|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 0904-5853-61
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.18 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna American Axle |
$97.76
|
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.76
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.84
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.28
|
| Rate for Payer: Priority Health SBD |
$94.75
|
| Rate for Payer: UMR Bronson Commercial |
$66.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$164.50
|
|
|
Service Code
|
NDC 63739-684-10
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna American Axle |
$106.92
|
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.92
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$115.15
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.82
|
| Rate for Payer: PHP Commercial |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.15
|
| Rate for Payer: Priority Health SBD |
$103.64
|
| Rate for Payer: UMR Bronson Commercial |
$72.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.38
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 55111-683-01
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.86
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.74
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.08
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UMR Bronson Commercial |
$107.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 0904-5854-61
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.69 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.80
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.96
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$81.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 67877-320-01
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna American Axle |
$105.40
|
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.83
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.50
|
| Rate for Payer: Priority Health SBD |
$102.15
|
| Rate for Payer: UMR Bronson Commercial |
$71.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 60687-457-01
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.57
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.94
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: UMR Bronson Commercial |
$177.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$4.05
|
|
|
Service Code
|
NDC 60687-457-11
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna American Axle |
$2.63
|
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health SBD |
$2.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 0904-5854-60
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$136.54
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.79
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.54
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$85.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$333.70
|
|
|
Service Code
|
NDC 55111-684-01
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.83 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna American Axle |
$216.90
|
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.90
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$233.59
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.64
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.59
|
| Rate for Payer: Priority Health SBD |
$210.23
|
| Rate for Payer: UMR Bronson Commercial |
$146.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 0904-5855-61
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Aetna American Axle |
$10.54
|
| Rate for Payer: Aetna Commercial |
$13.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.54
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$13.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$14.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.79
|
| Rate for Payer: PHP Commercial |
$13.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.35
|
| Rate for Payer: Priority Health SBD |
$10.22
|
| Rate for Payer: UMR Bronson Commercial |
$7.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.16
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 63739-691-10
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.69 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.80
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.96
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$81.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 67877-296-01
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.60
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.60
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.41
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 0904-5855-60
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.14
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.14
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.53
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$117.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$885.22
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
76780
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$389.50 |
| Max. Negotiated Rate |
$796.70 |
| Rate for Payer: Aetna American Axle |
$575.39
|
| Rate for Payer: Aetna American Axle |
$571.37
|
| Rate for Payer: Aetna Commercial |
$747.18
|
| Rate for Payer: Aetna Commercial |
$752.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$571.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.39
|
| Rate for Payer: Cash Price |
$703.22
|
| Rate for Payer: Cash Price |
$708.18
|
| Rate for Payer: Cofinity Commercial |
$755.97
|
| Rate for Payer: Cofinity Commercial |
$615.32
|
| Rate for Payer: Cofinity Commercial |
$761.29
|
| Rate for Payer: Cofinity Commercial |
$619.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$703.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.18
|
| Rate for Payer: Healthscope Commercial |
$796.70
|
| Rate for Payer: Healthscope Commercial |
$791.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$615.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$619.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$659.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$663.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$747.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$752.44
|
| Rate for Payer: PHP Commercial |
$752.44
|
| Rate for Payer: PHP Commercial |
$747.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.65
|
| Rate for Payer: Priority Health SBD |
$553.79
|
| Rate for Payer: Priority Health SBD |
$557.69
|
| Rate for Payer: UMR Bronson Commercial |
$386.77
|
| Rate for Payer: UMR Bronson Commercial |
$389.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$659.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$663.92
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$269.20
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
16156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.45 |
| Max. Negotiated Rate |
$242.28 |
| Rate for Payer: Aetna American Axle |
$174.98
|
| Rate for Payer: Aetna Commercial |
$228.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.98
|
| Rate for Payer: Cash Price |
$215.36
|
| Rate for Payer: Cofinity Commercial |
$188.44
|
| Rate for Payer: Cofinity Commercial |
$231.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.36
|
| Rate for Payer: Healthscope Commercial |
$242.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.82
|
| Rate for Payer: PHP Commercial |
$228.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.44
|
| Rate for Payer: Priority Health SBD |
$169.60
|
| Rate for Payer: UMR Bronson Commercial |
$118.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.90
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$899.38
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
22144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.73 |
| Max. Negotiated Rate |
$809.44 |
| Rate for Payer: Aetna American Axle |
$584.60
|
| Rate for Payer: Aetna American Axle |
$309.89
|
| Rate for Payer: Aetna American Axle |
$497.80
|
| Rate for Payer: Aetna Commercial |
$405.24
|
| Rate for Payer: Aetna Commercial |
$650.97
|
| Rate for Payer: Aetna Commercial |
$764.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.80
|
| Rate for Payer: BCBS Complete |
$359.75
|
| Rate for Payer: BCBS Complete |
$306.34
|
| Rate for Payer: BCBS Complete |
$190.70
|
| Rate for Payer: BCBS Trust/PPO |
$138.73
|
| Rate for Payer: BCBS Trust/PPO |
$138.73
|
| Rate for Payer: BCBS Trust/PPO |
$138.73
|
| Rate for Payer: Cash Price |
$612.68
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cash Price |
$381.40
|
| Rate for Payer: Cash Price |
$612.68
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cash Price |
$381.40
|
| Rate for Payer: Cofinity Commercial |
$410.00
|
| Rate for Payer: Cofinity Commercial |
$773.47
|
| Rate for Payer: Cofinity Commercial |
$629.57
|
| Rate for Payer: Cofinity Commercial |
$536.10
|
| Rate for Payer: Cofinity Commercial |
$658.63
|
| Rate for Payer: Cofinity Commercial |
$333.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.40
|
| Rate for Payer: Healthscope Commercial |
$429.08
|
| Rate for Payer: Healthscope Commercial |
$689.26
|
| Rate for Payer: Healthscope Commercial |
$809.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$650.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$764.47
|
| Rate for Payer: PHP Commercial |
$405.24
|
| Rate for Payer: PHP Commercial |
$764.47
|
| Rate for Payer: PHP Commercial |
$650.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.57
|
| Rate for Payer: Priority Health SBD |
$300.35
|
| Rate for Payer: Priority Health SBD |
$482.49
|
| Rate for Payer: Priority Health SBD |
$566.61
|
| Rate for Payer: UMR Bronson Commercial |
$176.40
|
| Rate for Payer: UMR Bronson Commercial |
$283.36
|
| Rate for Payer: UMR Bronson Commercial |
$332.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.56
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$899.38
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
22144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$395.73 |
| Max. Negotiated Rate |
$809.44 |
| Rate for Payer: Aetna American Axle |
$584.60
|
| Rate for Payer: Aetna American Axle |
$497.80
|
| Rate for Payer: Aetna Commercial |
$650.97
|
| Rate for Payer: Aetna Commercial |
$764.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.60
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cash Price |
$612.68
|
| Rate for Payer: Cofinity Commercial |
$536.10
|
| Rate for Payer: Cofinity Commercial |
$773.47
|
| Rate for Payer: Cofinity Commercial |
$629.57
|
| Rate for Payer: Cofinity Commercial |
$658.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.50
|
| Rate for Payer: Healthscope Commercial |
$809.44
|
| Rate for Payer: Healthscope Commercial |
$689.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$650.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$764.47
|
| Rate for Payer: PHP Commercial |
$650.97
|
| Rate for Payer: PHP Commercial |
$764.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.57
|
| Rate for Payer: Priority Health SBD |
$482.49
|
| Rate for Payer: Priority Health SBD |
$566.61
|
| Rate for Payer: UMR Bronson Commercial |
$336.97
|
| Rate for Payer: UMR Bronson Commercial |
$395.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.54
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,098.12
|
|
|
Service Code
|
NDC 0597-0197-05
|
| Hospital Charge Code |
176112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,003.17 |
| Max. Negotiated Rate |
$8,188.31 |
| Rate for Payer: Aetna American Axle |
$5,913.78
|
| Rate for Payer: Aetna Commercial |
$7,733.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,913.78
|
| Rate for Payer: Cash Price |
$7,278.50
|
| Rate for Payer: Cofinity Commercial |
$6,368.68
|
| Rate for Payer: Cofinity Commercial |
$7,824.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,278.50
|
| Rate for Payer: Healthscope Commercial |
$8,188.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,368.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,823.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,733.40
|
| Rate for Payer: PHP Commercial |
$7,733.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,368.68
|
| Rate for Payer: Priority Health SBD |
$5,731.82
|
| Rate for Payer: UMR Bronson Commercial |
$4,003.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,823.59
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$498.95
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.54 |
| Max. Negotiated Rate |
$449.06 |
| Rate for Payer: Aetna American Axle |
$324.32
|
| Rate for Payer: Aetna American Axle |
$175.43
|
| Rate for Payer: Aetna Commercial |
$424.11
|
| Rate for Payer: Aetna Commercial |
$229.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.32
|
| Rate for Payer: Cash Price |
$399.16
|
| Rate for Payer: Cash Price |
$215.91
|
| Rate for Payer: Cofinity Commercial |
$429.10
|
| Rate for Payer: Cofinity Commercial |
$349.26
|
| Rate for Payer: Cofinity Commercial |
$188.92
|
| Rate for Payer: Cofinity Commercial |
$232.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.91
|
| Rate for Payer: Healthscope Commercial |
$449.06
|
| Rate for Payer: Healthscope Commercial |
$242.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$424.11
|
| Rate for Payer: PHP Commercial |
$424.11
|
| Rate for Payer: PHP Commercial |
$229.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.26
|
| Rate for Payer: Priority Health SBD |
$170.03
|
| Rate for Payer: Priority Health SBD |
$314.34
|
| Rate for Payer: UMR Bronson Commercial |
$219.54
|
| Rate for Payer: UMR Bronson Commercial |
$118.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.21
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$269.89
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.43 |
| Max. Negotiated Rate |
$242.90 |
| Rate for Payer: Aetna American Axle |
$175.43
|
| Rate for Payer: Aetna Commercial |
$229.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.43
|
| Rate for Payer: BCBS Complete |
$107.96
|
| Rate for Payer: BCBS Trust/PPO |
$86.43
|
| Rate for Payer: Cash Price |
$215.91
|
| Rate for Payer: Cash Price |
$215.91
|
| Rate for Payer: Cofinity Commercial |
$188.92
|
| Rate for Payer: Cofinity Commercial |
$232.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.91
|
| Rate for Payer: Healthscope Commercial |
$242.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.41
|
| Rate for Payer: PHP Commercial |
$229.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.92
|
| Rate for Payer: Priority Health SBD |
$170.03
|
| Rate for Payer: UMR Bronson Commercial |
$99.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.42
|
|
|
IFOSFAMIDE 3 GRAM/60 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$925.19
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
87926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.43 |
| Max. Negotiated Rate |
$832.67 |
| Rate for Payer: Aetna American Axle |
$601.37
|
| Rate for Payer: Aetna Commercial |
$786.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.37
|
| Rate for Payer: BCBS Complete |
$370.08
|
| Rate for Payer: BCBS Trust/PPO |
$86.43
|
| Rate for Payer: Cash Price |
$740.15
|
| Rate for Payer: Cash Price |
$740.15
|
| Rate for Payer: Cofinity Commercial |
$647.63
|
| Rate for Payer: Cofinity Commercial |
$795.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.15
|
| Rate for Payer: Healthscope Commercial |
$832.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$647.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$786.41
|
| Rate for Payer: PHP Commercial |
$786.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.63
|
| Rate for Payer: Priority Health SBD |
$582.87
|
| Rate for Payer: UMR Bronson Commercial |
$342.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.89
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$766.64
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.43 |
| Max. Negotiated Rate |
$689.98 |
| Rate for Payer: Aetna American Axle |
$498.32
|
| Rate for Payer: Aetna Commercial |
$651.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.32
|
| Rate for Payer: BCBS Complete |
$306.66
|
| Rate for Payer: BCBS Trust/PPO |
$86.43
|
| Rate for Payer: Cash Price |
$613.31
|
| Rate for Payer: Cash Price |
$613.31
|
| Rate for Payer: Cofinity Commercial |
$659.31
|
| Rate for Payer: Cofinity Commercial |
$536.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$613.31
|
| Rate for Payer: Healthscope Commercial |
$689.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$651.64
|
| Rate for Payer: PHP Commercial |
$651.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.65
|
| Rate for Payer: Priority Health SBD |
$482.98
|
| Rate for Payer: UMR Bronson Commercial |
$283.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.98
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$766.64
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$337.32 |
| Max. Negotiated Rate |
$689.98 |
| Rate for Payer: Aetna American Axle |
$498.32
|
| Rate for Payer: Aetna Commercial |
$651.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.32
|
| Rate for Payer: Cash Price |
$613.31
|
| Rate for Payer: Cofinity Commercial |
$536.65
|
| Rate for Payer: Cofinity Commercial |
$659.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$613.31
|
| Rate for Payer: Healthscope Commercial |
$689.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$651.64
|
| Rate for Payer: PHP Commercial |
$651.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.65
|
| Rate for Payer: Priority Health SBD |
$482.98
|
| Rate for Payer: UMR Bronson Commercial |
$337.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.98
|
|
|
ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 44382
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$72.04 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.10
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.24
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Exchange |
$72.04
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE
|
Facility
|
OP
|
$3,645.32
|
|
|
Service Code
|
CPT 44310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,018.34 |
| Max. Negotiated Rate |
$3,645.32 |
| Rate for Payer: BCBS Trust/PPO |
$3,645.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,120.17
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$1,018.34
|
|
