|
FENTANYL (PF) 4 MCG/ML SD (NICU)
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
165999
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.19
|
|
|
FENTANYL (PF) 4 MCG/ML SD (NICU)
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
165999
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna Medicare |
$0.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.19
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
OP
|
$40.91
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$36.82 |
| Rate for Payer: Aetna American Axle |
$26.59
|
| Rate for Payer: Aetna American Axle |
$190.07
|
| Rate for Payer: Aetna American Axle |
$16.07
|
| Rate for Payer: Aetna American Axle |
$13.64
|
| Rate for Payer: Aetna American Axle |
$18.52
|
| Rate for Payer: Aetna American Axle |
$9.26
|
| Rate for Payer: Aetna American Axle |
$45.02
|
| Rate for Payer: Aetna American Axle |
$27.38
|
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: Aetna Commercial |
$248.55
|
| Rate for Payer: Aetna Commercial |
$34.77
|
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna Commercial |
$58.87
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Medicare |
$12.36
|
| Rate for Payer: Aetna Medicare |
$7.12
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna Medicare |
$20.45
|
| Rate for Payer: Aetna Medicare |
$34.63
|
| Rate for Payer: Aetna Medicare |
$146.21
|
| Rate for Payer: Aetna Medicare |
$21.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.59
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS Complete |
$5.70
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: BCBS Complete |
$9.89
|
| Rate for Payer: BCBS Complete |
$116.96
|
| Rate for Payer: BCBS Complete |
$16.36
|
| Rate for Payer: BCBS Complete |
$16.85
|
| Rate for Payer: BCBS Complete |
$27.70
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$33.70
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$233.93
|
| Rate for Payer: Cash Price |
$32.73
|
| Rate for Payer: Cash Price |
$55.41
|
| Rate for Payer: Cofinity Commercial |
$204.69
|
| Rate for Payer: Cofinity Commercial |
$59.56
|
| Rate for Payer: Cofinity Commercial |
$48.48
|
| Rate for Payer: Cofinity Commercial |
$36.22
|
| Rate for Payer: Cofinity Commercial |
$29.48
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$12.26
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$35.18
|
| Rate for Payer: Cofinity Commercial |
$28.64
|
| Rate for Payer: Cofinity Commercial |
$17.30
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$9.97
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$251.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.73
|
| Rate for Payer: Healthscope Commercial |
$12.82
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$263.17
|
| Rate for Payer: Healthscope Commercial |
$36.82
|
| Rate for Payer: Healthscope Commercial |
$37.91
|
| Rate for Payer: Healthscope Commercial |
$62.33
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.80
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$248.55
|
| Rate for Payer: PHP Commercial |
$58.87
|
| Rate for Payer: PHP Commercial |
$34.77
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$35.80
|
| Rate for Payer: PHP Commercial |
$12.11
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.02
|
| Rate for Payer: Priority Health SBD |
$8.98
|
| Rate for Payer: Priority Health SBD |
$43.63
|
| Rate for Payer: Priority Health SBD |
$26.54
|
| Rate for Payer: Priority Health SBD |
$17.95
|
| Rate for Payer: Priority Health SBD |
$15.57
|
| Rate for Payer: Priority Health SBD |
$184.22
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$25.77
|
| Rate for Payer: UMR Bronson Commercial |
$15.14
|
| Rate for Payer: UMR Bronson Commercial |
$15.58
|
| Rate for Payer: UMR Bronson Commercial |
$7.76
|
| Rate for Payer: UMR Bronson Commercial |
$25.63
|
| Rate for Payer: UMR Bronson Commercial |
$108.19
|
| Rate for Payer: UMR Bronson Commercial |
$10.54
|
| Rate for Payer: UMR Bronson Commercial |
$9.15
|
| Rate for Payer: UMR Bronson Commercial |
$5.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.37
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
IP
|
$42.12
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$37.91 |
| Rate for Payer: Aetna American Axle |
$27.38
|
| Rate for Payer: Aetna American Axle |
$26.59
|
| Rate for Payer: Aetna American Axle |
$190.07
|
| Rate for Payer: Aetna American Axle |
$16.07
|
| Rate for Payer: Aetna American Axle |
$9.26
|
| Rate for Payer: Aetna American Axle |
$13.64
|
| Rate for Payer: Aetna American Axle |
$18.52
|
| Rate for Payer: Aetna American Axle |
$45.02
|
| Rate for Payer: Aetna Commercial |
$58.87
|
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna Commercial |
$34.77
|
| Rate for Payer: Aetna Commercial |
$248.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.07
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$33.70
|
| Rate for Payer: Cash Price |
$233.93
|
| Rate for Payer: Cash Price |
$55.41
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$32.73
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$12.26
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$17.30
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$9.97
|
| Rate for Payer: Cofinity Commercial |
$204.69
|
| Rate for Payer: Cofinity Commercial |
$251.47
|
| Rate for Payer: Cofinity Commercial |
$28.64
|
| Rate for Payer: Cofinity Commercial |
$35.18
|
| Rate for Payer: Cofinity Commercial |
$29.48
|
| Rate for Payer: Cofinity Commercial |
$36.22
|
| Rate for Payer: Cofinity Commercial |
$48.48
|
| Rate for Payer: Cofinity Commercial |
$59.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$204.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Healthscope Commercial |
$12.82
|
| Rate for Payer: Healthscope Commercial |
$62.33
|
| Rate for Payer: Healthscope Commercial |
$37.91
|
| Rate for Payer: Healthscope Commercial |
$263.17
|
| Rate for Payer: Healthscope Commercial |
$36.82
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$35.80
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$34.77
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$58.87
|
| Rate for Payer: PHP Commercial |
$12.11
|
| Rate for Payer: PHP Commercial |
$248.55
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.07
|
| Rate for Payer: Priority Health SBD |
$15.57
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$8.98
|
| Rate for Payer: Priority Health SBD |
$17.95
|
| Rate for Payer: Priority Health SBD |
$25.77
|
| Rate for Payer: Priority Health SBD |
$184.22
|
| Rate for Payer: Priority Health SBD |
$43.63
|
| Rate for Payer: Priority Health SBD |
$26.54
|
| Rate for Payer: UMR Bronson Commercial |
$10.88
|
| Rate for Payer: UMR Bronson Commercial |
$12.54
|
| Rate for Payer: UMR Bronson Commercial |
$18.00
|
| Rate for Payer: UMR Bronson Commercial |
$18.53
|
| Rate for Payer: UMR Bronson Commercial |
$9.23
|
| Rate for Payer: UMR Bronson Commercial |
$30.47
|
| Rate for Payer: UMR Bronson Commercial |
$128.66
|
| Rate for Payer: UMR Bronson Commercial |
$6.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.31
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$13.37
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Aetna American Axle |
$8.69
|
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna American Axle |
$9.35
|
| Rate for Payer: Aetna American Axle |
$11.41
|
| Rate for Payer: Aetna American Axle |
$12.15
|
| Rate for Payer: Aetna American Axle |
$12.51
|
| Rate for Payer: Aetna American Axle |
$12.65
|
| Rate for Payer: Aetna American Axle |
$13.64
|
| Rate for Payer: Aetna American Axle |
$18.52
|
| Rate for Payer: Aetna American Axle |
$20.92
|
| Rate for Payer: Aetna American Axle |
$23.46
|
| Rate for Payer: Aetna American Axle |
$25.22
|
| Rate for Payer: Aetna American Axle |
$28.93
|
| Rate for Payer: Aetna American Axle |
$47.45
|
| Rate for Payer: Aetna American Axle |
$51.02
|
| Rate for Payer: Aetna American Axle |
$6.40
|
| Rate for Payer: Aetna Commercial |
$66.72
|
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Commercial |
$37.83
|
| Rate for Payer: Aetna Commercial |
$30.68
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$16.54
|
| Rate for Payer: Aetna Commercial |
$27.36
|
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$32.98
|
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna Commercial |
$11.36
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: Aetna Medicare |
$22.25
|
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: Aetna Medicare |
$4.92
|
| Rate for Payer: Aetna Medicare |
$39.25
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna Medicare |
$16.09
|
| Rate for Payer: Aetna Medicare |
$18.05
|
| Rate for Payer: Aetna Medicare |
$9.62
|
| Rate for Payer: Aetna Medicare |
$19.40
|
| Rate for Payer: Aetna Medicare |
$9.35
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$9.73
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.65
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: BCBS Complete |
$5.76
|
| Rate for Payer: BCBS Complete |
$15.52
|
| Rate for Payer: BCBS Complete |
$3.94
|
| Rate for Payer: BCBS Complete |
$12.88
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS Complete |
$5.35
|
| Rate for Payer: BCBS Complete |
$6.31
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Complete |
$7.78
|
| Rate for Payer: BCBS Complete |
$31.40
|
| Rate for Payer: BCBS Complete |
$17.80
|
| Rate for Payer: BCBS Complete |
$14.44
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$31.04
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$15.57
|
| Rate for Payer: Cash Price |
$25.75
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$28.88
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$31.15
|
| Rate for Payer: Cofinity Commercial |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$6.89
|
| Rate for Payer: Cofinity Commercial |
$33.37
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Cofinity Commercial |
$16.07
|
| Rate for Payer: Cofinity Commercial |
$27.16
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$10.07
|
| Rate for Payer: Cofinity Commercial |
$9.36
|
| Rate for Payer: Cofinity Commercial |
$31.05
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Cofinity Commercial |
$13.62
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$22.53
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$54.95
|
| Rate for Payer: Cofinity Commercial |
$67.51
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Cofinity Commercial |
$51.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.57
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$17.51
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$28.97
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$12.03
|
| Rate for Payer: Healthscope Commercial |
$32.49
|
| Rate for Payer: Healthscope Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$34.92
|
| Rate for Payer: Healthscope Commercial |
$70.65
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$37.83
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: PHP Commercial |
$16.54
|
| Rate for Payer: PHP Commercial |
$66.72
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: PHP Commercial |
$30.68
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$11.36
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$27.36
|
| Rate for Payer: PHP Commercial |
$32.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.02
|
| Rate for Payer: Priority Health SBD |
$20.28
|
| Rate for Payer: Priority Health SBD |
$28.04
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: Priority Health SBD |
$45.99
|
| Rate for Payer: Priority Health SBD |
$9.07
|
| Rate for Payer: Priority Health SBD |
$8.42
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$12.26
|
| Rate for Payer: Priority Health SBD |
$24.44
|
| Rate for Payer: Priority Health SBD |
$22.74
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$49.45
|
| Rate for Payer: Priority Health SBD |
$11.77
|
| Rate for Payer: Priority Health SBD |
$6.21
|
| Rate for Payer: Priority Health SBD |
$12.12
|
| Rate for Payer: Priority Health SBD |
$17.95
|
| Rate for Payer: UMR Bronson Commercial |
$14.36
|
| Rate for Payer: UMR Bronson Commercial |
$29.05
|
| Rate for Payer: UMR Bronson Commercial |
$16.46
|
| Rate for Payer: UMR Bronson Commercial |
$13.36
|
| Rate for Payer: UMR Bronson Commercial |
$11.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.50
|
| Rate for Payer: UMR Bronson Commercial |
$7.20
|
| Rate for Payer: UMR Bronson Commercial |
$5.32
|
| Rate for Payer: UMR Bronson Commercial |
$27.01
|
| Rate for Payer: UMR Bronson Commercial |
$10.54
|
| Rate for Payer: UMR Bronson Commercial |
$3.64
|
| Rate for Payer: UMR Bronson Commercial |
$5.83
|
| Rate for Payer: UMR Bronson Commercial |
$4.95
|
| Rate for Payer: UMR Bronson Commercial |
$7.12
|
| Rate for Payer: UMR Bronson Commercial |
$7.76
|
| Rate for Payer: UMR Bronson Commercial |
$6.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.73
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.37
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Aetna American Axle |
$8.69
|
| Rate for Payer: Aetna American Axle |
$10.25
|
| Rate for Payer: Aetna American Axle |
$9.35
|
| Rate for Payer: Aetna American Axle |
$11.41
|
| Rate for Payer: Aetna American Axle |
$12.15
|
| Rate for Payer: Aetna American Axle |
$12.51
|
| Rate for Payer: Aetna American Axle |
$12.65
|
| Rate for Payer: Aetna American Axle |
$13.64
|
| Rate for Payer: Aetna American Axle |
$18.52
|
| Rate for Payer: Aetna American Axle |
$20.92
|
| Rate for Payer: Aetna American Axle |
$23.46
|
| Rate for Payer: Aetna American Axle |
$25.22
|
| Rate for Payer: Aetna American Axle |
$28.93
|
| Rate for Payer: Aetna American Axle |
$47.45
|
| Rate for Payer: Aetna American Axle |
$51.02
|
| Rate for Payer: Aetna American Axle |
$6.40
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$11.36
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$30.68
|
| Rate for Payer: Aetna Commercial |
$16.54
|
| Rate for Payer: Aetna Commercial |
$32.98
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$37.83
|
| Rate for Payer: Aetna Commercial |
$27.36
|
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: Aetna Commercial |
$66.72
|
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Cash Price |
$10.70
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$25.75
|
| Rate for Payer: Cash Price |
$62.80
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$28.88
|
| Rate for Payer: Cash Price |
$15.57
|
| Rate for Payer: Cash Price |
$31.04
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$67.51
|
| Rate for Payer: Cofinity Commercial |
$54.95
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Cofinity Commercial |
$51.10
|
| Rate for Payer: Cofinity Commercial |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Cofinity Commercial |
$16.07
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$31.15
|
| Rate for Payer: Cofinity Commercial |
$33.37
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$27.16
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$31.05
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Cofinity Commercial |
$13.62
|
| Rate for Payer: Cofinity Commercial |
$6.89
|
| Rate for Payer: Cofinity Commercial |
$9.36
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$10.07
|
| Rate for Payer: Cofinity Commercial |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$22.53
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$12.03
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$17.51
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$28.97
|
| Rate for Payer: Healthscope Commercial |
$32.49
|
| Rate for Payer: Healthscope Commercial |
$34.92
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Healthscope Commercial |
$70.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.83
|
| Rate for Payer: PHP Commercial |
$30.68
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$66.72
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$27.36
|
| Rate for Payer: PHP Commercial |
$16.54
|
| Rate for Payer: PHP Commercial |
$11.36
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$37.83
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$32.98
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$17.95
|
| Rate for Payer: Priority Health SBD |
$12.26
|
| Rate for Payer: Priority Health SBD |
$20.28
|
| Rate for Payer: Priority Health SBD |
$12.12
|
| Rate for Payer: Priority Health SBD |
$22.74
|
| Rate for Payer: Priority Health SBD |
$11.77
|
| Rate for Payer: Priority Health SBD |
$24.44
|
| Rate for Payer: Priority Health SBD |
$28.04
|
| Rate for Payer: Priority Health SBD |
$6.21
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: Priority Health SBD |
$45.99
|
| Rate for Payer: Priority Health SBD |
$9.07
|
| Rate for Payer: Priority Health SBD |
$8.42
|
| Rate for Payer: Priority Health SBD |
$49.45
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: UMR Bronson Commercial |
$6.33
|
| Rate for Payer: UMR Bronson Commercial |
$12.54
|
| Rate for Payer: UMR Bronson Commercial |
$6.94
|
| Rate for Payer: UMR Bronson Commercial |
$5.88
|
| Rate for Payer: UMR Bronson Commercial |
$19.58
|
| Rate for Payer: UMR Bronson Commercial |
$7.73
|
| Rate for Payer: UMR Bronson Commercial |
$34.54
|
| Rate for Payer: UMR Bronson Commercial |
$17.07
|
| Rate for Payer: UMR Bronson Commercial |
$8.22
|
| Rate for Payer: UMR Bronson Commercial |
$15.88
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: UMR Bronson Commercial |
$14.16
|
| Rate for Payer: UMR Bronson Commercial |
$8.56
|
| Rate for Payer: UMR Bronson Commercial |
$32.12
|
| Rate for Payer: UMR Bronson Commercial |
$4.33
|
| Rate for Payer: UMR Bronson Commercial |
$9.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.39
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$33.38
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
112217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Aetna American Axle |
$21.70
|
| Rate for Payer: Aetna Commercial |
$28.37
|
| Rate for Payer: Aetna Medicare |
$16.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.70
|
| Rate for Payer: BCBS Complete |
$13.35
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$28.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.70
|
| Rate for Payer: Healthscope Commercial |
$30.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.37
|
| Rate for Payer: PHP Commercial |
$28.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$21.03
|
| Rate for Payer: UMR Bronson Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.04
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$33.38
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
112217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$30.04 |
| Rate for Payer: Aetna American Axle |
$21.70
|
| Rate for Payer: Aetna Commercial |
$28.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$28.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.70
|
| Rate for Payer: Healthscope Commercial |
$30.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.37
|
| Rate for Payer: PHP Commercial |
$28.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$21.03
|
| Rate for Payer: UMR Bronson Commercial |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.04
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,185.43
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,401.59 |
| Max. Negotiated Rate |
$2,866.89 |
| Rate for Payer: Aetna American Axle |
$2,070.53
|
| Rate for Payer: Aetna Commercial |
$2,707.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,070.53
|
| Rate for Payer: Cash Price |
$2,548.34
|
| Rate for Payer: Cofinity Commercial |
$2,229.80
|
| Rate for Payer: Cofinity Commercial |
$2,739.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,229.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,548.34
|
| Rate for Payer: Healthscope Commercial |
$2,866.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,229.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,389.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,707.62
|
| Rate for Payer: PHP Commercial |
$2,707.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.53
|
| Rate for Payer: Priority Health SBD |
$2,006.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,401.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,389.07
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,185.43
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2,866.89 |
| Rate for Payer: Aetna American Axle |
$2,070.53
|
| Rate for Payer: Aetna Commercial |
$2,707.62
|
| Rate for Payer: Aetna Medicare |
$1.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,070.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.39
|
| Rate for Payer: BCBS Complete |
$0.62
|
| Rate for Payer: BCBS MAPPO |
$1.11
|
| Rate for Payer: BCN Medicare Advantage |
$1.11
|
| Rate for Payer: Cash Price |
$2,548.34
|
| Rate for Payer: Cash Price |
$2,548.34
|
| Rate for Payer: Cofinity Commercial |
$2,739.47
|
| Rate for Payer: Cofinity Commercial |
$2,229.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,229.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,548.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.11
|
| Rate for Payer: Healthscope Commercial |
$2,866.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,229.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,389.07
|
| Rate for Payer: Mclaren Medicaid |
$0.59
|
| Rate for Payer: Mclaren Medicare |
$1.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.17
|
| Rate for Payer: Meridian Medicaid |
$0.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,707.62
|
| Rate for Payer: PACE Medicare |
$1.05
|
| Rate for Payer: PACE SWMI |
$1.11
|
| Rate for Payer: PHP Commercial |
$2,707.62
|
| Rate for Payer: PHP Medicare Advantage |
$1.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.53
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health SBD |
$2,006.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.11
|
| Rate for Payer: UHC Exchange |
$2.12
|
| Rate for Payer: UHC Medicare Advantage |
$1.11
|
| Rate for Payer: UHCCP Medicaid |
$0.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,178.61
|
| Rate for Payer: VA VA |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,389.07
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,271.33
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$5,644.20 |
| Rate for Payer: Aetna American Axle |
$4,076.36
|
| Rate for Payer: Aetna Commercial |
$5,330.63
|
| Rate for Payer: Aetna Medicare |
$22.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,076.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.52
|
| Rate for Payer: BCBS Complete |
$12.39
|
| Rate for Payer: BCBS MAPPO |
$22.02
|
| Rate for Payer: BCN Medicare Advantage |
$22.02
|
| Rate for Payer: Cash Price |
$5,017.06
|
| Rate for Payer: Cash Price |
$5,017.06
|
| Rate for Payer: Cofinity Commercial |
$5,393.34
|
| Rate for Payer: Cofinity Commercial |
$4,389.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,389.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,017.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$5,644.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,389.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,703.50
|
| Rate for Payer: Mclaren Medicaid |
$11.80
|
| Rate for Payer: Mclaren Medicare |
$22.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.12
|
| Rate for Payer: Meridian Medicaid |
$12.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,330.63
|
| Rate for Payer: PACE Medicare |
$20.92
|
| Rate for Payer: PACE SWMI |
$22.02
|
| Rate for Payer: PHP Commercial |
$5,330.63
|
| Rate for Payer: PHP Medicare Advantage |
$22.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,076.36
|
| Rate for Payer: Priority Health Medicare |
$22.02
|
| Rate for Payer: Priority Health SBD |
$3,950.94
|
| Rate for Payer: Railroad Medicare Medicare |
$22.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.02
|
| Rate for Payer: UHC Exchange |
$42.08
|
| Rate for Payer: UHC Medicare Advantage |
$22.02
|
| Rate for Payer: UHCCP Medicaid |
$11.80
|
| Rate for Payer: UMR Bronson Commercial |
$2,320.39
|
| Rate for Payer: VA VA |
$22.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,703.50
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,271.33
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,759.39 |
| Max. Negotiated Rate |
$5,644.20 |
| Rate for Payer: Aetna American Axle |
$4,076.36
|
| Rate for Payer: Aetna Commercial |
$5,330.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,076.36
|
| Rate for Payer: Cash Price |
$5,017.06
|
| Rate for Payer: Cofinity Commercial |
$4,389.93
|
| Rate for Payer: Cofinity Commercial |
$5,393.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,389.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,017.06
|
| Rate for Payer: Healthscope Commercial |
$5,644.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,389.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,703.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,330.63
|
| Rate for Payer: PHP Commercial |
$5,330.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,076.36
|
| Rate for Payer: Priority Health SBD |
$3,950.94
|
| Rate for Payer: UMR Bronson Commercial |
$2,759.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,703.50
|
|
|
FERRIC SUBSULFATE 1.04 GM TOPICAL PASTE
|
Facility
|
OP
|
$87.81
|
|
|
Service Code
|
NDC 48783011208
|
| Hospital Charge Code |
155166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna American Axle |
$57.08
|
| Rate for Payer: Aetna Commercial |
$74.64
|
| Rate for Payer: Aetna Medicare |
$43.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.08
|
| Rate for Payer: BCBS Complete |
$35.12
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cofinity Commercial |
$61.47
|
| Rate for Payer: Cofinity Commercial |
$75.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.25
|
| Rate for Payer: Healthscope Commercial |
$79.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.64
|
| Rate for Payer: PHP Commercial |
$74.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: Priority Health SBD |
$55.32
|
| Rate for Payer: UMR Bronson Commercial |
$32.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.86
|
|
|
FERRIC SUBSULFATE 1.04 GM TOPICAL PASTE
|
Facility
|
IP
|
$87.81
|
|
|
Service Code
|
NDC 48783011208
|
| Hospital Charge Code |
155166
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna American Axle |
$57.08
|
| Rate for Payer: Aetna Commercial |
$74.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.08
|
| Rate for Payer: Cash Price |
$70.25
|
| Rate for Payer: Cofinity Commercial |
$61.47
|
| Rate for Payer: Cofinity Commercial |
$75.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.25
|
| Rate for Payer: Healthscope Commercial |
$79.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.64
|
| Rate for Payer: PHP Commercial |
$74.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: Priority Health SBD |
$55.32
|
| Rate for Payer: UMR Bronson Commercial |
$38.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.86
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
NDC 59365606500
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna American Axle |
$35.21
|
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna Medicare |
$27.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Commercial |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health SBD |
$34.13
|
| Rate for Payer: UMR Bronson Commercial |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.63
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
NDC 59365606501
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna American Axle |
$35.21
|
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna Medicare |
$27.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Commercial |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health SBD |
$34.13
|
| Rate for Payer: UMR Bronson Commercial |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.63
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
NDC 59365606500
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna American Axle |
$35.21
|
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Commercial |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health SBD |
$34.13
|
| Rate for Payer: UMR Bronson Commercial |
$23.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.63
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
NDC 59365606501
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna American Axle |
$35.21
|
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Commercial |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health SBD |
$34.13
|
| Rate for Payer: UMR Bronson Commercial |
$23.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.63
|
|
|
FERROUS FUMARATE 324 MG (106 MG IRON) TABLET
|
Facility
|
OP
|
$397.15
|
|
|
Service Code
|
NDC 60258018201
|
| Hospital Charge Code |
3063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.95 |
| Max. Negotiated Rate |
$357.44 |
| Rate for Payer: Aetna American Axle |
$258.15
|
| Rate for Payer: Aetna Commercial |
$337.58
|
| Rate for Payer: Aetna Medicare |
$198.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.15
|
| Rate for Payer: BCBS Complete |
$158.86
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$278.00
|
| Rate for Payer: Cofinity Commercial |
$341.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$357.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: PHP Commercial |
$337.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.15
|
| Rate for Payer: Priority Health SBD |
$250.20
|
| Rate for Payer: UMR Bronson Commercial |
$146.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.86
|
|
|
FERROUS FUMARATE 324 MG (106 MG IRON) TABLET
|
Facility
|
IP
|
$378.35
|
|
|
Service Code
|
NDC 51991018142
|
| Hospital Charge Code |
3063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.47 |
| Max. Negotiated Rate |
$340.51 |
| Rate for Payer: Aetna American Axle |
$245.93
|
| Rate for Payer: Aetna Commercial |
$321.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.93
|
| Rate for Payer: Cash Price |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$264.85
|
| Rate for Payer: Cofinity Commercial |
$325.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$264.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.68
|
| Rate for Payer: Healthscope Commercial |
$340.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.60
|
| Rate for Payer: PHP Commercial |
$321.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.93
|
| Rate for Payer: Priority Health SBD |
$238.36
|
| Rate for Payer: UMR Bronson Commercial |
$166.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.76
|
|
|
FERROUS FUMARATE 324 MG (106 MG IRON) TABLET
|
Facility
|
OP
|
$378.35
|
|
|
Service Code
|
NDC 51991018142
|
| Hospital Charge Code |
3063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$340.51 |
| Rate for Payer: Aetna American Axle |
$245.93
|
| Rate for Payer: Aetna Commercial |
$321.60
|
| Rate for Payer: Aetna Medicare |
$189.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.93
|
| Rate for Payer: BCBS Complete |
$151.34
|
| Rate for Payer: Cash Price |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$264.85
|
| Rate for Payer: Cofinity Commercial |
$325.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$264.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.68
|
| Rate for Payer: Healthscope Commercial |
$340.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.60
|
| Rate for Payer: PHP Commercial |
$321.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.93
|
| Rate for Payer: Priority Health SBD |
$238.36
|
| Rate for Payer: UMR Bronson Commercial |
$139.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.76
|
|
|
FERROUS FUMARATE 324 MG (106 MG IRON) TABLET
|
Facility
|
IP
|
$397.15
|
|
|
Service Code
|
NDC 60258018201
|
| Hospital Charge Code |
3063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.75 |
| Max. Negotiated Rate |
$357.44 |
| Rate for Payer: Aetna American Axle |
$258.15
|
| Rate for Payer: Aetna Commercial |
$337.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.15
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cofinity Commercial |
$278.00
|
| Rate for Payer: Cofinity Commercial |
$341.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.72
|
| Rate for Payer: Healthscope Commercial |
$357.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.58
|
| Rate for Payer: PHP Commercial |
$337.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.15
|
| Rate for Payer: Priority Health SBD |
$250.20
|
| Rate for Payer: UMR Bronson Commercial |
$174.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.86
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
NDC 39328005750
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.05
|
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Aetna Medicare |
$44.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.05
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.91
|
| Rate for Payer: PHP Commercial |
$75.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.05
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$33.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 54838001150
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
IP
|
$64.63
|
|
|
Service Code
|
NDC 50383062750
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.44 |
| Max. Negotiated Rate |
$58.17 |
| Rate for Payer: Aetna American Axle |
$42.01
|
| Rate for Payer: Aetna Commercial |
$54.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.01
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Cofinity Commercial |
$55.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.70
|
| Rate for Payer: Healthscope Commercial |
$58.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.94
|
| Rate for Payer: PHP Commercial |
$54.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.01
|
| Rate for Payer: Priority Health SBD |
$40.72
|
| Rate for Payer: UMR Bronson Commercial |
$28.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.47
|
|
