|
GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONCENTRATION) IV SOLN
|
Facility
|
OP
|
$47,151.96
|
|
|
Service Code
|
HCPCS J9203
|
| Hospital Charge Code |
184519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.61 |
| Max. Negotiated Rate |
$42,436.76 |
| Rate for Payer: Aetna American Axle |
$30,648.77
|
| Rate for Payer: Aetna Commercial |
$40,079.17
|
| Rate for Payer: Aetna Medicare |
$249.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30,648.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$300.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$300.21
|
| Rate for Payer: BCBS Complete |
$131.90
|
| Rate for Payer: BCBS MAPPO |
$240.17
|
| Rate for Payer: BCBS Trust/PPO |
$778.75
|
| Rate for Payer: BCN Commercial |
$778.75
|
| Rate for Payer: BCN Medicare Advantage |
$240.17
|
| Rate for Payer: Cash Price |
$37,721.57
|
| Rate for Payer: Cash Price |
$37,721.57
|
| Rate for Payer: Cofinity Advantage |
$33,006.37
|
| Rate for Payer: Cofinity Commercial |
$40,550.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37,721.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.17
|
| Rate for Payer: Healthscope Commercial |
$42,436.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33,006.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35,363.97
|
| Rate for Payer: Mclaren Medicaid |
$240.17
|
| Rate for Payer: Mclaren Medicare |
$240.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.18
|
| Rate for Payer: Meridian Medicaid |
$252.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$264.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,079.17
|
| Rate for Payer: Nomi Health Commercial |
$720.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35,363.97
|
| Rate for Payer: PACE Medicare |
$228.16
|
| Rate for Payer: PACE SWMI |
$240.17
|
| Rate for Payer: PHP Commercial |
$40,079.17
|
| Rate for Payer: PHP Medicare Advantage |
$240.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$746.29
|
| Rate for Payer: Priority Health Medicare |
$240.17
|
| Rate for Payer: Priority Health SBD |
$29,705.73
|
| Rate for Payer: Priority Health Tiered Network |
$597.03
|
| Rate for Payer: Railroad Medicare Medicare |
$240.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.28
|
| Rate for Payer: UHC Core |
$396.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$240.17
|
| Rate for Payer: UHC Exchange |
$396.28
|
| Rate for Payer: UHC Medicaid |
$125.61
|
| Rate for Payer: UHCCP Medicaid |
$125.61
|
| Rate for Payer: UMR Bronson Commercial |
$17,446.23
|
| Rate for Payer: VA VA |
$240.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35,363.97
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$58,835.77
|
|
|
Service Code
|
APR-DRG 8514
|
| Min. Negotiated Rate |
$56,034.07 |
| Max. Negotiated Rate |
$58,835.77 |
| Rate for Payer: BCBS Complete |
$58,835.77
|
| Rate for Payer: Mclaren Medicaid |
$56,034.07
|
| Rate for Payer: Meridian Medicaid |
$58,835.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$56,034.07
|
| Rate for Payer: UHC Medicaid |
$56,034.07
|
| Rate for Payer: UHCCP Medicaid |
$56,034.07
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$10,654.33
|
|
|
Service Code
|
APR-DRG 8511
|
| Min. Negotiated Rate |
$10,146.98 |
| Max. Negotiated Rate |
$10,654.33 |
| Rate for Payer: BCBS Complete |
$10,654.33
|
| Rate for Payer: Mclaren Medicaid |
$10,146.98
|
| Rate for Payer: Meridian Medicaid |
$10,654.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,146.98
|
| Rate for Payer: UHC Medicaid |
$10,146.98
|
| Rate for Payer: UHCCP Medicaid |
$10,146.98
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$15,370.41
|
|
|
Service Code
|
APR-DRG 8512
|
| Min. Negotiated Rate |
$14,638.49 |
| Max. Negotiated Rate |
$15,370.41 |
| Rate for Payer: BCBS Complete |
$15,370.41
|
| Rate for Payer: Mclaren Medicaid |
$14,638.49
|
| Rate for Payer: Meridian Medicaid |
$15,370.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,638.49
|
| Rate for Payer: UHC Medicaid |
$14,638.49
|
| Rate for Payer: UHCCP Medicaid |
$14,638.49
|
|
|
GENDER RELATED PROCEDURES
|
Facility
|
IP
|
$58,835.77
|
|
|
Service Code
|
APR-DRG 8513
|
| Min. Negotiated Rate |
$56,034.07 |
| Max. Negotiated Rate |
$58,835.77 |
| Rate for Payer: BCBS Complete |
$58,835.77
|
| Rate for Payer: Mclaren Medicaid |
$56,034.07
|
| Rate for Payer: Meridian Medicaid |
$58,835.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$56,034.07
|
| Rate for Payer: UHC Medicaid |
$56,034.07
|
| Rate for Payer: UHCCP Medicaid |
$56,034.07
|
|
|
GENETIC DISORDERS
|
Facility
|
IP
|
$26,356.46
|
|
|
Service Code
|
APR-DRG 4284
|
| Min. Negotiated Rate |
$25,101.39 |
| Max. Negotiated Rate |
$26,356.46 |
| Rate for Payer: BCBS Complete |
$26,356.46
|
| Rate for Payer: Mclaren Medicaid |
$25,101.39
|
| Rate for Payer: Meridian Medicaid |
$26,356.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,101.39
|
| Rate for Payer: UHC Medicaid |
$25,101.39
|
| Rate for Payer: UHCCP Medicaid |
$25,101.39
|
|
|
GENETIC DISORDERS
|
Facility
|
IP
|
$15,540.51
|
|
|
Service Code
|
APR-DRG 4283
|
| Min. Negotiated Rate |
$14,800.48 |
| Max. Negotiated Rate |
$15,540.51 |
| Rate for Payer: BCBS Complete |
$15,540.51
|
| Rate for Payer: Mclaren Medicaid |
$14,800.48
|
| Rate for Payer: Meridian Medicaid |
$15,540.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,800.48
|
| Rate for Payer: UHC Medicaid |
$14,800.48
|
| Rate for Payer: UHCCP Medicaid |
$14,800.48
|
|
|
GENETIC DISORDERS
|
Facility
|
IP
|
$7,134.36
|
|
|
Service Code
|
APR-DRG 4282
|
| Min. Negotiated Rate |
$6,794.63 |
| Max. Negotiated Rate |
$7,134.36 |
| Rate for Payer: BCBS Complete |
$7,134.36
|
| Rate for Payer: Mclaren Medicaid |
$6,794.63
|
| Rate for Payer: Meridian Medicaid |
$7,134.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,794.63
|
| Rate for Payer: UHC Medicaid |
$6,794.63
|
| Rate for Payer: UHCCP Medicaid |
$6,794.63
|
|
|
GENETIC DISORDERS
|
Facility
|
IP
|
$3,801.44
|
|
|
Service Code
|
APR-DRG 4281
|
| Min. Negotiated Rate |
$3,620.42 |
| Max. Negotiated Rate |
$3,801.44 |
| Rate for Payer: BCBS Complete |
$3,801.44
|
| Rate for Payer: Mclaren Medicaid |
$3,620.42
|
| Rate for Payer: Meridian Medicaid |
$3,801.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,620.42
|
| Rate for Payer: UHC Medicaid |
$3,620.42
|
| Rate for Payer: UHCCP Medicaid |
$3,620.42
|
|
|
GENTAMICIN 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$128.58
|
|
|
Service Code
|
NDC 45802005635
|
| Hospital Charge Code |
3423
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.57 |
| Max. Negotiated Rate |
$115.72 |
| Rate for Payer: Aetna American Axle |
$83.58
|
| Rate for Payer: Aetna Commercial |
$109.29
|
| Rate for Payer: Aetna Medicare |
$64.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.58
|
| Rate for Payer: BCBS Complete |
$51.43
|
| Rate for Payer: Cash Price |
$102.86
|
| Rate for Payer: Cofinity Advantage |
$90.01
|
| Rate for Payer: Cofinity Commercial |
$110.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.86
|
| Rate for Payer: Healthscope Commercial |
$115.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.44
|
| Rate for Payer: PHP Commercial |
$109.29
|
| Rate for Payer: Priority Health SBD |
$81.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.58
|
| Rate for Payer: UHC Core |
$66.99
|
| Rate for Payer: UHC Exchange |
$50.53
|
| Rate for Payer: UMR Bronson Commercial |
$47.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.44
|
|
|
GENTAMICIN 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$41.48
|
|
|
Service Code
|
NDC 00713068315
|
| Hospital Charge Code |
3423
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna Commercial |
$35.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Advantage |
$29.04
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$37.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.11
|
| Rate for Payer: PHP Commercial |
$35.26
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: UMR Bronson Commercial |
$18.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.11
|
|
|
GENTAMICIN 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$41.48
|
|
|
Service Code
|
NDC 00713068315
|
| Hospital Charge Code |
3423
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna Commercial |
$35.26
|
| Rate for Payer: Aetna Medicare |
$20.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: BCBS Complete |
$16.59
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Advantage |
$29.04
|
| Rate for Payer: Cofinity Commercial |
$35.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$37.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.11
|
| Rate for Payer: PHP Commercial |
$35.26
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.96
|
| Rate for Payer: UHC Core |
$21.61
|
| Rate for Payer: UHC Exchange |
$16.30
|
| Rate for Payer: UMR Bronson Commercial |
$15.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.11
|
|
|
GENTAMICIN 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$128.58
|
|
|
Service Code
|
NDC 45802005635
|
| Hospital Charge Code |
3423
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.58 |
| Max. Negotiated Rate |
$115.72 |
| Rate for Payer: Aetna American Axle |
$83.58
|
| Rate for Payer: Aetna Commercial |
$109.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.58
|
| Rate for Payer: Cash Price |
$102.86
|
| Rate for Payer: Cofinity Advantage |
$90.01
|
| Rate for Payer: Cofinity Commercial |
$110.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.86
|
| Rate for Payer: Healthscope Commercial |
$115.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.44
|
| Rate for Payer: PHP Commercial |
$109.29
|
| Rate for Payer: Priority Health SBD |
$81.01
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.44
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$17.82
|
|
|
Service Code
|
NDC 61314063305
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna American Axle |
$11.58
|
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: Aetna Medicare |
$8.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.58
|
| Rate for Payer: BCBS Complete |
$7.13
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Advantage |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$16.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: PHP Commercial |
$15.15
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.58
|
| Rate for Payer: UHC Core |
$9.28
|
| Rate for Payer: UHC Exchange |
$7.00
|
| Rate for Payer: UMR Bronson Commercial |
$6.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.37
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$116.24
|
|
|
Service Code
|
NDC 24208058060
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna American Axle |
$75.56
|
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Medicare |
$58.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.56
|
| Rate for Payer: BCBS Complete |
$46.50
|
| Rate for Payer: Cash Price |
$92.99
|
| Rate for Payer: Cofinity Advantage |
$81.37
|
| Rate for Payer: Cofinity Commercial |
$99.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.99
|
| Rate for Payer: Healthscope Commercial |
$104.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.18
|
| Rate for Payer: PHP Commercial |
$98.80
|
| Rate for Payer: Priority Health SBD |
$73.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.56
|
| Rate for Payer: UHC Core |
$60.56
|
| Rate for Payer: UHC Exchange |
$45.68
|
| Rate for Payer: UMR Bronson Commercial |
$43.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.18
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$18.23
|
|
|
Service Code
|
NDC 60758018805
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna American Axle |
$11.85
|
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.85
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Advantage |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.67
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.67
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$17.82
|
|
|
Service Code
|
NDC 61314063305
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna American Axle |
$11.58
|
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.58
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Advantage |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Healthscope Commercial |
$16.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: PHP Commercial |
$15.15
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.37
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$18.23
|
|
|
Service Code
|
NDC 60758018805
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna American Axle |
$11.85
|
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Medicare |
$9.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.85
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Advantage |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.67
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.85
|
| Rate for Payer: UHC Core |
$9.50
|
| Rate for Payer: UHC Exchange |
$7.16
|
| Rate for Payer: UMR Bronson Commercial |
$6.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.67
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$116.24
|
|
|
Service Code
|
NDC 24208058060
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna American Axle |
$75.56
|
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.56
|
| Rate for Payer: Cash Price |
$92.99
|
| Rate for Payer: Cofinity Advantage |
$81.37
|
| Rate for Payer: Cofinity Commercial |
$99.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.99
|
| Rate for Payer: Healthscope Commercial |
$104.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.18
|
| Rate for Payer: PHP Commercial |
$98.80
|
| Rate for Payer: Priority Health SBD |
$73.23
|
| Rate for Payer: UMR Bronson Commercial |
$51.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.18
|
|
|
GENTAMICIN 100 MG/50 ML IN NS PREMIX (BMH OSC)
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
169406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna American Axle |
$47.72
|
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.72
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.06
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: Priority Health SBD |
$46.25
|
| Rate for Payer: UMR Bronson Commercial |
$32.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.06
|
|
|
GENTAMICIN 100 MG/50 ML IN NS PREMIX (BMH OSC)
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
169406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna American Axle |
$47.72
|
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: Aetna Medicare |
$36.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.72
|
| Rate for Payer: BCBS Complete |
$29.37
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.06
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: Priority Health SBD |
$46.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.58
|
| Rate for Payer: UHC Core |
$3.58
|
| Rate for Payer: UHC Exchange |
$3.58
|
| Rate for Payer: UMR Bronson Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.06
|
|
|
GENTAMICIN 100 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
15912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna American Axle |
$47.72
|
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.72
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.06
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: Priority Health SBD |
$46.25
|
| Rate for Payer: UMR Bronson Commercial |
$32.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.06
|
|
|
GENTAMICIN 100 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
15912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna American Axle |
$47.72
|
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: Aetna Medicare |
$36.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.72
|
| Rate for Payer: BCBS Complete |
$29.37
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Advantage |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.06
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: Priority Health SBD |
$46.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.58
|
| Rate for Payer: UHC Core |
$3.58
|
| Rate for Payer: UHC Exchange |
$3.58
|
| Rate for Payer: UMR Bronson Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.06
|
|
|
GENTAMICIN 120 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$80.41
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
114156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.38 |
| Max. Negotiated Rate |
$72.37 |
| Rate for Payer: Aetna American Axle |
$52.27
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Advantage |
$56.29
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.31
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: UMR Bronson Commercial |
$35.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
|
GENTAMICIN 120 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$80.41
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
114156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$72.37 |
| Rate for Payer: Aetna American Axle |
$52.27
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna Medicare |
$40.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
| Rate for Payer: BCBS Complete |
$32.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.00
|
| Rate for Payer: BCN Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Advantage |
$56.29
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.31
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.58
|
| Rate for Payer: UHC Core |
$3.58
|
| Rate for Payer: UHC Exchange |
$3.58
|
| Rate for Payer: UMR Bronson Commercial |
$29.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
