|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
IP
|
$125.95
|
|
|
Service Code
|
NDC 0054-0046-41
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$113.36 |
| Rate for Payer: Aetna American Axle |
$81.87
|
| Rate for Payer: Aetna Commercial |
$107.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.87
|
| Rate for Payer: Cash Price |
$100.76
|
| Rate for Payer: Cofinity Commercial |
$108.32
|
| Rate for Payer: Cofinity Commercial |
$88.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.76
|
| Rate for Payer: Healthscope Commercial |
$113.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.06
|
| Rate for Payer: PHP Commercial |
$107.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.16
|
| Rate for Payer: Priority Health SBD |
$79.35
|
| Rate for Payer: UMR Bronson Commercial |
$55.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.46
|
|
|
IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASAL SPRAY
|
Facility
|
IP
|
$121.38
|
|
|
Service Code
|
NDC 24208-399-15
|
| Hospital Charge Code |
16071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna American Axle |
$78.90
|
| Rate for Payer: Aetna Commercial |
$103.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.90
|
| Rate for Payer: Cash Price |
$97.10
|
| Rate for Payer: Cofinity Commercial |
$104.39
|
| Rate for Payer: Cofinity Commercial |
$84.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.10
|
| Rate for Payer: Healthscope Commercial |
$109.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.17
|
| Rate for Payer: PHP Commercial |
$103.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.97
|
| Rate for Payer: Priority Health SBD |
$76.47
|
| Rate for Payer: UMR Bronson Commercial |
$53.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.04
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$790.21
|
|
|
Service Code
|
NDC 0024-5851-30
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.69 |
| Max. Negotiated Rate |
$711.19 |
| Rate for Payer: Aetna American Axle |
$513.64
|
| Rate for Payer: Aetna Commercial |
$671.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.64
|
| Rate for Payer: Cash Price |
$632.17
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Cofinity Commercial |
$679.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.17
|
| Rate for Payer: Healthscope Commercial |
$711.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.68
|
| Rate for Payer: PHP Commercial |
$671.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health SBD |
$497.83
|
| Rate for Payer: UMR Bronson Commercial |
$347.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.66
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$79.67
|
|
|
Service Code
|
NDC 43547-375-03
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.05 |
| Max. Negotiated Rate |
$71.70 |
| Rate for Payer: Aetna American Axle |
$51.79
|
| Rate for Payer: Aetna Commercial |
$67.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.79
|
| Rate for Payer: Cash Price |
$63.74
|
| Rate for Payer: Cofinity Commercial |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$68.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.74
|
| Rate for Payer: Healthscope Commercial |
$71.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.72
|
| Rate for Payer: PHP Commercial |
$67.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.77
|
| Rate for Payer: Priority Health SBD |
$50.19
|
| Rate for Payer: UMR Bronson Commercial |
$35.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.75
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$351.09
|
|
|
Service Code
|
NDC 42658-122-04
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.48 |
| Max. Negotiated Rate |
$315.98 |
| Rate for Payer: Aetna American Axle |
$228.21
|
| Rate for Payer: Aetna Commercial |
$298.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.21
|
| Rate for Payer: Cash Price |
$280.87
|
| Rate for Payer: Cofinity Commercial |
$245.76
|
| Rate for Payer: Cofinity Commercial |
$301.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.87
|
| Rate for Payer: Healthscope Commercial |
$315.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.43
|
| Rate for Payer: PHP Commercial |
$298.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.76
|
| Rate for Payer: Priority Health SBD |
$221.19
|
| Rate for Payer: UMR Bronson Commercial |
$154.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.32
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$98.04
|
|
|
Service Code
|
NDC 59746-448-30
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.14 |
| Max. Negotiated Rate |
$88.24 |
| Rate for Payer: Aetna American Axle |
$63.73
|
| Rate for Payer: Aetna Commercial |
$83.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.73
|
| Rate for Payer: Cash Price |
$78.43
|
| Rate for Payer: Cofinity Commercial |
$68.63
|
| Rate for Payer: Cofinity Commercial |
$84.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.43
|
| Rate for Payer: Healthscope Commercial |
$88.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.33
|
| Rate for Payer: PHP Commercial |
$83.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.63
|
| Rate for Payer: Priority Health SBD |
$61.77
|
| Rate for Payer: UMR Bronson Commercial |
$43.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.53
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$98.04
|
|
|
Service Code
|
NDC 62332-042-30
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.14 |
| Max. Negotiated Rate |
$88.24 |
| Rate for Payer: Aetna American Axle |
$63.73
|
| Rate for Payer: Aetna Commercial |
$83.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.73
|
| Rate for Payer: Cash Price |
$78.43
|
| Rate for Payer: Cofinity Commercial |
$68.63
|
| Rate for Payer: Cofinity Commercial |
$84.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.43
|
| Rate for Payer: Healthscope Commercial |
$88.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.33
|
| Rate for Payer: PHP Commercial |
$83.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.63
|
| Rate for Payer: Priority Health SBD |
$61.77
|
| Rate for Payer: UMR Bronson Commercial |
$43.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.53
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$79.67
|
|
|
Service Code
|
NDC 43547-278-03
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.05 |
| Max. Negotiated Rate |
$71.70 |
| Rate for Payer: Aetna American Axle |
$51.79
|
| Rate for Payer: Aetna Commercial |
$67.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.79
|
| Rate for Payer: Cash Price |
$63.74
|
| Rate for Payer: Cofinity Commercial |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$68.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.74
|
| Rate for Payer: Healthscope Commercial |
$71.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.72
|
| Rate for Payer: PHP Commercial |
$67.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.77
|
| Rate for Payer: Priority Health SBD |
$50.19
|
| Rate for Payer: UMR Bronson Commercial |
$35.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.75
|
|
|
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; PERIPHERAL FOR GLAUCOMA (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 66625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$418.14 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,451.85
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.95
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Exchange |
$418.14
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$112.14
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
17450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$100.93 |
| Rate for Payer: Aetna American Axle |
$72.89
|
| Rate for Payer: Aetna American Axle |
$128.13
|
| Rate for Payer: Aetna American Axle |
$86.75
|
| Rate for Payer: Aetna American Axle |
$143.73
|
| Rate for Payer: Aetna American Axle |
$142.71
|
| Rate for Payer: Aetna Commercial |
$187.96
|
| Rate for Payer: Aetna Commercial |
$113.44
|
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna Commercial |
$95.32
|
| Rate for Payer: Aetna Commercial |
$186.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.75
|
| Rate for Payer: BCBS Complete |
$44.86
|
| Rate for Payer: BCBS Complete |
$88.45
|
| Rate for Payer: BCBS Complete |
$78.85
|
| Rate for Payer: BCBS Complete |
$87.82
|
| Rate for Payer: BCBS Complete |
$53.38
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Cash Price |
$106.77
|
| Rate for Payer: Cash Price |
$106.77
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cash Price |
$175.65
|
| Rate for Payer: Cash Price |
$175.65
|
| Rate for Payer: Cash Price |
$176.90
|
| Rate for Payer: Cash Price |
$176.90
|
| Rate for Payer: Cofinity Commercial |
$153.69
|
| Rate for Payer: Cofinity Commercial |
$154.79
|
| Rate for Payer: Cofinity Commercial |
$93.42
|
| Rate for Payer: Cofinity Commercial |
$114.78
|
| Rate for Payer: Cofinity Commercial |
$78.50
|
| Rate for Payer: Cofinity Commercial |
$96.44
|
| Rate for Payer: Cofinity Commercial |
$137.99
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Cofinity Commercial |
$190.17
|
| Rate for Payer: Cofinity Commercial |
$188.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.71
|
| Rate for Payer: Healthscope Commercial |
$197.60
|
| Rate for Payer: Healthscope Commercial |
$199.02
|
| Rate for Payer: Healthscope Commercial |
$120.11
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: Healthscope Commercial |
$100.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.32
|
| Rate for Payer: PHP Commercial |
$187.96
|
| Rate for Payer: PHP Commercial |
$113.44
|
| Rate for Payer: PHP Commercial |
$186.63
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: PHP Commercial |
$95.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.42
|
| Rate for Payer: Priority Health SBD |
$139.31
|
| Rate for Payer: Priority Health SBD |
$84.08
|
| Rate for Payer: Priority Health SBD |
$70.65
|
| Rate for Payer: Priority Health SBD |
$124.19
|
| Rate for Payer: Priority Health SBD |
$138.32
|
| Rate for Payer: UMR Bronson Commercial |
$41.49
|
| Rate for Payer: UMR Bronson Commercial |
$81.82
|
| Rate for Payer: UMR Bronson Commercial |
$72.94
|
| Rate for Payer: UMR Bronson Commercial |
$81.24
|
| Rate for Payer: UMR Bronson Commercial |
$49.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.67
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$333.95
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
17450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.94 |
| Max. Negotiated Rate |
$300.56 |
| Rate for Payer: Aetna American Axle |
$217.07
|
| Rate for Payer: Aetna American Axle |
$162.10
|
| Rate for Payer: Aetna Commercial |
$211.97
|
| Rate for Payer: Aetna Commercial |
$283.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.07
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$267.16
|
| Rate for Payer: Cofinity Commercial |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$174.57
|
| Rate for Payer: Cofinity Commercial |
$214.47
|
| Rate for Payer: Cofinity Commercial |
$233.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.16
|
| Rate for Payer: Healthscope Commercial |
$300.56
|
| Rate for Payer: Healthscope Commercial |
$224.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.86
|
| Rate for Payer: PHP Commercial |
$283.86
|
| Rate for Payer: PHP Commercial |
$211.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.76
|
| Rate for Payer: Priority Health SBD |
$157.11
|
| Rate for Payer: Priority Health SBD |
$210.39
|
| Rate for Payer: UMR Bronson Commercial |
$146.94
|
| Rate for Payer: UMR Bronson Commercial |
$109.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.46
|
|
|
IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$158.88
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
91055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$142.99 |
| Rate for Payer: Aetna American Axle |
$103.27
|
| Rate for Payer: Aetna American Axle |
$121.39
|
| Rate for Payer: Aetna American Axle |
$82.08
|
| Rate for Payer: Aetna American Axle |
$86.09
|
| Rate for Payer: Aetna Commercial |
$107.34
|
| Rate for Payer: Aetna Commercial |
$112.57
|
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna Commercial |
$135.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.27
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS Complete |
$50.51
|
| Rate for Payer: BCBS Complete |
$52.98
|
| Rate for Payer: BCBS Complete |
$63.55
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.28
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Cash Price |
$127.10
|
| Rate for Payer: Cash Price |
$127.10
|
| Rate for Payer: Cash Price |
$149.41
|
| Rate for Payer: Cofinity Commercial |
$111.22
|
| Rate for Payer: Cofinity Commercial |
$88.40
|
| Rate for Payer: Cofinity Commercial |
$92.71
|
| Rate for Payer: Cofinity Commercial |
$136.64
|
| Rate for Payer: Cofinity Commercial |
$113.90
|
| Rate for Payer: Cofinity Commercial |
$160.61
|
| Rate for Payer: Cofinity Commercial |
$130.73
|
| Rate for Payer: Cofinity Commercial |
$108.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.10
|
| Rate for Payer: Healthscope Commercial |
$168.08
|
| Rate for Payer: Healthscope Commercial |
$119.20
|
| Rate for Payer: Healthscope Commercial |
$142.99
|
| Rate for Payer: Healthscope Commercial |
$113.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.75
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: PHP Commercial |
$107.34
|
| Rate for Payer: PHP Commercial |
$112.57
|
| Rate for Payer: PHP Commercial |
$135.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.71
|
| Rate for Payer: Priority Health SBD |
$117.66
|
| Rate for Payer: Priority Health SBD |
$100.09
|
| Rate for Payer: Priority Health SBD |
$83.44
|
| Rate for Payer: Priority Health SBD |
$79.56
|
| Rate for Payer: UMR Bronson Commercial |
$69.10
|
| Rate for Payer: UMR Bronson Commercial |
$49.00
|
| Rate for Payer: UMR Bronson Commercial |
$46.72
|
| Rate for Payer: UMR Bronson Commercial |
$58.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.07
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS
|
Facility
|
OP
|
$12,419.34
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
176129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$11,177.41 |
| Rate for Payer: Aetna American Axle |
$8,072.57
|
| Rate for Payer: Aetna Commercial |
$10,556.44
|
| Rate for Payer: Aetna Medicare |
$64.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,072.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.52
|
| Rate for Payer: BCBS Complete |
$35.62
|
| Rate for Payer: BCBS MAPPO |
$62.02
|
| Rate for Payer: BCBS Trust/PPO |
$200.42
|
| Rate for Payer: BCN Medicare Advantage |
$62.02
|
| Rate for Payer: Cash Price |
$9,935.47
|
| Rate for Payer: Cash Price |
$9,935.47
|
| Rate for Payer: Cofinity Commercial |
$10,680.63
|
| Rate for Payer: Cofinity Commercial |
$8,693.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,935.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.02
|
| Rate for Payer: Healthscope Commercial |
$11,177.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,693.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,314.50
|
| Rate for Payer: Mclaren Medicaid |
$33.92
|
| Rate for Payer: Mclaren Medicare |
$62.02
|
| Rate for Payer: Meridian Medicaid |
$35.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,556.44
|
| Rate for Payer: PACE Medicare |
$58.92
|
| Rate for Payer: PACE SWMI |
$62.02
|
| Rate for Payer: PHP Commercial |
$10,556.44
|
| Rate for Payer: PHP Medicare Advantage |
$62.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,693.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.52
|
| Rate for Payer: Priority Health Medicare |
$62.02
|
| Rate for Payer: Priority Health Narrow Network |
$146.82
|
| Rate for Payer: Priority Health SBD |
$7,824.18
|
| Rate for Payer: Railroad Medicare Medicare |
$62.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.02
|
| Rate for Payer: UHC Medicare Advantage |
$63.88
|
| Rate for Payer: UMR Bronson Commercial |
$4,595.16
|
| Rate for Payer: VA VA |
$62.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,314.50
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS
|
Facility
|
IP
|
$12,419.34
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
176129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,464.51 |
| Max. Negotiated Rate |
$11,177.41 |
| Rate for Payer: Aetna American Axle |
$8,072.57
|
| Rate for Payer: Aetna Commercial |
$10,556.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,072.57
|
| Rate for Payer: Cash Price |
$9,935.47
|
| Rate for Payer: Cofinity Commercial |
$10,680.63
|
| Rate for Payer: Cofinity Commercial |
$8,693.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,935.47
|
| Rate for Payer: Healthscope Commercial |
$11,177.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,693.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,314.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,556.44
|
| Rate for Payer: PHP Commercial |
$10,556.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,693.54
|
| Rate for Payer: Priority Health SBD |
$7,824.18
|
| Rate for Payer: UMR Bronson Commercial |
$5,464.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,314.50
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$146.88
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna American Axle |
$95.47
|
| Rate for Payer: Aetna Commercial |
$124.85
|
| Rate for Payer: Aetna Medicare |
$18.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.66
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS MAPPO |
$17.32
|
| Rate for Payer: BCBS Trust/PPO |
$55.98
|
| Rate for Payer: BCN Medicare Advantage |
$17.32
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Commercial |
$126.32
|
| Rate for Payer: Cofinity Commercial |
$102.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.16
|
| Rate for Payer: Mclaren Medicaid |
$9.48
|
| Rate for Payer: Mclaren Medicare |
$17.32
|
| Rate for Payer: Meridian Medicaid |
$9.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.85
|
| Rate for Payer: PACE Medicare |
$16.46
|
| Rate for Payer: PACE SWMI |
$17.32
|
| Rate for Payer: PHP Commercial |
$124.85
|
| Rate for Payer: PHP Medicare Advantage |
$17.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.12
|
| Rate for Payer: Priority Health Medicare |
$17.32
|
| Rate for Payer: Priority Health Narrow Network |
$40.90
|
| Rate for Payer: Priority Health SBD |
$92.53
|
| Rate for Payer: Railroad Medicare Medicare |
$17.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.32
|
| Rate for Payer: UHC Medicare Advantage |
$17.84
|
| Rate for Payer: UMR Bronson Commercial |
$54.35
|
| Rate for Payer: VA VA |
$17.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.16
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$146.88
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna American Axle |
$95.47
|
| Rate for Payer: Aetna Commercial |
$124.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.47
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Commercial |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$126.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.85
|
| Rate for Payer: PHP Commercial |
$124.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.82
|
| Rate for Payer: Priority Health SBD |
$92.53
|
| Rate for Payer: UMR Bronson Commercial |
$64.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.16
|
|
|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 5199119811
|
| Hospital Charge Code |
28034
|
|
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
|
|
|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 5199119899
|
| Hospital Charge Code |
28034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
IP
|
$198.55
|
|
|
Service Code
|
NDC 60258-186-00
|
| Hospital Charge Code |
28034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$178.70 |
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Cofinity Commercial |
$138.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.77
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.98
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: UMR Bronson Commercial |
$87.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$146.94
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$132.25 |
| Rate for Payer: Aetna American Axle |
$95.51
|
| Rate for Payer: Aetna Commercial |
$124.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.51
|
| Rate for Payer: BCBS Complete |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$0.70
|
| Rate for Payer: Cash Price |
$117.55
|
| Rate for Payer: Cash Price |
$117.55
|
| Rate for Payer: Cofinity Commercial |
$126.37
|
| Rate for Payer: Cofinity Commercial |
$102.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.55
|
| Rate for Payer: Healthscope Commercial |
$132.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.90
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.86
|
| Rate for Payer: Priority Health SBD |
$92.57
|
| Rate for Payer: UMR Bronson Commercial |
$54.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.20
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$146.94
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$132.25 |
| Rate for Payer: Aetna American Axle |
$95.51
|
| Rate for Payer: Aetna American Axle |
$88.78
|
| Rate for Payer: Aetna Commercial |
$124.90
|
| Rate for Payer: Aetna Commercial |
$116.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.78
|
| Rate for Payer: Cash Price |
$117.55
|
| Rate for Payer: Cash Price |
$109.26
|
| Rate for Payer: Cofinity Commercial |
$117.46
|
| Rate for Payer: Cofinity Commercial |
$95.61
|
| Rate for Payer: Cofinity Commercial |
$126.37
|
| Rate for Payer: Cofinity Commercial |
$102.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.26
|
| Rate for Payer: Healthscope Commercial |
$122.92
|
| Rate for Payer: Healthscope Commercial |
$132.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.90
|
| Rate for Payer: PHP Commercial |
$124.90
|
| Rate for Payer: PHP Commercial |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.86
|
| Rate for Payer: Priority Health SBD |
$92.57
|
| Rate for Payer: Priority Health SBD |
$86.05
|
| Rate for Payer: UMR Bronson Commercial |
$60.10
|
| Rate for Payer: UMR Bronson Commercial |
$64.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.44
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
IP
|
$368.15
|
|
|
Service Code
|
NDC 0469-0520-01
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.99 |
| Max. Negotiated Rate |
$331.34 |
| Rate for Payer: Aetna American Axle |
$239.30
|
| Rate for Payer: Aetna Commercial |
$312.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.30
|
| Rate for Payer: Cash Price |
$294.52
|
| Rate for Payer: Cofinity Commercial |
$257.70
|
| Rate for Payer: Cofinity Commercial |
$316.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.52
|
| Rate for Payer: Healthscope Commercial |
$331.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.93
|
| Rate for Payer: PHP Commercial |
$312.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.70
|
| Rate for Payer: Priority Health SBD |
$231.93
|
| Rate for Payer: UMR Bronson Commercial |
$161.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.11
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
IP
|
$4,889.98
|
|
|
Service Code
|
NDC 0469-0520-14
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,151.59 |
| Max. Negotiated Rate |
$4,400.98 |
| Rate for Payer: Aetna American Axle |
$3,178.49
|
| Rate for Payer: Aetna Commercial |
$4,156.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,178.49
|
| Rate for Payer: Cash Price |
$3,911.98
|
| Rate for Payer: Cofinity Commercial |
$3,422.99
|
| Rate for Payer: Cofinity Commercial |
$4,205.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,911.98
|
| Rate for Payer: Healthscope Commercial |
$4,400.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,422.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,667.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,156.48
|
| Rate for Payer: PHP Commercial |
$4,156.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,422.99
|
| Rate for Payer: Priority Health SBD |
$3,080.69
|
| Rate for Payer: UMR Bronson Commercial |
$2,151.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,667.48
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
IP
|
$5,154.10
|
|
|
Service Code
|
NDC 0469-0520-02
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,267.80 |
| Max. Negotiated Rate |
$4,638.69 |
| Rate for Payer: Aetna American Axle |
$3,350.16
|
| Rate for Payer: Aetna Commercial |
$4,380.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,350.16
|
| Rate for Payer: Cash Price |
$4,123.28
|
| Rate for Payer: Cofinity Commercial |
$3,607.87
|
| Rate for Payer: Cofinity Commercial |
$4,432.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,123.28
|
| Rate for Payer: Healthscope Commercial |
$4,638.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,607.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,865.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,380.98
|
| Rate for Payer: PHP Commercial |
$4,380.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,607.87
|
| Rate for Payer: Priority Health SBD |
$3,247.08
|
| Rate for Payer: UMR Bronson Commercial |
$2,267.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,865.58
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC
|
Facility
|
IP
|
$37,309.03
|
|
|
Service Code
|
MS-DRG 062
|
| Min. Negotiated Rate |
$14,188.95 |
| Max. Negotiated Rate |
$37,309.03 |
| Rate for Payer: Aetna Medicare |
$15,533.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,669.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,669.68
|
| Rate for Payer: BCBS MAPPO |
$14,935.74
|
| Rate for Payer: BCBS Trust/PPO |
$37,309.03
|
| Rate for Payer: BCN Medicare Advantage |
$14,935.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,935.74
|
| Rate for Payer: Mclaren Medicare |
$14,935.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,682.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,176.10
|
| Rate for Payer: PACE Medicare |
$14,188.95
|
| Rate for Payer: PACE SWMI |
$14,935.74
|
| Rate for Payer: PHP Medicare Advantage |
$14,935.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,858.75
|
| Rate for Payer: Priority Health Medicare |
$14,935.74
|
| Rate for Payer: Priority Health Narrow Network |
$21,487.00
|
| Rate for Payer: Railroad Medicare Medicare |
$14,935.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,550.91
|
| Rate for Payer: UHC Core |
$23,411.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,935.74
|
| Rate for Payer: UHC Exchange |
$18,612.18
|
| Rate for Payer: UHC Medicare Advantage |
$15,383.81
|
| Rate for Payer: VA VA |
$14,935.74
|
|
