|
FOLIC ACID-VIT B6-VIT B12 2.5 MG-25 MG-2 MG TABLET
|
Facility
|
OP
|
$285.56
|
|
|
Service Code
|
NDC 75834008090
|
| Hospital Charge Code |
38624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.66 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: Aetna American Axle |
$185.61
|
| Rate for Payer: Aetna Commercial |
$242.73
|
| Rate for Payer: Aetna Medicare |
$142.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.61
|
| Rate for Payer: BCBS Complete |
$114.22
|
| Rate for Payer: Cash Price |
$228.45
|
| Rate for Payer: Cofinity Commercial |
$199.89
|
| Rate for Payer: Cofinity Commercial |
$245.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.45
|
| Rate for Payer: Healthscope Commercial |
$257.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.73
|
| Rate for Payer: PHP Commercial |
$242.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.61
|
| Rate for Payer: Priority Health SBD |
$179.90
|
| Rate for Payer: UMR Bronson Commercial |
$105.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.17
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,517.76
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
22185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$667.81 |
| Max. Negotiated Rate |
$1,365.98 |
| Rate for Payer: Aetna American Axle |
$986.54
|
| Rate for Payer: Aetna American Axle |
$1,089.76
|
| Rate for Payer: Aetna American Axle |
$1,907.30
|
| Rate for Payer: Aetna Commercial |
$1,425.07
|
| Rate for Payer: Aetna Commercial |
$1,290.10
|
| Rate for Payer: Aetna Commercial |
$2,494.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,907.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,089.76
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cash Price |
$1,341.24
|
| Rate for Payer: Cash Price |
$1,214.21
|
| Rate for Payer: Cofinity Commercial |
$1,305.27
|
| Rate for Payer: Cofinity Commercial |
$1,441.83
|
| Rate for Payer: Cofinity Commercial |
$1,173.59
|
| Rate for Payer: Cofinity Commercial |
$2,523.51
|
| Rate for Payer: Cofinity Commercial |
$2,054.02
|
| Rate for Payer: Cofinity Commercial |
$1,062.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,173.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,062.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,054.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,347.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,341.24
|
| Rate for Payer: Healthscope Commercial |
$1,508.89
|
| Rate for Payer: Healthscope Commercial |
$1,365.98
|
| Rate for Payer: Healthscope Commercial |
$2,640.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,062.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,173.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,054.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,257.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,138.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,200.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,494.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,425.07
|
| Rate for Payer: PHP Commercial |
$2,494.16
|
| Rate for Payer: PHP Commercial |
$1,425.07
|
| Rate for Payer: PHP Commercial |
$1,290.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,089.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.54
|
| Rate for Payer: Priority Health SBD |
$1,848.62
|
| Rate for Payer: Priority Health SBD |
$1,056.23
|
| Rate for Payer: Priority Health SBD |
$956.19
|
| Rate for Payer: UMR Bronson Commercial |
$667.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,291.10
|
| Rate for Payer: UMR Bronson Commercial |
$737.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,200.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,138.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,257.41
|
|
|
FOMEPIZOLE 1 GRAM/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,934.31
|
|
|
Service Code
|
HCPCS J1451
|
| Hospital Charge Code |
22185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$2,640.88 |
| Rate for Payer: Aetna American Axle |
$1,907.30
|
| Rate for Payer: Aetna American Axle |
$1,089.76
|
| Rate for Payer: Aetna American Axle |
$986.54
|
| Rate for Payer: Aetna Commercial |
$2,494.16
|
| Rate for Payer: Aetna Commercial |
$1,290.10
|
| Rate for Payer: Aetna Commercial |
$1,425.07
|
| Rate for Payer: Aetna Medicare |
$6.53
|
| Rate for Payer: Aetna Medicare |
$6.53
|
| Rate for Payer: Aetna Medicare |
$6.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,089.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,907.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.85
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: BCBS MAPPO |
$6.28
|
| Rate for Payer: BCBS MAPPO |
$6.28
|
| Rate for Payer: BCBS MAPPO |
$6.28
|
| Rate for Payer: BCN Medicare Advantage |
$6.28
|
| Rate for Payer: BCN Medicare Advantage |
$6.28
|
| Rate for Payer: BCN Medicare Advantage |
$6.28
|
| Rate for Payer: Cash Price |
$1,341.24
|
| Rate for Payer: Cash Price |
$1,341.24
|
| Rate for Payer: Cash Price |
$1,214.21
|
| Rate for Payer: Cash Price |
$1,214.21
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cash Price |
$2,347.45
|
| Rate for Payer: Cofinity Commercial |
$1,062.43
|
| Rate for Payer: Cofinity Commercial |
$2,523.51
|
| Rate for Payer: Cofinity Commercial |
$2,054.02
|
| Rate for Payer: Cofinity Commercial |
$1,173.59
|
| Rate for Payer: Cofinity Commercial |
$1,305.27
|
| Rate for Payer: Cofinity Commercial |
$1,441.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,054.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,173.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,062.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,347.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,341.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,214.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.28
|
| Rate for Payer: Healthscope Commercial |
$1,365.98
|
| Rate for Payer: Healthscope Commercial |
$2,640.88
|
| Rate for Payer: Healthscope Commercial |
$1,508.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,173.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,054.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,062.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,200.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,138.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,257.41
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Mclaren Medicare |
$6.28
|
| Rate for Payer: Mclaren Medicare |
$6.28
|
| Rate for Payer: Mclaren Medicare |
$6.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.59
|
| Rate for Payer: Meridian Medicaid |
$3.53
|
| Rate for Payer: Meridian Medicaid |
$3.53
|
| Rate for Payer: Meridian Medicaid |
$3.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,425.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,494.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,290.10
|
| Rate for Payer: PACE Medicare |
$5.97
|
| Rate for Payer: PACE Medicare |
$5.97
|
| Rate for Payer: PACE Medicare |
$5.97
|
| Rate for Payer: PACE SWMI |
$6.28
|
| Rate for Payer: PACE SWMI |
$6.28
|
| Rate for Payer: PACE SWMI |
$6.28
|
| Rate for Payer: PHP Commercial |
$2,494.16
|
| Rate for Payer: PHP Commercial |
$1,290.10
|
| Rate for Payer: PHP Commercial |
$1,425.07
|
| Rate for Payer: PHP Medicare Advantage |
$6.28
|
| Rate for Payer: PHP Medicare Advantage |
$6.28
|
| Rate for Payer: PHP Medicare Advantage |
$6.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,089.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.54
|
| Rate for Payer: Priority Health Medicare |
$6.28
|
| Rate for Payer: Priority Health Medicare |
$6.28
|
| Rate for Payer: Priority Health Medicare |
$6.28
|
| Rate for Payer: Priority Health SBD |
$956.19
|
| Rate for Payer: Priority Health SBD |
$1,056.23
|
| Rate for Payer: Priority Health SBD |
$1,848.62
|
| Rate for Payer: Railroad Medicare Medicare |
$6.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.28
|
| Rate for Payer: Railroad Medicare Medicare |
$6.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.28
|
| Rate for Payer: UHC Exchange |
$12.00
|
| Rate for Payer: UHC Exchange |
$12.00
|
| Rate for Payer: UHC Exchange |
$12.00
|
| Rate for Payer: UHC Medicare Advantage |
$6.28
|
| Rate for Payer: UHC Medicare Advantage |
$6.28
|
| Rate for Payer: UHC Medicare Advantage |
$6.28
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: UMR Bronson Commercial |
$620.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,085.69
|
| Rate for Payer: UMR Bronson Commercial |
$561.57
|
| Rate for Payer: VA VA |
$6.28
|
| Rate for Payer: VA VA |
$6.28
|
| Rate for Payer: VA VA |
$6.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,257.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,200.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,138.32
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$28.25
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.25
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.77
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$39.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$36.94
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.25
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: Priority Health SBD |
$27.38
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: UMR Bronson Commercial |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.59
|
|
|
FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115590
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.04 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$28.25
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Aetna Medicare |
$21.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.25
|
| Rate for Payer: BCBS Complete |
$17.38
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.77
|
| Rate for Payer: Healthscope Commercial |
$39.11
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.94
|
| Rate for Payer: PHP Commercial |
$36.94
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.25
|
| Rate for Payer: Priority Health SBD |
$27.38
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$49.04
|
| Rate for Payer: UMR Bronson Commercial |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$27.18
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
32215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$24.46 |
| Rate for Payer: Aetna American Axle |
$17.67
|
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$19.03
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$24.46
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.10
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: PHP Commercial |
$23.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.96
|
| Rate for Payer: Priority Health SBD |
$17.12
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$18.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
|
|
FONDAPARINUX 2.5 MG/0.5 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$27.18
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
32215
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$24.46 |
| Rate for Payer: Aetna American Axle |
$17.67
|
| Rate for Payer: Aetna American Axle |
$26.96
|
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Medicare |
$13.59
|
| Rate for Payer: Aetna Medicare |
$20.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.96
|
| Rate for Payer: BCBS Complete |
$16.59
|
| Rate for Payer: BCBS Complete |
$10.87
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$19.03
|
| Rate for Payer: Cofinity Commercial |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$35.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.18
|
| Rate for Payer: Healthscope Commercial |
$37.32
|
| Rate for Payer: Healthscope Commercial |
$24.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.25
|
| Rate for Payer: PHP Commercial |
$35.25
|
| Rate for Payer: PHP Commercial |
$23.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.96
|
| Rate for Payer: Priority Health SBD |
$26.13
|
| Rate for Payer: Priority Health SBD |
$17.12
|
| Rate for Payer: UMR Bronson Commercial |
$10.06
|
| Rate for Payer: UMR Bronson Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
|
|
FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.04 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.14
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$49.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
FONDAPARINUX 5 MG/0.4 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
115589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.14
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
IP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
39803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$285.61
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Commercial |
$373.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.61
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$351.52
|
| Rate for Payer: Cofinity Commercial |
$377.88
|
| Rate for Payer: Cofinity Commercial |
$307.58
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.52
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$395.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: PHP Commercial |
$373.49
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.61
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: Priority Health SBD |
$276.82
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: UMR Bronson Commercial |
$193.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.55
|
|
|
FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE
|
Facility
|
OP
|
$132.53
|
|
|
Service Code
|
HCPCS J1652
|
| Hospital Charge Code |
39803
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.04 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna American Axle |
$285.61
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna Commercial |
$373.49
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Aetna Medicare |
$219.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.61
|
| Rate for Payer: BCBS Complete |
$175.76
|
| Rate for Payer: BCBS Complete |
$53.01
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cash Price |
$351.52
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$307.58
|
| Rate for Payer: Cofinity Commercial |
$377.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.52
|
| Rate for Payer: Healthscope Commercial |
$395.46
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.49
|
| Rate for Payer: PHP Commercial |
$373.49
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.61
|
| Rate for Payer: Priority Health SBD |
$276.82
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$49.04
|
| Rate for Payer: UMR Bronson Commercial |
$162.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
FOREHEAD FLAP WITH PRESERVATION OF VASCULAR PEDICLE (EG, AXIAL PATTERN FLAP, PARAMEDIAN FOREHEAD FLAP)
|
Facility
|
OP
|
$10,050.52
|
|
|
Service Code
|
CPT 15731
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,913.77 |
| Max. Negotiated Rate |
$10,050.52 |
| Rate for Payer: Aetna Medicare |
$3,713.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,050.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$6,823.53
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING
|
Facility
|
OP
|
$667.69
|
|
|
Service Code
|
CPT 54450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Exchange |
$453.31
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$127.14
|
| Rate for Payer: VA VA |
$237.20
|
|
|
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; EYELIDS, NOSE, EARS, LIPS, OR INTRAORAL
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 15576
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUT TRANSFER; FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS OR FEET
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 15574
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$16.98
|
|
|
Service Code
|
HCPCS J7606
|
| Hospital Charge Code |
88225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$15.28 |
| Rate for Payer: Aetna American Axle |
$11.04
|
| Rate for Payer: Aetna American Axle |
$18.36
|
| Rate for Payer: Aetna Commercial |
$14.43
|
| Rate for Payer: Aetna Commercial |
$24.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.36
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cash Price |
$22.59
|
| Rate for Payer: Cofinity Commercial |
$24.29
|
| Rate for Payer: Cofinity Commercial |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.59
|
| Rate for Payer: Healthscope Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$25.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.43
|
| Rate for Payer: PHP Commercial |
$24.00
|
| Rate for Payer: PHP Commercial |
$14.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health SBD |
$10.70
|
| Rate for Payer: Priority Health SBD |
$17.79
|
| Rate for Payer: UMR Bronson Commercial |
$7.47
|
| Rate for Payer: UMR Bronson Commercial |
$12.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.18
|
|
|
FORMOTEROL FUMARATE 20 MCG/2 ML SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$16.98
|
|
|
Service Code
|
HCPCS J7606
|
| Hospital Charge Code |
88225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$15.28 |
| Rate for Payer: Aetna American Axle |
$11.04
|
| Rate for Payer: Aetna American Axle |
$18.36
|
| Rate for Payer: Aetna Commercial |
$14.43
|
| Rate for Payer: Aetna Commercial |
$24.00
|
| Rate for Payer: Aetna Medicare |
$8.49
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.36
|
| Rate for Payer: BCBS Complete |
$11.30
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cash Price |
$22.59
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$19.77
|
| Rate for Payer: Cofinity Commercial |
$24.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.59
|
| Rate for Payer: Healthscope Commercial |
$25.42
|
| Rate for Payer: Healthscope Commercial |
$15.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.00
|
| Rate for Payer: PHP Commercial |
$24.00
|
| Rate for Payer: PHP Commercial |
$14.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.36
|
| Rate for Payer: Priority Health SBD |
$17.79
|
| Rate for Payer: Priority Health SBD |
$10.70
|
| Rate for Payer: UMR Bronson Commercial |
$6.28
|
| Rate for Payer: UMR Bronson Commercial |
$10.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.73
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$501.13
|
|
|
Service Code
|
HCPCS J1456
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$451.02 |
| Rate for Payer: Aetna American Axle |
$325.73
|
| Rate for Payer: Aetna Commercial |
$425.96
|
| Rate for Payer: Aetna Medicare |
$1.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.29
|
| Rate for Payer: BCBS Complete |
$0.58
|
| Rate for Payer: BCBS MAPPO |
$1.03
|
| Rate for Payer: BCN Medicare Advantage |
$1.03
|
| Rate for Payer: Cash Price |
$400.90
|
| Rate for Payer: Cash Price |
$400.90
|
| Rate for Payer: Cofinity Commercial |
$350.79
|
| Rate for Payer: Cofinity Commercial |
$430.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.03
|
| Rate for Payer: Healthscope Commercial |
$451.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.85
|
| Rate for Payer: Mclaren Medicaid |
$0.55
|
| Rate for Payer: Mclaren Medicare |
$1.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.08
|
| Rate for Payer: Meridian Medicaid |
$0.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.96
|
| Rate for Payer: PACE Medicare |
$0.98
|
| Rate for Payer: PACE SWMI |
$1.03
|
| Rate for Payer: PHP Commercial |
$425.96
|
| Rate for Payer: PHP Medicare Advantage |
$1.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.73
|
| Rate for Payer: Priority Health Medicare |
$1.03
|
| Rate for Payer: Priority Health SBD |
$315.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.03
|
| Rate for Payer: UHC Exchange |
$1.97
|
| Rate for Payer: UHC Medicare Advantage |
$1.03
|
| Rate for Payer: UHCCP Medicaid |
$0.55
|
| Rate for Payer: UMR Bronson Commercial |
$185.42
|
| Rate for Payer: VA VA |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.85
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$187.63
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$168.87 |
| Rate for Payer: Aetna American Axle |
$121.96
|
| Rate for Payer: Aetna American Axle |
$126.83
|
| Rate for Payer: Aetna American Axle |
$873.86
|
| Rate for Payer: Aetna American Axle |
$324.19
|
| Rate for Payer: Aetna American Axle |
$134.15
|
| Rate for Payer: Aetna American Axle |
$138.86
|
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna American Axle |
$166.24
|
| Rate for Payer: Aetna American Axle |
$123.79
|
| Rate for Payer: Aetna American Axle |
$960.71
|
| Rate for Payer: Aetna American Axle |
$278.76
|
| Rate for Payer: Aetna American Axle |
$151.12
|
| Rate for Payer: Aetna Commercial |
$181.59
|
| Rate for Payer: Aetna Commercial |
$1,256.31
|
| Rate for Payer: Aetna Commercial |
$197.62
|
| Rate for Payer: Aetna Commercial |
$159.49
|
| Rate for Payer: Aetna Commercial |
$175.42
|
| Rate for Payer: Aetna Commercial |
$364.53
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$1,142.74
|
| Rate for Payer: Aetna Commercial |
$165.86
|
| Rate for Payer: Aetna Commercial |
$423.95
|
| Rate for Payer: Aetna Commercial |
$161.88
|
| Rate for Payer: Aetna Medicare |
$127.88
|
| Rate for Payer: Aetna Medicare |
$133.69
|
| Rate for Payer: Aetna Medicare |
$672.20
|
| Rate for Payer: Aetna Medicare |
$95.22
|
| Rate for Payer: Aetna Medicare |
$739.00
|
| Rate for Payer: Aetna Medicare |
$106.81
|
| Rate for Payer: Aetna Medicare |
$103.19
|
| Rate for Payer: Aetna Medicare |
$116.25
|
| Rate for Payer: Aetna Medicare |
$249.38
|
| Rate for Payer: Aetna Medicare |
$97.56
|
| Rate for Payer: Aetna Medicare |
$214.43
|
| Rate for Payer: Aetna Medicare |
$93.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.12
|
| Rate for Payer: BCBS Complete |
$82.55
|
| Rate for Payer: BCBS Complete |
$85.45
|
| Rate for Payer: BCBS Complete |
$591.20
|
| Rate for Payer: BCBS Complete |
$75.05
|
| Rate for Payer: BCBS Complete |
$78.05
|
| Rate for Payer: BCBS Complete |
$76.18
|
| Rate for Payer: BCBS Complete |
$199.50
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS Complete |
$93.00
|
| Rate for Payer: BCBS Complete |
$537.76
|
| Rate for Payer: BCBS Complete |
$102.30
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cash Price |
$170.90
|
| Rate for Payer: Cash Price |
$150.10
|
| Rate for Payer: Cash Price |
$1,075.52
|
| Rate for Payer: Cash Price |
$1,182.41
|
| Rate for Payer: Cash Price |
$152.36
|
| Rate for Payer: Cash Price |
$399.01
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$165.10
|
| Rate for Payer: Cofinity Commercial |
$133.31
|
| Rate for Payer: Cofinity Commercial |
$131.34
|
| Rate for Payer: Cofinity Commercial |
$161.36
|
| Rate for Payer: Cofinity Commercial |
$1,156.18
|
| Rate for Payer: Cofinity Commercial |
$183.72
|
| Rate for Payer: Cofinity Commercial |
$144.47
|
| Rate for Payer: Cofinity Commercial |
$177.49
|
| Rate for Payer: Cofinity Commercial |
$167.81
|
| Rate for Payer: Cofinity Commercial |
$163.79
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$179.03
|
| Rate for Payer: Cofinity Commercial |
$1,271.09
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Commercial |
$428.93
|
| Rate for Payer: Cofinity Commercial |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$368.82
|
| Rate for Payer: Cofinity Commercial |
$199.95
|
| Rate for Payer: Cofinity Commercial |
$162.75
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$349.13
|
| Rate for Payer: Cofinity Commercial |
$149.54
|
| Rate for Payer: Cofinity Commercial |
$136.59
|
| Rate for Payer: Cofinity Commercial |
$1,034.61
|
| Rate for Payer: Cofinity Commercial |
$941.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,034.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$941.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,075.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.01
|
| Rate for Payer: Healthscope Commercial |
$209.25
|
| Rate for Payer: Healthscope Commercial |
$448.88
|
| Rate for Payer: Healthscope Commercial |
$168.87
|
| Rate for Payer: Healthscope Commercial |
$385.97
|
| Rate for Payer: Healthscope Commercial |
$1,209.96
|
| Rate for Payer: Healthscope Commercial |
$175.62
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$171.41
|
| Rate for Payer: Healthscope Commercial |
$1,330.21
|
| Rate for Payer: Healthscope Commercial |
$185.74
|
| Rate for Payer: Healthscope Commercial |
$192.27
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$941.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,142.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.95
|
| Rate for Payer: PHP Commercial |
$175.42
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$423.95
|
| Rate for Payer: PHP Commercial |
$161.88
|
| Rate for Payer: PHP Commercial |
$181.59
|
| Rate for Payer: PHP Commercial |
$165.86
|
| Rate for Payer: PHP Commercial |
$364.53
|
| Rate for Payer: PHP Commercial |
$197.62
|
| Rate for Payer: PHP Commercial |
$1,256.31
|
| Rate for Payer: PHP Commercial |
$1,142.74
|
| Rate for Payer: PHP Commercial |
$159.49
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$873.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.79
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: Priority Health SBD |
$270.18
|
| Rate for Payer: Priority Health SBD |
$314.22
|
| Rate for Payer: Priority Health SBD |
$846.97
|
| Rate for Payer: Priority Health SBD |
$119.98
|
| Rate for Payer: Priority Health SBD |
$931.15
|
| Rate for Payer: Priority Health SBD |
$118.21
|
| Rate for Payer: Priority Health SBD |
$122.93
|
| Rate for Payer: Priority Health SBD |
$134.59
|
| Rate for Payer: Priority Health SBD |
$130.02
|
| Rate for Payer: Priority Health SBD |
$146.47
|
| Rate for Payer: UMR Bronson Commercial |
$69.42
|
| Rate for Payer: UMR Bronson Commercial |
$546.86
|
| Rate for Payer: UMR Bronson Commercial |
$86.03
|
| Rate for Payer: UMR Bronson Commercial |
$184.54
|
| Rate for Payer: UMR Bronson Commercial |
$98.93
|
| Rate for Payer: UMR Bronson Commercial |
$70.47
|
| Rate for Payer: UMR Bronson Commercial |
$94.63
|
| Rate for Payer: UMR Bronson Commercial |
$79.04
|
| Rate for Payer: UMR Bronson Commercial |
$158.68
|
| Rate for Payer: UMR Bronson Commercial |
$497.43
|
| Rate for Payer: UMR Bronson Commercial |
$76.36
|
| Rate for Payer: UMR Bronson Commercial |
$72.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.53
|
|
|
FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$1,478.01
|
|
|
Service Code
|
HCPCS J1453
|
| Hospital Charge Code |
106783
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$650.32 |
| Max. Negotiated Rate |
$1,330.21 |
| Rate for Payer: Aetna American Axle |
$960.71
|
| Rate for Payer: Aetna American Axle |
$173.80
|
| Rate for Payer: Aetna American Axle |
$166.24
|
| Rate for Payer: Aetna American Axle |
$121.96
|
| Rate for Payer: Aetna American Axle |
$134.15
|
| Rate for Payer: Aetna American Axle |
$278.76
|
| Rate for Payer: Aetna Commercial |
$1,256.31
|
| Rate for Payer: Aetna Commercial |
$159.49
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Commercial |
$364.53
|
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Commercial |
$175.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.80
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$1,182.41
|
| Rate for Payer: Cash Price |
$165.10
|
| Rate for Payer: Cash Price |
$150.10
|
| Rate for Payer: Cash Price |
$343.09
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$1,034.61
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$179.03
|
| Rate for Payer: Cofinity Commercial |
$144.47
|
| Rate for Payer: Cofinity Commercial |
$131.34
|
| Rate for Payer: Cofinity Commercial |
$161.36
|
| Rate for Payer: Cofinity Commercial |
$177.49
|
| Rate for Payer: Cofinity Commercial |
$1,271.09
|
| Rate for Payer: Cofinity Commercial |
$368.82
|
| Rate for Payer: Cofinity Commercial |
$300.20
|
| Rate for Payer: Cofinity Commercial |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,034.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.09
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$385.97
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$168.87
|
| Rate for Payer: Healthscope Commercial |
$185.74
|
| Rate for Payer: Healthscope Commercial |
$1,330.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.42
|
| Rate for Payer: PHP Commercial |
$1,256.31
|
| Rate for Payer: PHP Commercial |
$159.49
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Commercial |
$175.42
|
| Rate for Payer: PHP Commercial |
$364.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.76
|
| Rate for Payer: Priority Health SBD |
$168.45
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: Priority Health SBD |
$931.15
|
| Rate for Payer: Priority Health SBD |
$118.21
|
| Rate for Payer: Priority Health SBD |
$130.02
|
| Rate for Payer: Priority Health SBD |
$270.18
|
| Rate for Payer: UMR Bronson Commercial |
$188.70
|
| Rate for Payer: UMR Bronson Commercial |
$82.56
|
| Rate for Payer: UMR Bronson Commercial |
$90.81
|
| Rate for Payer: UMR Bronson Commercial |
$117.65
|
| Rate for Payer: UMR Bronson Commercial |
$112.53
|
| Rate for Payer: UMR Bronson Commercial |
$650.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.51
|
|
|
FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,061.45
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
10093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$955.30 |
| Rate for Payer: Aetna American Axle |
$689.94
|
| Rate for Payer: Aetna Commercial |
$902.23
|
| Rate for Payer: Aetna Medicare |
$16.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$689.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.10
|
| Rate for Payer: BCBS Complete |
$9.05
|
| Rate for Payer: BCBS MAPPO |
$16.08
|
| Rate for Payer: BCN Medicare Advantage |
$16.08
|
| Rate for Payer: Cash Price |
$849.16
|
| Rate for Payer: Cash Price |
$849.16
|
| Rate for Payer: Cofinity Commercial |
$912.85
|
| Rate for Payer: Cofinity Commercial |
$743.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$743.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$849.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.08
|
| Rate for Payer: Healthscope Commercial |
$955.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$743.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$796.09
|
| Rate for Payer: Mclaren Medicaid |
$8.62
|
| Rate for Payer: Mclaren Medicare |
$16.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.88
|
| Rate for Payer: Meridian Medicaid |
$9.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$902.23
|
| Rate for Payer: PACE Medicare |
$15.28
|
| Rate for Payer: PACE SWMI |
$16.08
|
| Rate for Payer: PHP Commercial |
$902.23
|
| Rate for Payer: PHP Medicare Advantage |
$16.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.94
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: Priority Health SBD |
$668.71
|
| Rate for Payer: Railroad Medicare Medicare |
$16.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.08
|
| Rate for Payer: UHC Exchange |
$30.73
|
| Rate for Payer: UHC Medicare Advantage |
$16.08
|
| Rate for Payer: UHCCP Medicaid |
$8.62
|
| Rate for Payer: UMR Bronson Commercial |
$392.74
|
| Rate for Payer: VA VA |
$16.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$796.09
|
|
|
FOSCARNET 24 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,061.45
|
|
|
Service Code
|
HCPCS J1455
|
| Hospital Charge Code |
10093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$467.04 |
| Max. Negotiated Rate |
$955.30 |
| Rate for Payer: Aetna American Axle |
$689.94
|
| Rate for Payer: Aetna Commercial |
$902.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$689.94
|
| Rate for Payer: Cash Price |
$849.16
|
| Rate for Payer: Cofinity Commercial |
$743.01
|
| Rate for Payer: Cofinity Commercial |
$912.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$743.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$849.16
|
| Rate for Payer: Healthscope Commercial |
$955.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$743.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$796.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$902.23
|
| Rate for Payer: PHP Commercial |
$902.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.94
|
| Rate for Payer: Priority Health SBD |
$668.71
|
| Rate for Payer: UMR Bronson Commercial |
$467.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$796.09
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$194.25
|
|
|
Service Code
|
NDC 70700026894
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Aetna American Axle |
$126.26
|
| Rate for Payer: Aetna Commercial |
$165.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.26
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cofinity Commercial |
$135.97
|
| Rate for Payer: Cofinity Commercial |
$167.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.40
|
| Rate for Payer: Healthscope Commercial |
$174.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.11
|
| Rate for Payer: PHP Commercial |
$165.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.26
|
| Rate for Payer: Priority Health SBD |
$122.38
|
| Rate for Payer: UMR Bronson Commercial |
$85.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.69
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
OP
|
$241.84
|
|
|
Service Code
|
NDC 00456430001
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.48 |
| Max. Negotiated Rate |
$217.66 |
| Rate for Payer: Aetna American Axle |
$157.20
|
| Rate for Payer: Aetna Commercial |
$205.56
|
| Rate for Payer: Aetna Medicare |
$120.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.20
|
| Rate for Payer: BCBS Complete |
$96.74
|
| Rate for Payer: Cash Price |
$193.47
|
| Rate for Payer: Cofinity Commercial |
$169.29
|
| Rate for Payer: Cofinity Commercial |
$207.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.47
|
| Rate for Payer: Healthscope Commercial |
$217.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.56
|
| Rate for Payer: PHP Commercial |
$205.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.20
|
| Rate for Payer: Priority Health SBD |
$152.36
|
| Rate for Payer: UMR Bronson Commercial |
$89.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.38
|
|
|
FOSFOMYCIN TROMETHAMINE 3 GRAM ORAL PACKET
|
Facility
|
IP
|
$206.46
|
|
|
Service Code
|
NDC 82036427408
|
| Hospital Charge Code |
14825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.84 |
| Max. Negotiated Rate |
$185.81 |
| Rate for Payer: Aetna American Axle |
$134.20
|
| Rate for Payer: Aetna Commercial |
$175.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.20
|
| Rate for Payer: Cash Price |
$165.17
|
| Rate for Payer: Cofinity Commercial |
$144.52
|
| Rate for Payer: Cofinity Commercial |
$177.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.17
|
| Rate for Payer: Healthscope Commercial |
$185.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.49
|
| Rate for Payer: PHP Commercial |
$175.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.20
|
| Rate for Payer: Priority Health SBD |
$130.07
|
| Rate for Payer: UMR Bronson Commercial |
$90.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.84
|
|
