rate for Payer: Cofinity Commercial |
$581.32
|
| Rate for Payer: Cofinity Commercial |
$714.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$581.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$664.36
|
| Rate for Payer: Healthscope Commercial |
$747.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$581.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$622.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$705.88
|
| Rate for Payer: PHP Commercial |
$705.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.79
|
| Rate for Payer: Priority Health SBD |
$523.18
|
| Rate for Payer: UMR Bronson Commercial |
$365.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$622.84
|
|
|
ETOPOSIDE PHOSPHATE 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$830.45
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
17451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$747.40 |
| Rate for Payer: Aetna American Axle |
$539.79
|
| Rate for Payer: Aetna Commercial |
$705.88
|
| Rate for Payer: Aetna Medicare |
$415.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.79
|
| Rate for Payer: BCBS Complete |
$332.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: Cash Price |
$664.36
|
| Rate for Payer: Cash Price |
$664.36
|
| Rate for Payer: Cofinity Commercial |
$581.32
|
| Rate for Payer: Cofinity Commercial |
$714.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$581.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$664.36
|
| Rate for Payer: Healthscope Commercial |
$747.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$581.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$622.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$705.88
|
| Rate for Payer: PHP Commercial |
$705.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.79
|
| Rate for Payer: Priority Health SBD |
$523.18
|
| Rate for Payer: UMR Bronson Commercial |
$307.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$622.84
|
|
|
ETRAVIRINE 200 MG TABLET
|
Facility
|
IP
|
$5,403.71
|
|
|
Service Code
|
NDC 59676057101
|
| Hospital Charge Code |
151955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,377.63 |
| Max. Negotiated Rate |
$4,863.34 |
| Rate for Payer: Aetna American Axle |
$3,512.41
|
| Rate for Payer: Aetna Commercial |
$4,593.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,512.41
|
| Rate for Payer: Cash Price |
$4,322.97
|
| Rate for Payer: Cofinity Commercial |
$3,782.60
|
| Rate for Payer: Cofinity Commercial |
$4,647.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,782.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,322.97
|
| Rate for Payer: Healthscope Commercial |
$4,863.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,782.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,052.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,593.15
|
| Rate for Payer: PHP Commercial |
$4,593.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,512.41
|
| Rate for Payer: Priority Health SBD |
$3,404.34
|
| Rate for Payer: UMR Bronson Commercial |
$2,377.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,052.78
|
|
|
ETRAVIRINE 200 MG TABLET
|
Facility
|
OP
|
$5,403.71
|
|
|
Service Code
|
NDC 59676057101
|
| Hospital Charge Code |
151955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,999.37 |
| Max. Negotiated Rate |
$4,863.34 |
| Rate for Payer: Aetna American Axle |
$3,512.41
|
| Rate for Payer: Aetna Commercial |
$4,593.15
|
| Rate for Payer: Aetna Medicare |
$2,701.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,512.41
|
| Rate for Payer: BCBS Complete |
$2,161.48
|
| Rate for Payer: Cash Price |
$4,322.97
|
| Rate for Payer: Cofinity Commercial |
$3,782.60
|
| Rate for Payer: Cofinity Commercial |
$4,647.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,782.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,322.97
|
| Rate for Payer: Healthscope Commercial |
$4,863.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,782.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,052.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,593.15
|
| Rate for Payer: PHP Commercial |
$4,593.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,512.41
|
| Rate for Payer: Priority Health SBD |
$3,404.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,999.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,052.78
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET
|
Facility
|
OP
|
$14.34
|
|
|
Service Code
|
NDC 67877071833
|
| Hospital Charge Code |
104555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna American Axle |
$9.32
|
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.32
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.32
|
| Rate for Payer: Priority Health SBD |
$9.03
|
| Rate for Payer: UMR Bronson Commercial |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET
|
Facility
|
IP
|
$860.25
|
|
|
Service Code
|
NDC 67877071831
|
| Hospital Charge Code |
104555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.51 |
| Max. Negotiated Rate |
$774.22 |
| Rate for Payer: Aetna American Axle |
$559.16
|
| Rate for Payer: Aetna Commercial |
$731.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.16
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cofinity Commercial |
$602.18
|
| Rate for Payer: Cofinity Commercial |
$739.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$602.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Healthscope Commercial |
$774.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.21
|
| Rate for Payer: PHP Commercial |
$731.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.16
|
| Rate for Payer: Priority Health SBD |
$541.96
|
| Rate for Payer: UMR Bronson Commercial |
$378.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.19
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET
|
Facility
|
IP
|
$14.34
|
|
|
Service Code
|
NDC 67877071833
|
| Hospital Charge Code |
104555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna American Axle |
$9.32
|
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.32
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.19
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.32
|
| Rate for Payer: Priority Health SBD |
$9.03
|
| Rate for Payer: UMR Bronson Commercial |
$6.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.25 MG TABLET
|
Facility
|
OP
|
$860.25
|
|
|
Service Code
|
NDC 67877071831
|
| Hospital Charge Code |
104555
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.29 |
| Max. Negotiated Rate |
$774.22 |
| Rate for Payer: Aetna American Axle |
$559.16
|
| Rate for Payer: Aetna Commercial |
$731.21
|
| Rate for Payer: Aetna Medicare |
$430.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.16
|
| Rate for Payer: BCBS Complete |
$344.10
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cofinity Commercial |
$602.18
|
| Rate for Payer: Cofinity Commercial |
$739.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$602.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Healthscope Commercial |
$774.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$602.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.21
|
| Rate for Payer: PHP Commercial |
$731.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.16
|
| Rate for Payer: Priority Health SBD |
$541.96
|
| Rate for Payer: UMR Bronson Commercial |
$318.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.19
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET
|
Facility
|
IP
|
$2,580.75
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
104556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,135.53 |
| Max. Negotiated Rate |
$2,322.68 |
| Rate for Payer: Aetna American Axle |
$1,677.49
|
| Rate for Payer: Aetna American Axle |
$27.96
|
| Rate for Payer: Aetna Commercial |
$2,193.64
|
| Rate for Payer: Aetna Commercial |
$36.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,677.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.96
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cofinity Commercial |
$37.00
|
| Rate for Payer: Cofinity Commercial |
$30.11
|
| Rate for Payer: Cofinity Commercial |
$1,806.52
|
| Rate for Payer: Cofinity Commercial |
$2,219.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,806.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.42
|
| Rate for Payer: Healthscope Commercial |
$2,322.68
|
| Rate for Payer: Healthscope Commercial |
$38.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,806.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.64
|
| Rate for Payer: PHP Commercial |
$36.57
|
| Rate for Payer: PHP Commercial |
$2,193.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.96
|
| Rate for Payer: Priority Health SBD |
$1,625.87
|
| Rate for Payer: Priority Health SBD |
$27.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,135.53
|
| Rate for Payer: UMR Bronson Commercial |
$18.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.26
|
|
|
EVEROLIMUS (IMMUNOSUPPRESSIVE) 0.75 MG TABLET
|
Facility
|
OP
|
$2,580.75
|
|
|
Service Code
|
HCPCS J7527
|
| Hospital Charge Code |
104556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$2,322.68 |
| Rate for Payer: Aetna American Axle |
$1,677.49
|
| Rate for Payer: Aetna American Axle |
$27.96
|
| Rate for Payer: Aetna Commercial |
$36.57
|
| Rate for Payer: Aetna Commercial |
$2,193.64
|
| Rate for Payer: Aetna Medicare |
$1,290.38
|
| Rate for Payer: Aetna Medicare |
$21.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,677.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.96
|
| Rate for Payer: BCBS Complete |
$17.21
|
| Rate for Payer: BCBS Complete |
$1,032.30
|
| Rate for Payer: BCBS Trust/PPO |
$5.93
|
| Rate for Payer: BCBS Trust/PPO |
$5.93
|
| Rate for Payer: BCN Commercial |
$5.93
|
| Rate for Payer: BCN Commercial |
$5.93
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cofinity Commercial |
$37.00
|
| Rate for Payer: Cofinity Commercial |
$1,806.52
|
| Rate for Payer: Cofinity Commercial |
$30.11
|
| Rate for Payer: Cofinity Commercial |
$2,219.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,806.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.60
|
| Rate for Payer: Healthscope Commercial |
$38.72
|
| Rate for Payer: Healthscope Commercial |
$2,322.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,806.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.57
|
| Rate for Payer: PHP Commercial |
$2,193.64
|
| Rate for Payer: PHP Commercial |
$36.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.96
|
| Rate for Payer: Priority Health SBD |
$27.10
|
| Rate for Payer: Priority Health SBD |
$1,625.87
|
| Rate for Payer: UMR Bronson Commercial |
$954.88
|
| Rate for Payer: UMR Bronson Commercial |
$15.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.56
|
|
|
EXCHANGE OF INTRAOCULAR LENS
|
Facility
|
OP
|
$7,023.35
|
|
|
Service Code
|
CPT 66986
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$842.51 |
| Max. Negotiated Rate |
$7,023.35 |
| Rate for Payer: Aetna Medicare |
$2,323.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,793.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,793.26
|
| Rate for Payer: BCBS Complete |
$1,257.64
|
| Rate for Payer: BCBS MAPPO |
$2,234.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,030.29
|
| Rate for Payer: BCN Commercial |
$2,030.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,234.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,234.61
|
| Rate for Payer: Mclaren Medicaid |
$1,197.75
|
| Rate for Payer: Mclaren Medicare |
$2,234.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,346.34
|
| Rate for Payer: Meridian Medicaid |
$1,257.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,569.80
|
| Rate for Payer: Nomi Health Commercial |
$4,692.68
|
| Rate for Payer: PACE Medicare |
$2,122.88
|
| Rate for Payer: PACE SWMI |
$2,234.61
|
| Rate for Payer: PHP Medicare Advantage |
$2,234.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,197.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,023.35
|
| Rate for Payer: Priority Health Medicare |
$2,234.61
|
| Rate for Payer: Priority Health Narrow Network |
$5,618.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2,234.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$926.76
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,234.61
|
| Rate for Payer: UHC Exchange |
$842.51
|
| Rate for Payer: UHC Medicare Advantage |
$2,234.61
|
| Rate for Payer: UHCCP Medicaid |
$1,197.75
|
| Rate for Payer: VA VA |
$2,234.61
|
|
|
EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA, CANTHUS, OR FULL THICKNESS, MAY INCLUDE PREPARATION FOR SKIN GRAFT OR PEDICLE FLAP WITH ADJACENT TISSUE TRANSFER OR REARRANGEMENT; UP TO ONE-FOURTH OF LID MARGIN
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 67961
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$423.90 |
| Max. Negotiated Rate |
$7,184.18 |
| Rate for Payer: Aetna Medicare |
$2,377.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,857.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,857.24
|
| Rate for Payer: BCBS Complete |
$1,286.44
|
| Rate for Payer: BCBS MAPPO |
$2,285.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.11
|
| Rate for Payer: BCN Commercial |
$1,593.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,285.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,285.79
|
| Rate for Payer: Mclaren Medicaid |
$1,225.18
|
| Rate for Payer: Mclaren Medicare |
$2,285.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,400.08
|
| Rate for Payer: Meridian Medicaid |
$1,286.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,628.66
|
| Rate for Payer: Nomi Health Commercial |
$4,800.16
|
| Rate for Payer: PACE Medicare |
$2,171.50
|
| Rate for Payer: PACE SWMI |
$2,285.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,285.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,225.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,184.18
|
| Rate for Payer: Priority Health Medicare |
$2,285.79
|
| Rate for Payer: Priority Health Narrow Network |
$5,747.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,285.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.29
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$423.90
|
| Rate for Payer: UHC Medicare Advantage |
$2,285.79
|
| Rate for Payer: UHCCP Medicaid |
$1,225.18
|
| Rate for Payer: VA VA |
$2,285.79
|
|
