|
IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
27737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna American Axle |
$27.30
|
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health SBD |
$26.46
|
| Rate for Payer: UMR Bronson Commercial |
$18.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10328
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna American Axle |
$1.16
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna Commercial |
$1.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.53
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$1.25
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Healthscope Commercial |
$1.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.51
|
| Rate for Payer: PHP Commercial |
$1.51
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.25
|
| Rate for Payer: Priority Health SBD |
$1.12
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UMR Bronson Commercial |
$77.00
|
| Rate for Payer: UMR Bronson Commercial |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
IOPAMIDOL 61 % ORAL SOLUTION
|
Facility
|
IP
|
$11.20
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
180462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna American Axle |
$7.28
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.84
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
IPILIMUMAB 200 MG/40 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$88,737.69
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.31 |
| Max. Negotiated Rate |
$79,863.92 |
| Rate for Payer: Aetna American Axle |
$57,679.50
|
| Rate for Payer: Aetna Commercial |
$75,427.04
|
| Rate for Payer: Aetna Medicare |
$179.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57,679.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.52
|
| Rate for Payer: BCBS Complete |
$99.04
|
| Rate for Payer: BCBS MAPPO |
$172.42
|
| Rate for Payer: BCBS Trust/PPO |
$557.17
|
| Rate for Payer: BCN Medicare Advantage |
$172.42
|
| Rate for Payer: Cash Price |
$70,990.15
|
| Rate for Payer: Cash Price |
$70,990.15
|
| Rate for Payer: Cofinity Commercial |
$76,314.41
|
| Rate for Payer: Cofinity Commercial |
$62,116.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70,990.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.42
|
| Rate for Payer: Healthscope Commercial |
$79,863.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62,116.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66,553.27
|
| Rate for Payer: Mclaren Medicaid |
$94.31
|
| Rate for Payer: Mclaren Medicare |
$172.42
|
| Rate for Payer: Meridian Medicaid |
$99.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75,427.04
|
| Rate for Payer: PACE Medicare |
$163.80
|
| Rate for Payer: PACE SWMI |
$172.42
|
| Rate for Payer: PHP Commercial |
$75,427.04
|
| Rate for Payer: PHP Medicare Advantage |
$172.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62,116.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.04
|
| Rate for Payer: Priority Health Medicare |
$172.42
|
| Rate for Payer: Priority Health Narrow Network |
$396.03
|
| Rate for Payer: Priority Health SBD |
$55,904.74
|
| Rate for Payer: Railroad Medicare Medicare |
$172.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.42
|
| Rate for Payer: UHC Medicare Advantage |
$177.59
|
| Rate for Payer: UMR Bronson Commercial |
$32,832.95
|
| Rate for Payer: VA VA |
$172.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66,553.27
|
|
|
IPILIMUMAB 200 MG/40 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$88,737.69
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39,044.58 |
| Max. Negotiated Rate |
$79,863.92 |
| Rate for Payer: Aetna American Axle |
$57,679.50
|
| Rate for Payer: Aetna Commercial |
$75,427.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57,679.50
|
| Rate for Payer: Cash Price |
$70,990.15
|
| Rate for Payer: Cofinity Commercial |
$62,116.38
|
| Rate for Payer: Cofinity Commercial |
$76,314.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70,990.15
|
| Rate for Payer: Healthscope Commercial |
$79,863.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62,116.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66,553.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75,427.04
|
| Rate for Payer: PHP Commercial |
$75,427.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62,116.38
|
| Rate for Payer: Priority Health SBD |
$55,904.74
|
| Rate for Payer: UMR Bronson Commercial |
$39,044.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66,553.27
|
|
|
IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22,184.48
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,761.17 |
| Max. Negotiated Rate |
$19,966.03 |
| Rate for Payer: Aetna American Axle |
$14,419.91
|
| Rate for Payer: Aetna Commercial |
$18,856.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,419.91
|
| Rate for Payer: Cash Price |
$17,747.58
|
| Rate for Payer: Cofinity Commercial |
$15,529.14
|
| Rate for Payer: Cofinity Commercial |
$19,078.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,747.58
|
| Rate for Payer: Healthscope Commercial |
$19,966.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,529.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,638.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18,856.81
|
| Rate for Payer: PHP Commercial |
$18,856.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,529.14
|
| Rate for Payer: Priority Health SBD |
$13,976.22
|
| Rate for Payer: UMR Bronson Commercial |
$9,761.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,638.36
|
|
|
IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22,184.48
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.31 |
| Max. Negotiated Rate |
$19,966.03 |
| Rate for Payer: Aetna American Axle |
$14,419.91
|
| Rate for Payer: Aetna Commercial |
$18,856.81
|
| Rate for Payer: Aetna Medicare |
$179.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,419.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.52
|
| Rate for Payer: BCBS Complete |
$99.04
|
| Rate for Payer: BCBS MAPPO |
$172.42
|
| Rate for Payer: BCBS Trust/PPO |
$557.17
|
| Rate for Payer: BCN Medicare Advantage |
$172.42
|
| Rate for Payer: Cash Price |
$17,747.58
|
| Rate for Payer: Cash Price |
$17,747.58
|
| Rate for Payer: Cofinity Commercial |
$15,529.14
|
| Rate for Payer: Cofinity Commercial |
$19,078.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,747.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.42
|
| Rate for Payer: Healthscope Commercial |
$19,966.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,529.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,638.36
|
| Rate for Payer: Mclaren Medicaid |
$94.31
|
| Rate for Payer: Mclaren Medicare |
$172.42
|
| Rate for Payer: Meridian Medicaid |
$99.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18,856.81
|
| Rate for Payer: PACE Medicare |
$163.80
|
| Rate for Payer: PACE SWMI |
$172.42
|
| Rate for Payer: PHP Commercial |
$18,856.81
|
| Rate for Payer: PHP Medicare Advantage |
$172.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,529.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.04
|
| Rate for Payer: Priority Health Medicare |
$172.42
|
| Rate for Payer: Priority Health Narrow Network |
$396.03
|
| Rate for Payer: Priority Health SBD |
$13,976.22
|
| Rate for Payer: Railroad Medicare Medicare |
$172.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.42
|
| Rate for Payer: UHC Medicare Advantage |
$177.59
|
| Rate for Payer: UMR Bronson Commercial |
$8,208.26
|
| Rate for Payer: VA VA |
$172.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,638.36
|
|
|
IPL CHEEKS FIRST
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 00126
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
IPL CHEST FIRST
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00128
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: UMR Bronson Commercial |
$138.00
|
|
|
IPL CHEST SECOND
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 00129
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: UMR Bronson Commercial |
$92.00
|
|
|
IPL FACE FIRST
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 00130
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$103.50
|
|
|
IPL FACE, NECK, CHEST FIRST
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 00132
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: UMR Bronson Commercial |
$184.00
|
|
|
IPL FACE, NECK, CHEST SECOND
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 00133
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: UMR Bronson Commercial |
$126.50
|
|
|
IPL FACE & NECK FIRST
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00134
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: UMR Bronson Commercial |
$115.00
|
|
|
IPL FACE & NECK SECOND
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 00135
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: UMR Bronson Commercial |
$80.50
|
|
|
IPL FACE SECOND
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 00131
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
|
|
IPL HANDS & ARMS FIRST
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 00136
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: UMR Bronson Commercial |
$161.00
|
|
|
IPL HANDS & ARMS SECOND
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 00137
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$103.50
|
|
|
IPL NECK
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 00138
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
|
|
IPL NOSE & CHEEKS FIRST
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 00127
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: UMR Bronson Commercial |
$69.00
|
|
|
IPRATROPIUM 0.5 MG-ALBUTEROL 3 MG (2.5 MG BASE)/3 ML NEBULIZATION SOLN
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
HCPCS J7620
|
| Hospital Charge Code |
30510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna American Axle |
$2.89
|
| Rate for Payer: Aetna American Axle |
$2.66
|
| Rate for Payer: Aetna American Axle |
$2.87
|
| Rate for Payer: Aetna American Axle |
$1.93
|
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna American Axle |
$2.15
|
| Rate for Payer: Aetna American Axle |
$2.04
|
| Rate for Payer: Aetna American Axle |
$1.95
|
| Rate for Payer: Aetna American Axle |
$2.30
|
| Rate for Payer: Aetna American Axle |
$2.35
|
| Rate for Payer: Aetna Commercial |
$2.55
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: Aetna Commercial |
$3.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.30
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cash Price |
$2.83
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$3.11
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$2.83
|
| Rate for Payer: Healthscope Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Healthscope Commercial |
$2.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.26
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: PHP Commercial |
$2.55
|
| Rate for Payer: PHP Commercial |
$2.67
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.76
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: PHP Commercial |
$3.01
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: PHP Commercial |
$3.08
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.12
|
| Rate for Payer: Priority Health SBD |
$2.28
|
| Rate for Payer: Priority Health SBD |
$1.98
|
| Rate for Payer: Priority Health SBD |
$2.23
|
| Rate for Payer: Priority Health SBD |
$1.87
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.89
|
| Rate for Payer: Priority Health SBD |
$2.09
|
| Rate for Payer: Priority Health SBD |
$2.78
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.94
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: UMR Bronson Commercial |
$1.96
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: UMR Bronson Commercial |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: UMR Bronson Commercial |
$1.46
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
|
|
IPRATROPIUM BROMIDE 0.02 % SOLUTION FOR INHALATION
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
HCPCS J7644
|
| Hospital Charge Code |
12580
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$3.44 |
| Rate for Payer: Aetna American Axle |
$2.48
|
| Rate for Payer: Aetna American Axle |
$2.14
|
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna American Axle |
$2.64
|
| Rate for Payer: Aetna American Axle |
$2.60
|
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Commercial |
$3.25
|
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.45
|
| Rate for Payer: PHP Commercial |
$3.45
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.25
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.21
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: Priority Health SBD |
$2.37
|
| Rate for Payer: Priority Health SBD |
$2.52
|
| Rate for Payer: Priority Health SBD |
$2.07
|
| Rate for Payer: Priority Health SBD |
$2.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: UMR Bronson Commercial |
$1.79
|
| Rate for Payer: UMR Bronson Commercial |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.45
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.82
|
|
|
IPRATROPIUM BROMIDE 17 MCG/ACTUATION HFA AEROSOL INHALER
|
Facility
|
IP
|
$1,624.40
|
|
|
Service Code
|
NDC 0597-0087-17
|
| Hospital Charge Code |
41142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$714.74 |
| Max. Negotiated Rate |
$1,461.96 |
| Rate for Payer: Aetna American Axle |
$1,055.86
|
| Rate for Payer: Aetna Commercial |
$1,380.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.86
|
| Rate for Payer: Cash Price |
$1,299.52
|
| Rate for Payer: Cofinity Commercial |
$1,137.08
|
| Rate for Payer: Cofinity Commercial |
$1,396.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,299.52
|
| Rate for Payer: Healthscope Commercial |
$1,461.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,137.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,218.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,380.74
|
| Rate for Payer: PHP Commercial |
$1,380.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.08
|
| Rate for Payer: Priority Health SBD |
$1,023.37
|
| Rate for Payer: UMR Bronson Commercial |
$714.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,218.30
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
IP
|
$60.90
|
|
|
Service Code
|
NDC 69238-2016-3
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$54.81 |
| Rate for Payer: Aetna American Axle |
$39.58
|
| Rate for Payer: Aetna Commercial |
$51.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.58
|
| Rate for Payer: Cash Price |
$48.72
|
| Rate for Payer: Cofinity Commercial |
$42.63
|
| Rate for Payer: Cofinity Commercial |
$52.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.72
|
| Rate for Payer: Healthscope Commercial |
$54.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.76
|
| Rate for Payer: PHP Commercial |
$51.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.63
|
| Rate for Payer: Priority Health SBD |
$38.37
|
| Rate for Payer: UMR Bronson Commercial |
$26.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.68
|
|
|
IPRATROPIUM BROMIDE 21 MCG (0.03 %) NASAL SPRAY
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
NDC 0054-0045-44
|
| Hospital Charge Code |
16070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna American Axle |
$81.90
|
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Cofinity Commercial |
$88.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.10
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| Rate for Payer: UMR Bronson Commercial |
$55.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
|
