|
GENTAMICIN 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$35.97
|
|
|
Service Code
|
NDC 00713068315
|
| Hospital Charge Code |
3423
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$32.37 |
| Rate for Payer: Aetna American Axle |
$23.38
|
| Rate for Payer: Aetna Commercial |
$30.57
|
| Rate for Payer: Aetna Medicare |
$17.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.38
|
| Rate for Payer: BCBS Complete |
$14.39
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$25.18
|
| Rate for Payer: Cofinity Commercial |
$30.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$32.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.57
|
| Rate for Payer: PHP Commercial |
$30.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.38
|
| Rate for Payer: Priority Health SBD |
$22.66
|
| Rate for Payer: UMR Bronson Commercial |
$13.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.98
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$19.22
|
|
|
Service Code
|
NDC 61314063305
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Aetna American Axle |
$12.49
|
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Aetna Medicare |
$9.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.49
|
| Rate for Payer: BCBS Complete |
$7.69
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$13.45
|
| Rate for Payer: Cofinity Commercial |
$16.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Healthscope Commercial |
$17.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.34
|
| Rate for Payer: PHP Commercial |
$16.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.49
|
| Rate for Payer: Priority Health SBD |
$12.11
|
| Rate for Payer: UMR Bronson Commercial |
$7.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.41
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$18.23
|
|
|
Service Code
|
NDC 60758018805
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna American Axle |
$11.85
|
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.85
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.85
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.67
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$116.24
|
|
|
Service Code
|
NDC 24208058060
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna American Axle |
$75.56
|
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.56
|
| Rate for Payer: Cash Price |
$92.99
|
| Rate for Payer: Cofinity Commercial |
$81.37
|
| Rate for Payer: Cofinity Commercial |
$99.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.99
|
| Rate for Payer: Healthscope Commercial |
$104.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.80
|
| Rate for Payer: PHP Commercial |
$98.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.56
|
| Rate for Payer: Priority Health SBD |
$73.23
|
| Rate for Payer: UMR Bronson Commercial |
$51.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.18
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$19.22
|
|
|
Service Code
|
NDC 61314063305
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: Aetna American Axle |
$12.49
|
| Rate for Payer: Aetna Commercial |
$16.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.49
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$13.45
|
| Rate for Payer: Cofinity Commercial |
$16.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Healthscope Commercial |
$17.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.34
|
| Rate for Payer: PHP Commercial |
$16.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.49
|
| Rate for Payer: Priority Health SBD |
$12.11
|
| Rate for Payer: UMR Bronson Commercial |
$8.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.41
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$116.24
|
|
|
Service Code
|
NDC 24208058060
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$104.62 |
| Rate for Payer: Aetna American Axle |
$75.56
|
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Medicare |
$58.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.56
|
| Rate for Payer: BCBS Complete |
$46.50
|
| Rate for Payer: Cash Price |
$92.99
|
| Rate for Payer: Cofinity Commercial |
$81.37
|
| Rate for Payer: Cofinity Commercial |
$99.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.99
|
| Rate for Payer: Healthscope Commercial |
$104.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.80
|
| Rate for Payer: PHP Commercial |
$98.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.56
|
| Rate for Payer: Priority Health SBD |
$73.23
|
| Rate for Payer: UMR Bronson Commercial |
$43.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.18
|
|
|
GENTAMICIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$18.23
|
|
|
Service Code
|
NDC 60758018805
|
| Hospital Charge Code |
3428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$16.41 |
| Rate for Payer: Aetna American Axle |
$11.85
|
| Rate for Payer: Aetna Commercial |
$15.50
|
| Rate for Payer: Aetna Medicare |
$9.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.85
|
| Rate for Payer: BCBS Complete |
$7.29
|
| Rate for Payer: Cash Price |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$15.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.58
|
| Rate for Payer: Healthscope Commercial |
$16.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.50
|
| Rate for Payer: PHP Commercial |
$15.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.85
|
| Rate for Payer: Priority Health SBD |
$11.48
|
| Rate for Payer: UMR Bronson Commercial |
$6.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.67
|
|
|
GENTAMICIN 100 MG/50 ML IN NS PREMIX (BMH OSC)
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
169406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna American Axle |
$47.72
|
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.72
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.72
|
| Rate for Payer: Priority Health SBD |
$46.25
|
| Rate for Payer: UMR Bronson Commercial |
$32.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.06
|
|
|
GENTAMICIN 100 MG/50 ML IN NS PREMIX (BMH OSC)
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
169406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna American Axle |
$47.72
|
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: Aetna Medicare |
$36.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.72
|
| Rate for Payer: BCBS Complete |
$29.37
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.72
|
| Rate for Payer: Priority Health SBD |
$46.25
|
| Rate for Payer: UMR Bronson Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.06
|
|
|
GENTAMICIN 100 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$73.42
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
15912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna American Axle |
$47.72
|
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.72
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.72
|
| Rate for Payer: Priority Health SBD |
$46.25
|
| Rate for Payer: UMR Bronson Commercial |
$32.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.06
|
|
|
GENTAMICIN 100 MG/50 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$73.42
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
15912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna American Axle |
$47.72
|
| Rate for Payer: Aetna Commercial |
$62.41
|
| Rate for Payer: Aetna Medicare |
$36.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.72
|
| Rate for Payer: BCBS Complete |
$29.37
|
| Rate for Payer: Cash Price |
$58.74
|
| Rate for Payer: Cofinity Commercial |
$51.39
|
| Rate for Payer: Cofinity Commercial |
$63.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.74
|
| Rate for Payer: Healthscope Commercial |
$66.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.41
|
| Rate for Payer: PHP Commercial |
$62.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.72
|
| Rate for Payer: Priority Health SBD |
$46.25
|
| Rate for Payer: UMR Bronson Commercial |
$27.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.06
|
|
|
GENTAMICIN 120 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$80.41
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
114156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.38 |
| Max. Negotiated Rate |
$72.37 |
| Rate for Payer: Aetna American Axle |
$52.27
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.27
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: UMR Bronson Commercial |
$35.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
|
GENTAMICIN 120 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$80.41
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
114156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$72.37 |
| Rate for Payer: Aetna American Axle |
$52.27
|
| Rate for Payer: Aetna Commercial |
$68.35
|
| Rate for Payer: Aetna Medicare |
$40.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.27
|
| Rate for Payer: BCBS Complete |
$32.16
|
| Rate for Payer: Cash Price |
$64.33
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Cofinity Commercial |
$69.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.33
|
| Rate for Payer: Healthscope Commercial |
$72.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.35
|
| Rate for Payer: PHP Commercial |
$68.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.27
|
| Rate for Payer: Priority Health SBD |
$50.66
|
| Rate for Payer: UMR Bronson Commercial |
$29.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.31
|
|
|
GENTAMICIN 14 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
OP
|
$209.86
|
|
|
Service Code
|
NDC 09900000088
|
| Hospital Charge Code |
500593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.65 |
| Max. Negotiated Rate |
$188.87 |
| Rate for Payer: Aetna American Axle |
$136.41
|
| Rate for Payer: Aetna Commercial |
$178.38
|
| Rate for Payer: Aetna Medicare |
$104.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.41
|
| Rate for Payer: BCBS Complete |
$83.94
|
| Rate for Payer: Cash Price |
$167.89
|
| Rate for Payer: Cofinity Commercial |
$146.90
|
| Rate for Payer: Cofinity Commercial |
$180.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.89
|
| Rate for Payer: Healthscope Commercial |
$188.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.38
|
| Rate for Payer: PHP Commercial |
$178.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.41
|
| Rate for Payer: Priority Health SBD |
$132.21
|
| Rate for Payer: UMR Bronson Commercial |
$77.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.40
|
|
|
GENTAMICIN 14 MG/ML FORTIFIED OPHTHALMIC DROPS
|
Facility
|
IP
|
$209.86
|
|
|
Service Code
|
NDC 09900000088
|
| Hospital Charge Code |
500593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.34 |
| Max. Negotiated Rate |
$188.87 |
| Rate for Payer: Aetna American Axle |
$136.41
|
| Rate for Payer: Aetna Commercial |
$178.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.41
|
| Rate for Payer: Cash Price |
$167.89
|
| Rate for Payer: Cofinity Commercial |
$146.90
|
| Rate for Payer: Cofinity Commercial |
$180.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.89
|
| Rate for Payer: Healthscope Commercial |
$188.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.38
|
| Rate for Payer: PHP Commercial |
$178.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.41
|
| Rate for Payer: Priority Health SBD |
$132.21
|
| Rate for Payer: UMR Bronson Commercial |
$92.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.40
|
|
|
GENTAMICIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$34.65
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
3426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$31.18 |
| Rate for Payer: Aetna American Axle |
$22.52
|
| Rate for Payer: Aetna American Axle |
$12.71
|
| Rate for Payer: Aetna American Axle |
$14.95
|
| Rate for Payer: Aetna American Axle |
$29.80
|
| Rate for Payer: Aetna American Axle |
$218.66
|
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: Aetna Commercial |
$16.62
|
| Rate for Payer: Aetna Commercial |
$38.97
|
| Rate for Payer: Aetna Commercial |
$285.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.95
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$36.68
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$269.12
|
| Rate for Payer: Cash Price |
$15.64
|
| Rate for Payer: Cofinity Commercial |
$32.09
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Cofinity Commercial |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$24.25
|
| Rate for Payer: Cofinity Commercial |
$235.48
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Cofinity Commercial |
$289.30
|
| Rate for Payer: Cofinity Commercial |
$16.81
|
| Rate for Payer: Cofinity Commercial |
$39.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.12
|
| Rate for Payer: Healthscope Commercial |
$20.70
|
| Rate for Payer: Healthscope Commercial |
$31.18
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Commercial |
$41.27
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.62
|
| Rate for Payer: PHP Commercial |
$16.62
|
| Rate for Payer: PHP Commercial |
$38.97
|
| Rate for Payer: PHP Commercial |
$285.94
|
| Rate for Payer: PHP Commercial |
$29.45
|
| Rate for Payer: PHP Commercial |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.71
|
| Rate for Payer: Priority Health SBD |
$28.89
|
| Rate for Payer: Priority Health SBD |
$211.93
|
| Rate for Payer: Priority Health SBD |
$14.49
|
| Rate for Payer: Priority Health SBD |
$12.32
|
| Rate for Payer: Priority Health SBD |
$21.83
|
| Rate for Payer: UMR Bronson Commercial |
$8.60
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
| Rate for Payer: UMR Bronson Commercial |
$15.25
|
| Rate for Payer: UMR Bronson Commercial |
$20.17
|
| Rate for Payer: UMR Bronson Commercial |
$148.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.99
|
|
|
GENTAMICIN 40 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
3426
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna American Axle |
$14.95
|
| Rate for Payer: Aetna American Axle |
$22.52
|
| Rate for Payer: Aetna American Axle |
$29.80
|
| Rate for Payer: Aetna American Axle |
$12.71
|
| Rate for Payer: Aetna American Axle |
$218.66
|
| Rate for Payer: Aetna Commercial |
$16.62
|
| Rate for Payer: Aetna Commercial |
$38.97
|
| Rate for Payer: Aetna Commercial |
$285.94
|
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: Aetna Medicare |
$17.32
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: Aetna Medicare |
$22.93
|
| Rate for Payer: Aetna Medicare |
$168.20
|
| Rate for Payer: Aetna Medicare |
$9.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.52
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS Complete |
$7.82
|
| Rate for Payer: BCBS Complete |
$13.86
|
| Rate for Payer: BCBS Complete |
$134.56
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: Cash Price |
$36.68
|
| Rate for Payer: Cash Price |
$15.64
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$27.72
|
| Rate for Payer: Cash Price |
$269.12
|
| Rate for Payer: Cofinity Commercial |
$32.09
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Cofinity Commercial |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Cofinity Commercial |
$289.30
|
| Rate for Payer: Cofinity Commercial |
$235.48
|
| Rate for Payer: Cofinity Commercial |
$24.25
|
| Rate for Payer: Cofinity Commercial |
$16.81
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$39.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.12
|
| Rate for Payer: Healthscope Commercial |
$17.59
|
| Rate for Payer: Healthscope Commercial |
$302.76
|
| Rate for Payer: Healthscope Commercial |
$41.27
|
| Rate for Payer: Healthscope Commercial |
$31.18
|
| Rate for Payer: Healthscope Commercial |
$20.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.97
|
| Rate for Payer: PHP Commercial |
$29.45
|
| Rate for Payer: PHP Commercial |
$285.94
|
| Rate for Payer: PHP Commercial |
$16.62
|
| Rate for Payer: PHP Commercial |
$19.55
|
| Rate for Payer: PHP Commercial |
$38.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health SBD |
$14.49
|
| Rate for Payer: Priority Health SBD |
$12.32
|
| Rate for Payer: Priority Health SBD |
$211.93
|
| Rate for Payer: Priority Health SBD |
$21.83
|
| Rate for Payer: Priority Health SBD |
$28.89
|
| Rate for Payer: UMR Bronson Commercial |
$16.96
|
| Rate for Payer: UMR Bronson Commercial |
$12.82
|
| Rate for Payer: UMR Bronson Commercial |
$8.51
|
| Rate for Payer: UMR Bronson Commercial |
$7.23
|
| Rate for Payer: UMR Bronson Commercial |
$124.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.30
|
|
|
GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
15906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
15906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$62.93 |
| Rate for Payer: Aetna American Axle |
$45.45
|
| Rate for Payer: Aetna Commercial |
$59.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.45
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$48.94
|
| Rate for Payer: Cofinity Commercial |
$60.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$62.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: PHP Commercial |
$59.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health SBD |
$44.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.44
|
|
|
GENTAMICIN 9 MG/ML FORTIFIED OPHTHAMIC DROPS
|
Facility
|
OP
|
$177.35
|
|
|
Service Code
|
NDC 09900000087
|
| Hospital Charge Code |
500592
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.62 |
| Max. Negotiated Rate |
$159.62 |
| Rate for Payer: Aetna American Axle |
$115.28
|
| Rate for Payer: Aetna Commercial |
$150.75
|
| Rate for Payer: Aetna Medicare |
$88.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.28
|
| Rate for Payer: BCBS Complete |
$70.94
|
| Rate for Payer: Cash Price |
$141.88
|
| Rate for Payer: Cofinity Commercial |
$124.14
|
| Rate for Payer: Cofinity Commercial |
$152.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.88
|
| Rate for Payer: Healthscope Commercial |
$159.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.75
|
| Rate for Payer: PHP Commercial |
$150.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.28
|
| Rate for Payer: Priority Health SBD |
$111.73
|
| Rate for Payer: UMR Bronson Commercial |
$65.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.01
|
|
|
GENTAMICIN 9 MG/ML FORTIFIED OPHTHAMIC DROPS
|
Facility
|
IP
|
$177.35
|
|
|
Service Code
|
NDC 09900000087
|
| Hospital Charge Code |
500592
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.03 |
| Max. Negotiated Rate |
$159.62 |
| Rate for Payer: Aetna American Axle |
$115.28
|
| Rate for Payer: Aetna Commercial |
$150.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.28
|
| Rate for Payer: Cash Price |
$141.88
|
| Rate for Payer: Cofinity Commercial |
$124.14
|
| Rate for Payer: Cofinity Commercial |
$152.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.88
|
| Rate for Payer: Healthscope Commercial |
$159.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.75
|
| Rate for Payer: PHP Commercial |
$150.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.28
|
| Rate for Payer: Priority Health SBD |
$111.73
|
| Rate for Payer: UMR Bronson Commercial |
$78.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.01
|
|
|
GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$27.93
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
117665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna American Axle |
$18.15
|
| Rate for Payer: Aetna Commercial |
$23.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.15
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cofinity Commercial |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$24.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$25.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.74
|
| Rate for Payer: PHP Commercial |
$23.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.15
|
| Rate for Payer: Priority Health SBD |
$17.60
|
| Rate for Payer: UMR Bronson Commercial |
$12.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.95
|
|
|
GENTAMICIN SULFATE (PEDIATRIC) (PF) 20 MG/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$27.93
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
117665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna American Axle |
$18.15
|
| Rate for Payer: Aetna Commercial |
$23.74
|
| Rate for Payer: Aetna Medicare |
$13.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.15
|
| Rate for Payer: BCBS Complete |
$11.17
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cofinity Commercial |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$24.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$25.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.74
|
| Rate for Payer: PHP Commercial |
$23.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.15
|
| Rate for Payer: Priority Health SBD |
$17.60
|
| Rate for Payer: UMR Bronson Commercial |
$10.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.95
|
|
|
GIVOSIRAN 189 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$107,575.00
|
|
|
Service Code
|
HCPCS J0223
|
| Hospital Charge Code |
192158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.90 |
| Max. Negotiated Rate |
$96,817.50 |
| Rate for Payer: Aetna American Axle |
$69,923.75
|
| Rate for Payer: Aetna Commercial |
$91,438.75
|
| Rate for Payer: Aetna Medicare |
$122.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69,923.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.70
|
| Rate for Payer: BCBS Complete |
$66.05
|
| Rate for Payer: BCBS MAPPO |
$117.36
|
| Rate for Payer: BCN Medicare Advantage |
$117.36
|
| Rate for Payer: Cash Price |
$86,060.00
|
| Rate for Payer: Cash Price |
$86,060.00
|
| Rate for Payer: Cofinity Commercial |
$92,514.50
|
| Rate for Payer: Cofinity Commercial |
$75,302.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$75,302.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86,060.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.36
|
| Rate for Payer: Healthscope Commercial |
$96,817.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75,302.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80,681.25
|
| Rate for Payer: Mclaren Medicaid |
$62.90
|
| Rate for Payer: Mclaren Medicare |
$117.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.23
|
| Rate for Payer: Meridian Medicaid |
$66.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91,438.75
|
| Rate for Payer: PACE Medicare |
$111.49
|
| Rate for Payer: PACE SWMI |
$117.36
|
| Rate for Payer: PHP Commercial |
$91,438.75
|
| Rate for Payer: PHP Medicare Advantage |
$117.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69,923.75
|
| Rate for Payer: Priority Health Medicare |
$117.36
|
| Rate for Payer: Priority Health SBD |
$67,772.25
|
| Rate for Payer: Railroad Medicare Medicare |
$117.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.36
|
| Rate for Payer: UHC Exchange |
$224.29
|
| Rate for Payer: UHC Medicare Advantage |
$117.36
|
| Rate for Payer: UHCCP Medicaid |
$62.90
|
| Rate for Payer: UMR Bronson Commercial |
$39,802.75
|
| Rate for Payer: VA VA |
$117.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80,681.25
|
|
|
GIVOSIRAN 189 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$107,575.00
|
|
|
Service Code
|
HCPCS J0223
|
| Hospital Charge Code |
192158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47,333.00 |
| Max. Negotiated Rate |
$96,817.50 |
| Rate for Payer: Aetna American Axle |
$69,923.75
|
| Rate for Payer: Aetna Commercial |
$91,438.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69,923.75
|
| Rate for Payer: Cash Price |
$86,060.00
|
| Rate for Payer: Cofinity Commercial |
$75,302.50
|
| Rate for Payer: Cofinity Commercial |
$92,514.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$75,302.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86,060.00
|
| Rate for Payer: Healthscope Commercial |
$96,817.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75,302.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80,681.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91,438.75
|
| Rate for Payer: PHP Commercial |
$91,438.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69,923.75
|
| Rate for Payer: Priority Health SBD |
$67,772.25
|
| Rate for Payer: UMR Bronson Commercial |
$47,333.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80,681.25
|
|
