|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$256.50
|
|
|
Service Code
|
NDC 00591084401
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.91 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna American Axle |
$166.72
|
| Rate for Payer: Aetna Commercial |
$218.03
|
| Rate for Payer: Aetna Medicare |
$128.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.72
|
| Rate for Payer: BCBS Complete |
$102.60
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cofinity Advantage |
$179.55
|
| Rate for Payer: Cofinity Commercial |
$220.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.20
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.38
|
| Rate for Payer: PHP Commercial |
$218.03
|
| Rate for Payer: Priority Health SBD |
$161.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.72
|
| Rate for Payer: UHC Core |
$133.64
|
| Rate for Payer: UHC Exchange |
$100.80
|
| Rate for Payer: UMR Bronson Commercial |
$94.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.38
|
|
|
GLIPIZIDE ER 5 MG TABLET, EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$366.60
|
|
|
Service Code
|
NDC 59762054101
|
| Hospital Charge Code |
37649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.30 |
| Max. Negotiated Rate |
$329.94 |
| Rate for Payer: Aetna American Axle |
$238.29
|
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.29
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Advantage |
$256.62
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Healthscope Commercial |
$329.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.95
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: Priority Health SBD |
$230.96
|
| Rate for Payer: UMR Bronson Commercial |
$161.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.95
|
|
|
GLOFITAMAB-GXBM 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$49,407.70
|
|
|
Service Code
|
HCPCS J9286
|
| Hospital Charge Code |
204373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,485.68 |
| Max. Negotiated Rate |
$44,466.93 |
| Rate for Payer: Aetna American Axle |
$32,115.01
|
| Rate for Payer: Aetna American Axle |
$8,028.71
|
| Rate for Payer: Aetna Commercial |
$10,499.08
|
| Rate for Payer: Aetna Commercial |
$41,996.54
|
| Rate for Payer: Aetna Medicare |
$2,954.31
|
| Rate for Payer: Aetna Medicare |
$2,954.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,028.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,115.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,550.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,550.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,550.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,550.85
|
| Rate for Payer: BCBS Complete |
$1,560.10
|
| Rate for Payer: BCBS Complete |
$1,560.10
|
| Rate for Payer: BCBS MAPPO |
$2,840.68
|
| Rate for Payer: BCBS MAPPO |
$2,840.68
|
| Rate for Payer: BCBS Trust/PPO |
$9,220.76
|
| Rate for Payer: BCBS Trust/PPO |
$9,220.76
|
| Rate for Payer: BCN Commercial |
$9,220.76
|
| Rate for Payer: BCN Commercial |
$9,220.76
|
| Rate for Payer: BCN Medicare Advantage |
$2,840.68
|
| Rate for Payer: BCN Medicare Advantage |
$2,840.68
|
| Rate for Payer: Cash Price |
$9,881.49
|
| Rate for Payer: Cash Price |
$39,526.16
|
| Rate for Payer: Cash Price |
$39,526.16
|
| Rate for Payer: Cash Price |
$9,881.49
|
| Rate for Payer: Cofinity Advantage |
$34,585.39
|
| Rate for Payer: Cofinity Advantage |
$8,646.30
|
| Rate for Payer: Cofinity Commercial |
$10,622.60
|
| Rate for Payer: Cofinity Commercial |
$42,490.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,881.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,526.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,840.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,840.68
|
| Rate for Payer: Healthscope Commercial |
$11,116.67
|
| Rate for Payer: Healthscope Commercial |
$44,466.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34,585.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,646.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,263.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,055.78
|
| Rate for Payer: Mclaren Medicaid |
$2,840.68
|
| Rate for Payer: Mclaren Medicaid |
$2,840.68
|
| Rate for Payer: Mclaren Medicare |
$2,840.68
|
| Rate for Payer: Mclaren Medicare |
$2,840.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,982.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,982.71
|
| Rate for Payer: Meridian Medicaid |
$2,982.71
|
| Rate for Payer: Meridian Medicaid |
$2,982.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,266.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,266.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,124.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,124.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,499.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,996.54
|
| Rate for Payer: Nomi Health Commercial |
$8,522.04
|
| Rate for Payer: Nomi Health Commercial |
$8,522.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,055.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,263.90
|
| Rate for Payer: PACE Medicare |
$2,698.65
|
| Rate for Payer: PACE Medicare |
$2,698.65
|
| Rate for Payer: PACE SWMI |
$2,840.68
|
| Rate for Payer: PACE SWMI |
$2,840.68
|
| Rate for Payer: PHP Commercial |
$10,499.08
|
| Rate for Payer: PHP Commercial |
$41,996.54
|
| Rate for Payer: PHP Medicare Advantage |
$2,840.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,840.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,485.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,485.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,729.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,729.81
|
| Rate for Payer: Priority Health Medicare |
$2,840.68
|
| Rate for Payer: Priority Health Medicare |
$2,840.68
|
| Rate for Payer: Priority Health SBD |
$7,781.67
|
| Rate for Payer: Priority Health SBD |
$31,126.85
|
| Rate for Payer: Priority Health Tiered Network |
$6,983.85
|
| Rate for Payer: Priority Health Tiered Network |
$6,983.85
|
| Rate for Payer: Railroad Medicare Medicare |
$2,840.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2,840.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,691.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,691.92
|
| Rate for Payer: UHC Core |
$4,691.92
|
| Rate for Payer: UHC Core |
$4,691.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,840.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,840.68
|
| Rate for Payer: UHC Exchange |
$4,691.92
|
| Rate for Payer: UHC Exchange |
$4,691.92
|
| Rate for Payer: UHC Medicaid |
$1,485.68
|
| Rate for Payer: UHC Medicaid |
$1,485.68
|
| Rate for Payer: UHCCP Medicaid |
$1,485.68
|
| Rate for Payer: UHCCP Medicaid |
$1,485.68
|
| Rate for Payer: UMR Bronson Commercial |
$4,570.19
|
| Rate for Payer: UMR Bronson Commercial |
$18,280.85
|
| Rate for Payer: VA VA |
$2,840.68
|
| Rate for Payer: VA VA |
$2,840.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,055.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,263.90
|
|
|
GLOFITAMAB-GXBM 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,351.86
|
|
|
Service Code
|
HCPCS J9286
|
| Hospital Charge Code |
204373
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,434.82 |
| Max. Negotiated Rate |
$11,116.67 |
| Rate for Payer: Aetna American Axle |
$8,028.71
|
| Rate for Payer: Aetna American Axle |
$32,115.01
|
| Rate for Payer: Aetna Commercial |
$10,499.08
|
| Rate for Payer: Aetna Commercial |
$41,996.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,028.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32,115.01
|
| Rate for Payer: Cash Price |
$9,881.49
|
| Rate for Payer: Cash Price |
$39,526.16
|
| Rate for Payer: Cofinity Advantage |
$34,585.39
|
| Rate for Payer: Cofinity Advantage |
$8,646.30
|
| Rate for Payer: Cofinity Commercial |
$42,490.62
|
| Rate for Payer: Cofinity Commercial |
$10,622.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,881.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39,526.16
|
| Rate for Payer: Healthscope Commercial |
$11,116.67
|
| Rate for Payer: Healthscope Commercial |
$44,466.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34,585.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,646.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,263.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37,055.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,499.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41,996.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,263.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37,055.78
|
| Rate for Payer: PHP Commercial |
$10,499.08
|
| Rate for Payer: PHP Commercial |
$41,996.54
|
| Rate for Payer: Priority Health SBD |
$31,126.85
|
| Rate for Payer: Priority Health SBD |
$7,781.67
|
| Rate for Payer: UMR Bronson Commercial |
$5,434.82
|
| Rate for Payer: UMR Bronson Commercial |
$21,739.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,263.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37,055.78
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$924.42
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
109673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$831.98 |
| Rate for Payer: Aetna American Axle |
$600.87
|
| Rate for Payer: Aetna American Axle |
$664.15
|
| Rate for Payer: Aetna Commercial |
$868.50
|
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna Medicare |
$152.18
|
| Rate for Payer: Aetna Medicare |
$152.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$664.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.91
|
| Rate for Payer: BCBS Complete |
$80.36
|
| Rate for Payer: BCBS Complete |
$80.36
|
| Rate for Payer: BCBS MAPPO |
$146.33
|
| Rate for Payer: BCBS MAPPO |
$146.33
|
| Rate for Payer: BCBS Trust/PPO |
$534.58
|
| Rate for Payer: BCBS Trust/PPO |
$534.58
|
| Rate for Payer: BCN Commercial |
$534.58
|
| Rate for Payer: BCN Commercial |
$534.58
|
| Rate for Payer: BCN Medicare Advantage |
$146.33
|
| Rate for Payer: BCN Medicare Advantage |
$146.33
|
| Rate for Payer: Cash Price |
$817.42
|
| Rate for Payer: Cash Price |
$739.54
|
| Rate for Payer: Cash Price |
$739.54
|
| Rate for Payer: Cash Price |
$817.42
|
| Rate for Payer: Cofinity Advantage |
$647.09
|
| Rate for Payer: Cofinity Advantage |
$715.24
|
| Rate for Payer: Cofinity Commercial |
$878.72
|
| Rate for Payer: Cofinity Commercial |
$795.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.33
|
| Rate for Payer: Healthscope Commercial |
$919.59
|
| Rate for Payer: Healthscope Commercial |
$831.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$647.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$715.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$766.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.32
|
| Rate for Payer: Mclaren Medicaid |
$146.33
|
| Rate for Payer: Mclaren Medicaid |
$146.33
|
| Rate for Payer: Mclaren Medicare |
$146.33
|
| Rate for Payer: Mclaren Medicare |
$146.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.65
|
| Rate for Payer: Meridian Medicaid |
$153.65
|
| Rate for Payer: Meridian Medicaid |
$153.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.76
|
| Rate for Payer: Nomi Health Commercial |
$438.99
|
| Rate for Payer: Nomi Health Commercial |
$438.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$766.33
|
| Rate for Payer: PACE Medicare |
$139.01
|
| Rate for Payer: PACE Medicare |
$139.01
|
| Rate for Payer: PACE SWMI |
$146.33
|
| Rate for Payer: PACE SWMI |
$146.33
|
| Rate for Payer: PHP Commercial |
$868.50
|
| Rate for Payer: PHP Commercial |
$785.76
|
| Rate for Payer: PHP Medicare Advantage |
$146.33
|
| Rate for Payer: PHP Medicare Advantage |
$146.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$575.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$575.43
|
| Rate for Payer: Priority Health Medicare |
$146.33
|
| Rate for Payer: Priority Health Medicare |
$146.33
|
| Rate for Payer: Priority Health SBD |
$643.72
|
| Rate for Payer: Priority Health SBD |
$582.38
|
| Rate for Payer: Priority Health Tiered Network |
$460.34
|
| Rate for Payer: Priority Health Tiered Network |
$460.34
|
| Rate for Payer: Railroad Medicare Medicare |
$146.33
|
| Rate for Payer: Railroad Medicare Medicare |
$146.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.02
|
| Rate for Payer: UHC Core |
$272.02
|
| Rate for Payer: UHC Core |
$272.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$146.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$146.33
|
| Rate for Payer: UHC Exchange |
$272.02
|
| Rate for Payer: UHC Exchange |
$272.02
|
| Rate for Payer: UHC Medicaid |
$76.53
|
| Rate for Payer: UHC Medicaid |
$76.53
|
| Rate for Payer: UHCCP Medicaid |
$76.53
|
| Rate for Payer: UHCCP Medicaid |
$76.53
|
| Rate for Payer: UMR Bronson Commercial |
$378.05
|
| Rate for Payer: UMR Bronson Commercial |
$342.04
|
| Rate for Payer: VA VA |
$146.33
|
| Rate for Payer: VA VA |
$146.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$766.33
|
|
|
GLUCAGON 1 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,021.77
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
109673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$449.58 |
| Max. Negotiated Rate |
$919.59 |
| Rate for Payer: Aetna American Axle |
$664.15
|
| Rate for Payer: Aetna American Axle |
$600.87
|
| Rate for Payer: Aetna Commercial |
$868.50
|
| Rate for Payer: Aetna Commercial |
$785.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$664.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.87
|
| Rate for Payer: Cash Price |
$817.42
|
| Rate for Payer: Cash Price |
$739.54
|
| Rate for Payer: Cofinity Advantage |
$647.09
|
| Rate for Payer: Cofinity Advantage |
$715.24
|
| Rate for Payer: Cofinity Commercial |
$795.00
|
| Rate for Payer: Cofinity Commercial |
$878.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.54
|
| Rate for Payer: Healthscope Commercial |
$919.59
|
| Rate for Payer: Healthscope Commercial |
$831.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$647.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$715.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$766.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$766.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.32
|
| Rate for Payer: PHP Commercial |
$868.50
|
| Rate for Payer: PHP Commercial |
$785.76
|
| Rate for Payer: Priority Health SBD |
$582.38
|
| Rate for Payer: Priority Health SBD |
$643.72
|
| Rate for Payer: UMR Bronson Commercial |
$449.58
|
| Rate for Payer: UMR Bronson Commercial |
$406.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$766.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.32
|
|
|
GLUCAGON 3 MG/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$1,016.51
|
|
|
Service Code
|
NDC 00548835101
|
| Hospital Charge Code |
190849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.11 |
| Max. Negotiated Rate |
$914.86 |
| Rate for Payer: Aetna American Axle |
$660.73
|
| Rate for Payer: Aetna Commercial |
$864.03
|
| Rate for Payer: Aetna Medicare |
$508.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.73
|
| Rate for Payer: BCBS Complete |
$406.60
|
| Rate for Payer: Cash Price |
$813.21
|
| Rate for Payer: Cofinity Advantage |
$711.56
|
| Rate for Payer: Cofinity Commercial |
$874.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.21
|
| Rate for Payer: Healthscope Commercial |
$914.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$813.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.38
|
| Rate for Payer: PHP Commercial |
$864.03
|
| Rate for Payer: Priority Health SBD |
$640.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.73
|
| Rate for Payer: UHC Core |
$529.60
|
| Rate for Payer: UHC Exchange |
$399.49
|
| Rate for Payer: UMR Bronson Commercial |
$376.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.38
|
|
|
GLUCAGON 3 MG/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$1,016.51
|
|
|
Service Code
|
NDC 00548835112
|
| Hospital Charge Code |
190849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$447.26 |
| Max. Negotiated Rate |
$914.86 |
| Rate for Payer: Aetna American Axle |
$660.73
|
| Rate for Payer: Aetna Commercial |
$864.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.73
|
| Rate for Payer: Cash Price |
$813.21
|
| Rate for Payer: Cofinity Advantage |
$711.56
|
| Rate for Payer: Cofinity Commercial |
$874.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.21
|
| Rate for Payer: Healthscope Commercial |
$914.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.38
|
| Rate for Payer: PHP Commercial |
$864.03
|
| Rate for Payer: Priority Health SBD |
$640.40
|
| Rate for Payer: UMR Bronson Commercial |
$447.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.38
|
|
|
GLUCAGON 3 MG/ACTUATION NASAL SPRAY
|
Facility
|
IP
|
$1,016.51
|
|
|
Service Code
|
NDC 00548835101
|
| Hospital Charge Code |
190849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$447.26 |
| Max. Negotiated Rate |
$914.86 |
| Rate for Payer: Aetna American Axle |
$660.73
|
| Rate for Payer: Aetna Commercial |
$864.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.73
|
| Rate for Payer: Cash Price |
$813.21
|
| Rate for Payer: Cofinity Advantage |
$711.56
|
| Rate for Payer: Cofinity Commercial |
$874.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.21
|
| Rate for Payer: Healthscope Commercial |
$914.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.38
|
| Rate for Payer: PHP Commercial |
$864.03
|
| Rate for Payer: Priority Health SBD |
$640.40
|
| Rate for Payer: UMR Bronson Commercial |
$447.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.38
|
|
|
GLUCAGON 3 MG/ACTUATION NASAL SPRAY
|
Facility
|
OP
|
$1,016.51
|
|
|
Service Code
|
NDC 00548835112
|
| Hospital Charge Code |
190849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.11 |
| Max. Negotiated Rate |
$914.86 |
| Rate for Payer: Aetna American Axle |
$660.73
|
| Rate for Payer: Aetna Commercial |
$864.03
|
| Rate for Payer: Aetna Medicare |
$508.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.73
|
| Rate for Payer: BCBS Complete |
$406.60
|
| Rate for Payer: Cash Price |
$813.21
|
| Rate for Payer: Cofinity Advantage |
$711.56
|
| Rate for Payer: Cofinity Commercial |
$874.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.21
|
| Rate for Payer: Healthscope Commercial |
$914.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$813.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.38
|
| Rate for Payer: PHP Commercial |
$864.03
|
| Rate for Payer: Priority Health SBD |
$640.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.73
|
| Rate for Payer: UHC Core |
$529.60
|
| Rate for Payer: UHC Exchange |
$399.49
|
| Rate for Payer: UMR Bronson Commercial |
$376.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.38
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$426.98
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
168350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.87 |
| Max. Negotiated Rate |
$384.28 |
| Rate for Payer: Aetna American Axle |
$277.54
|
| Rate for Payer: Aetna American Axle |
$277.55
|
| Rate for Payer: Aetna Commercial |
$362.93
|
| Rate for Payer: Aetna Commercial |
$362.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.55
|
| Rate for Payer: Cash Price |
$341.58
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cofinity Advantage |
$298.90
|
| Rate for Payer: Cofinity Advantage |
$298.89
|
| Rate for Payer: Cofinity Commercial |
$367.22
|
| Rate for Payer: Cofinity Commercial |
$367.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.60
|
| Rate for Payer: Healthscope Commercial |
$384.28
|
| Rate for Payer: Healthscope Commercial |
$384.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.25
|
| Rate for Payer: PHP Commercial |
$362.93
|
| Rate for Payer: PHP Commercial |
$362.95
|
| Rate for Payer: Priority Health SBD |
$269.01
|
| Rate for Payer: Priority Health SBD |
$269.00
|
| Rate for Payer: UMR Bronson Commercial |
$187.87
|
| Rate for Payer: UMR Bronson Commercial |
$187.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.25
|
|
|
GLUCAGON HCL 1 MG/ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
168350
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.61 |
| Max. Negotiated Rate |
$469.90 |
| Rate for Payer: Aetna American Axle |
$277.55
|
| Rate for Payer: Aetna American Axle |
$277.54
|
| Rate for Payer: Aetna Commercial |
$362.93
|
| Rate for Payer: Aetna Commercial |
$362.95
|
| Rate for Payer: Aetna Medicare |
$140.40
|
| Rate for Payer: Aetna Medicare |
$140.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.75
|
| Rate for Payer: BCBS Complete |
$74.14
|
| Rate for Payer: BCBS Complete |
$74.14
|
| Rate for Payer: BCBS MAPPO |
$135.00
|
| Rate for Payer: BCBS MAPPO |
$135.00
|
| Rate for Payer: BCBS Trust/PPO |
$464.50
|
| Rate for Payer: BCBS Trust/PPO |
$464.50
|
| Rate for Payer: BCN Commercial |
$464.50
|
| Rate for Payer: BCN Commercial |
$464.50
|
| Rate for Payer: BCN Medicare Advantage |
$135.00
|
| Rate for Payer: BCN Medicare Advantage |
$135.00
|
| Rate for Payer: Cash Price |
$341.58
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.58
|
| Rate for Payer: Cofinity Advantage |
$298.90
|
| Rate for Payer: Cofinity Advantage |
$298.89
|
| Rate for Payer: Cofinity Commercial |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$367.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.00
|
| Rate for Payer: Healthscope Commercial |
$384.28
|
| Rate for Payer: Healthscope Commercial |
$384.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.25
|
| Rate for Payer: Mclaren Medicaid |
$135.00
|
| Rate for Payer: Mclaren Medicaid |
$135.00
|
| Rate for Payer: Mclaren Medicare |
$135.00
|
| Rate for Payer: Mclaren Medicare |
$135.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.75
|
| Rate for Payer: Meridian Medicaid |
$141.75
|
| Rate for Payer: Meridian Medicaid |
$141.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$148.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.95
|
| Rate for Payer: Nomi Health Commercial |
$405.00
|
| Rate for Payer: Nomi Health Commercial |
$405.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.24
|
| Rate for Payer: PACE Medicare |
$128.25
|
| Rate for Payer: PACE Medicare |
$128.25
|
| Rate for Payer: PACE SWMI |
$135.00
|
| Rate for Payer: PACE SWMI |
$135.00
|
| Rate for Payer: PHP Commercial |
$362.93
|
| Rate for Payer: PHP Commercial |
$362.95
|
| Rate for Payer: PHP Medicare Advantage |
$135.00
|
| Rate for Payer: PHP Medicare Advantage |
$135.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$469.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$469.90
|
| Rate for Payer: Priority Health Medicare |
$135.00
|
| Rate for Payer: Priority Health Medicare |
$135.00
|
| Rate for Payer: Priority Health SBD |
$269.00
|
| Rate for Payer: Priority Health SBD |
$269.01
|
| Rate for Payer: Priority Health Tiered Network |
$375.92
|
| Rate for Payer: Priority Health Tiered Network |
$375.92
|
| Rate for Payer: Railroad Medicare Medicare |
$135.00
|
| Rate for Payer: Railroad Medicare Medicare |
$135.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.36
|
| Rate for Payer: UHC Core |
$236.36
|
| Rate for Payer: UHC Core |
$236.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.00
|
| Rate for Payer: UHC Exchange |
$236.36
|
| Rate for Payer: UHC Exchange |
$236.36
|
| Rate for Payer: UHC Medicaid |
$70.61
|
| Rate for Payer: UHC Medicaid |
$70.61
|
| Rate for Payer: UHCCP Medicaid |
$70.61
|
| Rate for Payer: UHCCP Medicaid |
$70.61
|
| Rate for Payer: UMR Bronson Commercial |
$157.98
|
| Rate for Payer: UMR Bronson Commercial |
$157.99
|
| Rate for Payer: VA VA |
$135.00
|
| Rate for Payer: VA VA |
$135.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.24
|
|
|
GLUCAGON HCL 1 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$744.16
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
192635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$327.43 |
| Max. Negotiated Rate |
$669.74 |
| Rate for Payer: Aetna American Axle |
$483.70
|
| Rate for Payer: Aetna Commercial |
$632.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.70
|
| Rate for Payer: Cash Price |
$595.33
|
| Rate for Payer: Cofinity Advantage |
$520.91
|
| Rate for Payer: Cofinity Commercial |
$639.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.33
|
| Rate for Payer: Healthscope Commercial |
$669.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$558.12
|
| Rate for Payer: PHP Commercial |
$632.54
|
| Rate for Payer: Priority Health SBD |
$468.82
|
| Rate for Payer: UMR Bronson Commercial |
$327.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.12
|
|
|
GLUCAGON HCL 1 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$744.16
|
|
|
Service Code
|
HCPCS J1611
|
| Hospital Charge Code |
192635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.61 |
| Max. Negotiated Rate |
$669.74 |
| Rate for Payer: Aetna American Axle |
$483.70
|
| Rate for Payer: Aetna Commercial |
$632.54
|
| Rate for Payer: Aetna Medicare |
$140.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.75
|
| Rate for Payer: BCBS Complete |
$74.14
|
| Rate for Payer: BCBS MAPPO |
$135.00
|
| Rate for Payer: BCBS Trust/PPO |
$464.50
|
| Rate for Payer: BCN Commercial |
$464.50
|
| Rate for Payer: BCN Medicare Advantage |
$135.00
|
| Rate for Payer: Cash Price |
$595.33
|
| Rate for Payer: Cash Price |
$595.33
|
| Rate for Payer: Cofinity Advantage |
$520.91
|
| Rate for Payer: Cofinity Commercial |
$639.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.00
|
| Rate for Payer: Healthscope Commercial |
$669.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.12
|
| Rate for Payer: Mclaren Medicaid |
$135.00
|
| Rate for Payer: Mclaren Medicare |
$135.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.75
|
| Rate for Payer: Meridian Medicaid |
$141.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.54
|
| Rate for Payer: Nomi Health Commercial |
$405.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$558.12
|
| Rate for Payer: PACE Medicare |
$128.25
|
| Rate for Payer: PACE SWMI |
$135.00
|
| Rate for Payer: PHP Commercial |
$632.54
|
| Rate for Payer: PHP Medicare Advantage |
$135.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$469.90
|
| Rate for Payer: Priority Health Medicare |
$135.00
|
| Rate for Payer: Priority Health SBD |
$468.82
|
| Rate for Payer: Priority Health Tiered Network |
$375.92
|
| Rate for Payer: Railroad Medicare Medicare |
$135.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.36
|
| Rate for Payer: UHC Core |
$236.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.00
|
| Rate for Payer: UHC Exchange |
$236.36
|
| Rate for Payer: UHC Medicaid |
$70.61
|
| Rate for Payer: UHCCP Medicaid |
$70.61
|
| Rate for Payer: UMR Bronson Commercial |
$275.34
|
| Rate for Payer: VA VA |
$135.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.12
|
|
|
GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION FOR INJECTION VIAL
|
Facility
|
OP
|
$569.77
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
119849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.53 |
| Max. Negotiated Rate |
$575.43 |
| Rate for Payer: Aetna American Axle |
$370.35
|
| Rate for Payer: Aetna American Axle |
$370.36
|
| Rate for Payer: Aetna Commercial |
$484.30
|
| Rate for Payer: Aetna Commercial |
$484.31
|
| Rate for Payer: Aetna Medicare |
$152.18
|
| Rate for Payer: Aetna Medicare |
$152.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.91
|
| Rate for Payer: BCBS Complete |
$80.36
|
| Rate for Payer: BCBS Complete |
$80.36
|
| Rate for Payer: BCBS MAPPO |
$146.33
|
| Rate for Payer: BCBS MAPPO |
$146.33
|
| Rate for Payer: BCBS Trust/PPO |
$534.58
|
| Rate for Payer: BCBS Trust/PPO |
$534.58
|
| Rate for Payer: BCN Commercial |
$534.58
|
| Rate for Payer: BCN Commercial |
$534.58
|
| Rate for Payer: BCN Medicare Advantage |
$146.33
|
| Rate for Payer: BCN Medicare Advantage |
$146.33
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cofinity Advantage |
$398.85
|
| Rate for Payer: Cofinity Advantage |
$398.84
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Cofinity Commercial |
$490.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.33
|
| Rate for Payer: Healthscope Commercial |
$512.79
|
| Rate for Payer: Healthscope Commercial |
$512.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.33
|
| Rate for Payer: Mclaren Medicaid |
$146.33
|
| Rate for Payer: Mclaren Medicaid |
$146.33
|
| Rate for Payer: Mclaren Medicare |
$146.33
|
| Rate for Payer: Mclaren Medicare |
$146.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.65
|
| Rate for Payer: Meridian Medicaid |
$153.65
|
| Rate for Payer: Meridian Medicaid |
$153.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.30
|
| Rate for Payer: Nomi Health Commercial |
$438.99
|
| Rate for Payer: Nomi Health Commercial |
$438.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$427.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$427.33
|
| Rate for Payer: PACE Medicare |
$139.01
|
| Rate for Payer: PACE Medicare |
$139.01
|
| Rate for Payer: PACE SWMI |
$146.33
|
| Rate for Payer: PACE SWMI |
$146.33
|
| Rate for Payer: PHP Commercial |
$484.30
|
| Rate for Payer: PHP Commercial |
$484.31
|
| Rate for Payer: PHP Medicare Advantage |
$146.33
|
| Rate for Payer: PHP Medicare Advantage |
$146.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$575.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$575.43
|
| Rate for Payer: Priority Health Medicare |
$146.33
|
| Rate for Payer: Priority Health Medicare |
$146.33
|
| Rate for Payer: Priority Health SBD |
$358.96
|
| Rate for Payer: Priority Health SBD |
$358.96
|
| Rate for Payer: Priority Health Tiered Network |
$460.34
|
| Rate for Payer: Priority Health Tiered Network |
$460.34
|
| Rate for Payer: Railroad Medicare Medicare |
$146.33
|
| Rate for Payer: Railroad Medicare Medicare |
$146.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.02
|
| Rate for Payer: UHC Core |
$272.02
|
| Rate for Payer: UHC Core |
$272.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$146.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$146.33
|
| Rate for Payer: UHC Exchange |
$272.02
|
| Rate for Payer: UHC Exchange |
$272.02
|
| Rate for Payer: UHC Medicaid |
$76.53
|
| Rate for Payer: UHC Medicaid |
$76.53
|
| Rate for Payer: UHCCP Medicaid |
$76.53
|
| Rate for Payer: UHCCP Medicaid |
$76.53
|
| Rate for Payer: UMR Bronson Commercial |
$210.81
|
| Rate for Payer: UMR Bronson Commercial |
$210.82
|
| Rate for Payer: VA VA |
$146.33
|
| Rate for Payer: VA VA |
$146.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.33
|
|
|
GLUCAGON (HUMAN RECOMBINANT) 1 MG/ML SOLUTION FOR INJECTION VIAL
|
Facility
|
IP
|
$569.78
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
119849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$250.70 |
| Max. Negotiated Rate |
$512.80 |
| Rate for Payer: Aetna American Axle |
$370.36
|
| Rate for Payer: Aetna Commercial |
$484.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.36
|
| Rate for Payer: Cash Price |
$455.82
|
| Rate for Payer: Cofinity Advantage |
$398.85
|
| Rate for Payer: Cofinity Commercial |
$490.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.82
|
| Rate for Payer: Healthscope Commercial |
$512.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$427.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$427.33
|
| Rate for Payer: PHP Commercial |
$484.31
|
| Rate for Payer: Priority Health SBD |
$358.96
|
| Rate for Payer: UMR Bronson Commercial |
$250.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$427.33
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$24.21
|
|
|
Service Code
|
NDC 38396050208
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$21.79 |
| Rate for Payer: Aetna American Axle |
$15.74
|
| Rate for Payer: Aetna Commercial |
$20.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.74
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Cofinity Advantage |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$20.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$21.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.16
|
| Rate for Payer: PHP Commercial |
$20.58
|
| Rate for Payer: Priority Health SBD |
$15.25
|
| Rate for Payer: UMR Bronson Commercial |
$10.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.16
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$3.13
|
|
|
Service Code
|
NDC 38396052363
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Advantage |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.66
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$3.13
|
|
|
Service Code
|
NDC 38396050763
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Advantage |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.66
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$42.54
|
|
|
Service Code
|
NDC 56151161011
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$38.29 |
| Rate for Payer: Aetna American Axle |
$27.65
|
| Rate for Payer: Aetna Commercial |
$36.16
|
| Rate for Payer: Aetna Medicare |
$21.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.65
|
| Rate for Payer: BCBS Complete |
$17.02
|
| Rate for Payer: Cash Price |
$34.03
|
| Rate for Payer: Cofinity Advantage |
$29.78
|
| Rate for Payer: Cofinity Commercial |
$36.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.03
|
| Rate for Payer: Healthscope Commercial |
$38.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.91
|
| Rate for Payer: PHP Commercial |
$36.16
|
| Rate for Payer: Priority Health SBD |
$26.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.65
|
| Rate for Payer: UHC Core |
$22.16
|
| Rate for Payer: UHC Exchange |
$16.72
|
| Rate for Payer: UMR Bronson Commercial |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.91
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$24.21
|
|
|
Service Code
|
NDC 38396050208
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$21.79 |
| Rate for Payer: Aetna American Axle |
$15.74
|
| Rate for Payer: Aetna Commercial |
$20.58
|
| Rate for Payer: Aetna Medicare |
$12.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.74
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: Cash Price |
$19.37
|
| Rate for Payer: Cofinity Advantage |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$20.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$21.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.16
|
| Rate for Payer: PHP Commercial |
$20.58
|
| Rate for Payer: Priority Health SBD |
$15.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.74
|
| Rate for Payer: UHC Core |
$12.61
|
| Rate for Payer: UHC Exchange |
$9.51
|
| Rate for Payer: UMR Bronson Commercial |
$8.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.16
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$42.54
|
|
|
Service Code
|
NDC 56151161011
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$38.29 |
| Rate for Payer: Aetna American Axle |
$27.65
|
| Rate for Payer: Aetna Commercial |
$36.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.65
|
| Rate for Payer: Cash Price |
$34.03
|
| Rate for Payer: Cofinity Advantage |
$29.78
|
| Rate for Payer: Cofinity Commercial |
$36.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.03
|
| Rate for Payer: Healthscope Commercial |
$38.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.91
|
| Rate for Payer: PHP Commercial |
$36.16
|
| Rate for Payer: Priority Health SBD |
$26.80
|
| Rate for Payer: UMR Bronson Commercial |
$18.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.91
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
IP
|
$23.97
|
|
|
Service Code
|
NDC 38396052163
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$21.57 |
| Rate for Payer: Aetna American Axle |
$15.58
|
| Rate for Payer: Aetna Commercial |
$20.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.58
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cofinity Advantage |
$16.78
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Healthscope Commercial |
$21.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.98
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: Priority Health SBD |
$15.10
|
| Rate for Payer: UMR Bronson Commercial |
$10.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$3.13
|
|
|
Service Code
|
NDC 38396050763
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.66
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Advantage |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.66
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.03
|
| Rate for Payer: UHC Core |
$1.63
|
| Rate for Payer: UHC Exchange |
$1.23
|
| Rate for Payer: UMR Bronson Commercial |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.35
|
|
|
GLUCOSE 4 GRAM CHEWABLE TABLET
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 21292000434
|
| Hospital Charge Code |
16050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna American Axle |
$1.62
|
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna Medicare |
$1.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.62
|
| Rate for Payer: BCBS Complete |
$1.00
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: Cofinity Advantage |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$2.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$2.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.88
|
| Rate for Payer: PHP Commercial |
$2.12
|
| Rate for Payer: Priority Health SBD |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.62
|
| Rate for Payer: UHC Core |
$1.30
|
| Rate for Payer: UHC Exchange |
$0.98
|
| Rate for Payer: UMR Bronson Commercial |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.88
|
|
