|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna American Axle |
$2.65
|
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Advantage |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.05
|
| Rate for Payer: PHP Commercial |
$3.46
|
| Rate for Payer: Priority Health SBD |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.65
|
| Rate for Payer: UHC Core |
$2.12
|
| Rate for Payer: UHC Exchange |
$1.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.05
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$975.25
|
|
|
Service Code
|
NDC 59651036105
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.84 |
| Max. Negotiated Rate |
$877.73 |
| Rate for Payer: Aetna American Axle |
$633.91
|
| Rate for Payer: Aetna Commercial |
$828.96
|
| Rate for Payer: Aetna Medicare |
$487.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.91
|
| Rate for Payer: BCBS Complete |
$390.10
|
| Rate for Payer: Cash Price |
$780.20
|
| Rate for Payer: Cofinity Advantage |
$682.67
|
| Rate for Payer: Cofinity Commercial |
$838.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.20
|
| Rate for Payer: Healthscope Commercial |
$877.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$682.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.44
|
| Rate for Payer: PHP Commercial |
$828.96
|
| Rate for Payer: Priority Health SBD |
$614.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.91
|
| Rate for Payer: UHC Core |
$508.11
|
| Rate for Payer: UHC Exchange |
$383.27
|
| Rate for Payer: UMR Bronson Commercial |
$360.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.44
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$406.55
|
|
|
Service Code
|
NDC 60687045701
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.42 |
| Max. Negotiated Rate |
$365.89 |
| Rate for Payer: Aetna American Axle |
$264.26
|
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: Aetna Medicare |
$203.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: BCBS Complete |
$162.62
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Advantage |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.91
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.26
|
| Rate for Payer: UHC Core |
$211.81
|
| Rate for Payer: UHC Exchange |
$159.77
|
| Rate for Payer: UMR Bronson Commercial |
$150.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.91
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$634.50
|
|
|
Service Code
|
NDC 67877032005
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.76 |
| Max. Negotiated Rate |
$571.05 |
| Rate for Payer: Aetna American Axle |
$412.43
|
| Rate for Payer: Aetna Commercial |
$539.33
|
| Rate for Payer: Aetna Medicare |
$317.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.43
|
| Rate for Payer: BCBS Complete |
$253.80
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cofinity Advantage |
$444.15
|
| Rate for Payer: Cofinity Commercial |
$545.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.60
|
| Rate for Payer: Healthscope Commercial |
$571.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$444.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$475.88
|
| Rate for Payer: PHP Commercial |
$539.33
|
| Rate for Payer: Priority Health SBD |
$399.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.43
|
| Rate for Payer: UHC Core |
$330.57
|
| Rate for Payer: UHC Exchange |
$249.36
|
| Rate for Payer: UMR Bronson Commercial |
$234.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.88
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$18.80
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$16.92 |
| Rate for Payer: Aetna American Axle |
$12.22
|
| Rate for Payer: Aetna Commercial |
$15.98
|
| Rate for Payer: Aetna Medicare |
$9.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.22
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: Cash Price |
$15.04
|
| Rate for Payer: Cofinity Advantage |
$13.16
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.04
|
| Rate for Payer: Healthscope Commercial |
$16.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.10
|
| Rate for Payer: PHP Commercial |
$15.98
|
| Rate for Payer: Priority Health SBD |
$11.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.22
|
| Rate for Payer: UHC Core |
$9.79
|
| Rate for Payer: UHC Exchange |
$7.39
|
| Rate for Payer: UMR Bronson Commercial |
$6.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.10
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 00904585560
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$133.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Advantage |
$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 |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.93
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.13
|
| Rate for Payer: UHC Core |
$139.58
|
| Rate for Payer: UHC Exchange |
$105.28
|
| Rate for Payer: UMR Bronson Commercial |
$99.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 55111068401
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.90 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Advantage |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UMR Bronson Commercial |
$148.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 67877029601
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.59
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$68.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.59
|
| Rate for Payer: BCBS Complete |
$54.52
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Advantage |
$95.41
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| 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: MI Amish Medical Board Commercial |
$109.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.59
|
| Rate for Payer: UHC Core |
$71.01
|
| Rate for Payer: UHC Exchange |
$53.57
|
| Rate for Payer: UMR Bronson Commercial |
$50.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$18.80
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.27 |
| Max. Negotiated Rate |
$16.92 |
| Rate for Payer: Aetna American Axle |
$12.22
|
| Rate for Payer: Aetna Commercial |
$15.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.22
|
| Rate for Payer: Cash Price |
$15.04
|
| Rate for Payer: Cofinity Advantage |
$13.16
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.04
|
| Rate for Payer: Healthscope Commercial |
$16.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.10
|
| Rate for Payer: PHP Commercial |
$15.98
|
| Rate for Payer: Priority Health SBD |
$11.84
|
| Rate for Payer: UMR Bronson Commercial |
$8.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.10
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 00904585560
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Advantage |
$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 |
$200.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.93
|
| Rate for Payer: PHP Commercial |
$227.72
|
| 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 |
$200.93
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 55111068401
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$169.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Advantage |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.96
|
| Rate for Payer: UHC Core |
$176.31
|
| Rate for Payer: UHC Exchange |
$132.99
|
| Rate for Payer: UMR Bronson Commercial |
$125.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 67877029601
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.59
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.59
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Advantage |
$95.41
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| 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 Commercial |
$115.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| 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 LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$879.03
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
76780
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$791.13 |
| Rate for Payer: Aetna American Axle |
$571.37
|
| Rate for Payer: Aetna American Axle |
$575.39
|
| Rate for Payer: Aetna Commercial |
$747.18
|
| Rate for Payer: Aetna Commercial |
$752.44
|
| Rate for Payer: Aetna Medicare |
$439.51
|
| Rate for Payer: Aetna Medicare |
$442.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$571.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.39
|
| Rate for Payer: BCBS Complete |
$354.09
|
| Rate for Payer: BCBS Complete |
$351.61
|
| Rate for Payer: BCBS Trust/PPO |
$10.31
|
| Rate for Payer: BCBS Trust/PPO |
$10.31
|
| Rate for Payer: BCN Commercial |
$10.31
|
| Rate for Payer: BCN Commercial |
$10.31
|
| Rate for Payer: Cash Price |
$703.22
|
| Rate for Payer: Cash Price |
$708.18
|
| Rate for Payer: Cash Price |
$703.22
|
| Rate for Payer: Cash Price |
$708.18
|
| Rate for Payer: Cofinity Advantage |
$615.32
|
| Rate for Payer: Cofinity Advantage |
$619.65
|
| Rate for Payer: Cofinity Commercial |
$755.97
|
| Rate for Payer: Cofinity Commercial |
$761.29
|
| 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 |
$791.13
|
| Rate for Payer: Healthscope Commercial |
$796.70
|
| 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 |
$663.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$703.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$708.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$747.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$752.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$663.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$659.27
|
| Rate for Payer: PHP Commercial |
$747.18
|
| Rate for Payer: PHP Commercial |
$752.44
|
| Rate for Payer: Priority Health SBD |
$553.79
|
| Rate for Payer: Priority Health SBD |
$557.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.25
|
| Rate for Payer: UHC Core |
$5.25
|
| Rate for Payer: UHC Core |
$5.25
|
| Rate for Payer: UHC Exchange |
$5.25
|
| Rate for Payer: UHC Exchange |
$5.25
|
| Rate for Payer: UMR Bronson Commercial |
$325.24
|
| Rate for Payer: UMR Bronson Commercial |
$327.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$659.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$663.91
|
|
|
IBUPROFEN LYSINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$879.03
|
|
|
Service Code
|
HCPCS J1741
|
| Hospital Charge Code |
76780
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$386.77 |
| Max. Negotiated Rate |
$791.13 |
| Rate for Payer: Aetna American Axle |
$571.37
|
| Rate for Payer: Aetna American Axle |
$575.39
|
| 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 Advantage |
$619.65
|
| Rate for Payer: Cofinity Advantage |
$615.32
|
| Rate for Payer: Cofinity Commercial |
$761.29
|
| Rate for Payer: Cofinity Commercial |
$755.97
|
| 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 |
$791.13
|
| Rate for Payer: Healthscope Commercial |
$796.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$619.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$615.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$659.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$663.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$747.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$752.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$659.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$663.91
|
| Rate for Payer: PHP Commercial |
$747.18
|
| Rate for Payer: PHP Commercial |
$752.44
|
| Rate for Payer: Priority Health SBD |
$557.69
|
| Rate for Payer: Priority Health SBD |
$553.79
|
| 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 |
$663.91
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$290.75
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
16156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.58 |
| Max. Negotiated Rate |
$657.66 |
| Rate for Payer: Aetna American Axle |
$188.99
|
| Rate for Payer: Aetna Commercial |
$247.14
|
| Rate for Payer: Aetna Medicare |
$227.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.02
|
| Rate for Payer: BCBS Complete |
$120.40
|
| Rate for Payer: BCBS MAPPO |
$219.22
|
| Rate for Payer: BCBS Trust/PPO |
$512.62
|
| Rate for Payer: BCN Commercial |
$512.62
|
| Rate for Payer: BCN Medicare Advantage |
$219.22
|
| Rate for Payer: Cash Price |
$232.60
|
| Rate for Payer: Cash Price |
$232.60
|
| Rate for Payer: Cofinity Advantage |
$203.53
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.22
|
| Rate for Payer: Healthscope Commercial |
$261.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.06
|
| Rate for Payer: Mclaren Medicaid |
$219.22
|
| Rate for Payer: Mclaren Medicare |
$219.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.18
|
| Rate for Payer: Meridian Medicaid |
$230.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$241.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.14
|
| Rate for Payer: Nomi Health Commercial |
$657.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.06
|
| Rate for Payer: PACE Medicare |
$208.26
|
| Rate for Payer: PACE SWMI |
$219.22
|
| Rate for Payer: PHP Commercial |
$247.14
|
| Rate for Payer: PHP Medicare Advantage |
$219.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$543.45
|
| Rate for Payer: Priority Health Medicare |
$219.22
|
| Rate for Payer: Priority Health SBD |
$183.17
|
| Rate for Payer: Priority Health Tiered Network |
$434.76
|
| Rate for Payer: Railroad Medicare Medicare |
$219.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.54
|
| Rate for Payer: UHC Core |
$327.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$219.22
|
| Rate for Payer: UHC Exchange |
$327.54
|
| Rate for Payer: UHC Medicaid |
$114.65
|
| Rate for Payer: UHCCP Medicaid |
$114.65
|
| Rate for Payer: UMR Bronson Commercial |
$107.58
|
| Rate for Payer: VA VA |
$219.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.06
|
|
|
IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$290.75
|
|
|
Service Code
|
HCPCS J1742
|
| Hospital Charge Code |
16156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.93 |
| Max. Negotiated Rate |
$261.68 |
| Rate for Payer: Aetna American Axle |
$188.99
|
| Rate for Payer: Aetna Commercial |
$247.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.99
|
| Rate for Payer: Cash Price |
$232.60
|
| Rate for Payer: Cofinity Advantage |
$203.53
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.60
|
| Rate for Payer: Healthscope Commercial |
$261.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.06
|
| Rate for Payer: PHP Commercial |
$247.14
|
| Rate for Payer: Priority Health SBD |
$183.17
|
| Rate for Payer: UMR Bronson Commercial |
$127.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.06
|
|
|
ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,479.94
|
|
|
Service Code
|
HCPCS J1744
|
| Hospital Charge Code |
153436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.58 |
| Max. Negotiated Rate |
$4,031.95 |
| Rate for Payer: Aetna American Axle |
$2,911.96
|
| Rate for Payer: Aetna American Axle |
$4,992.69
|
| Rate for Payer: Aetna American Axle |
$5,439.58
|
| Rate for Payer: Aetna Commercial |
$7,113.29
|
| Rate for Payer: Aetna Commercial |
$3,807.95
|
| Rate for Payer: Aetna Commercial |
$6,528.90
|
| Rate for Payer: Aetna Medicare |
$4,184.29
|
| Rate for Payer: Aetna Medicare |
$3,840.53
|
| Rate for Payer: Aetna Medicare |
$2,239.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,439.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,911.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,992.69
|
| Rate for Payer: BCBS Complete |
$3,072.42
|
| Rate for Payer: BCBS Complete |
$3,347.43
|
| Rate for Payer: BCBS Complete |
$1,791.98
|
| Rate for Payer: BCBS Trust/PPO |
$234.14
|
| Rate for Payer: BCBS Trust/PPO |
$234.14
|
| Rate for Payer: BCBS Trust/PPO |
$234.14
|
| Rate for Payer: BCN Commercial |
$234.14
|
| Rate for Payer: BCN Commercial |
$234.14
|
| Rate for Payer: BCN Commercial |
$234.14
|
| Rate for Payer: Cash Price |
$3,583.95
|
| Rate for Payer: Cash Price |
$6,144.85
|
| Rate for Payer: Cash Price |
$6,144.85
|
| Rate for Payer: Cash Price |
$6,694.86
|
| Rate for Payer: Cash Price |
$6,694.86
|
| Rate for Payer: Cash Price |
$3,583.95
|
| Rate for Payer: Cofinity Advantage |
$5,376.74
|
| Rate for Payer: Cofinity Advantage |
$3,135.96
|
| Rate for Payer: Cofinity Advantage |
$5,858.01
|
| Rate for Payer: Cofinity Commercial |
$3,852.75
|
| Rate for Payer: Cofinity Commercial |
$6,605.71
|
| Rate for Payer: Cofinity Commercial |
$7,196.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,144.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,583.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,694.86
|
| Rate for Payer: Healthscope Commercial |
$4,031.95
|
| Rate for Payer: Healthscope Commercial |
$7,531.72
|
| Rate for Payer: Healthscope Commercial |
$6,912.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,858.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,376.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,135.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,276.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,359.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,760.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,694.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,144.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,583.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,113.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,807.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,528.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,359.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,760.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,276.44
|
| Rate for Payer: PHP Commercial |
$7,113.29
|
| Rate for Payer: PHP Commercial |
$3,807.95
|
| Rate for Payer: PHP Commercial |
$6,528.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.47
|
| Rate for Payer: Priority Health SBD |
$5,272.21
|
| Rate for Payer: Priority Health SBD |
$4,839.07
|
| Rate for Payer: Priority Health SBD |
$2,822.36
|
| Rate for Payer: Priority Health Tiered Network |
$39.58
|
| Rate for Payer: Priority Health Tiered Network |
$39.58
|
| Rate for Payer: Priority Health Tiered Network |
$39.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.38
|
| Rate for Payer: UHC Core |
$518.38
|
| Rate for Payer: UHC Core |
$518.38
|
| Rate for Payer: UHC Core |
$518.38
|
| Rate for Payer: UHC Exchange |
$518.38
|
| Rate for Payer: UHC Exchange |
$518.38
|
| Rate for Payer: UHC Exchange |
$518.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,657.58
|
| Rate for Payer: UMR Bronson Commercial |
$3,096.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,841.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,359.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,276.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,760.80
|
|
|
ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,479.94
|
|
|
Service Code
|
HCPCS J1744
|
| Hospital Charge Code |
153436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,971.17 |
| Max. Negotiated Rate |
$4,031.95 |
| Rate for Payer: Aetna American Axle |
$2,911.96
|
| Rate for Payer: Aetna American Axle |
$5,439.58
|
| Rate for Payer: Aetna American Axle |
$4,992.69
|
| Rate for Payer: Aetna Commercial |
$6,528.90
|
| Rate for Payer: Aetna Commercial |
$3,807.95
|
| Rate for Payer: Aetna Commercial |
$7,113.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,439.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,911.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,992.69
|
| Rate for Payer: Cash Price |
$6,144.85
|
| Rate for Payer: Cash Price |
$3,583.95
|
| Rate for Payer: Cash Price |
$6,694.86
|
| Rate for Payer: Cofinity Advantage |
$5,858.01
|
| Rate for Payer: Cofinity Advantage |
$3,135.96
|
| Rate for Payer: Cofinity Advantage |
$5,376.74
|
| Rate for Payer: Cofinity Commercial |
$7,196.98
|
| Rate for Payer: Cofinity Commercial |
$3,852.75
|
| Rate for Payer: Cofinity Commercial |
$6,605.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,583.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,144.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,694.86
|
| Rate for Payer: Healthscope Commercial |
$6,912.95
|
| Rate for Payer: Healthscope Commercial |
$7,531.72
|
| Rate for Payer: Healthscope Commercial |
$4,031.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,376.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,135.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,858.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,276.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,359.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,760.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,807.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,528.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,113.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,359.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,760.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,276.44
|
| Rate for Payer: PHP Commercial |
$6,528.90
|
| Rate for Payer: PHP Commercial |
$3,807.95
|
| Rate for Payer: PHP Commercial |
$7,113.29
|
| Rate for Payer: Priority Health SBD |
$2,822.36
|
| Rate for Payer: Priority Health SBD |
$4,839.07
|
| Rate for Payer: Priority Health SBD |
$5,272.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,971.17
|
| Rate for Payer: UMR Bronson Commercial |
$3,682.18
|
| Rate for Payer: UMR Bronson Commercial |
$3,379.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,760.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,359.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,276.44
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$765.85
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
22144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$689.26 |
| Rate for Payer: Aetna American Axle |
$497.80
|
| Rate for Payer: Aetna American Axle |
$325.52
|
| Rate for Payer: Aetna American Axle |
$584.60
|
| Rate for Payer: Aetna Commercial |
$650.97
|
| Rate for Payer: Aetna Commercial |
$764.47
|
| Rate for Payer: Aetna Commercial |
$425.68
|
| Rate for Payer: Aetna Medicare |
$382.93
|
| Rate for Payer: Aetna Medicare |
$250.40
|
| Rate for Payer: Aetna Medicare |
$449.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.60
|
| Rate for Payer: BCBS Complete |
$200.32
|
| Rate for Payer: BCBS Complete |
$306.34
|
| Rate for Payer: BCBS Complete |
$359.75
|
| Rate for Payer: BCBS Trust/PPO |
$129.85
|
| Rate for Payer: BCBS Trust/PPO |
$129.85
|
| Rate for Payer: BCBS Trust/PPO |
$129.85
|
| Rate for Payer: BCN Commercial |
$129.85
|
| Rate for Payer: BCN Commercial |
$129.85
|
| Rate for Payer: BCN Commercial |
$129.85
|
| Rate for Payer: Cash Price |
$400.64
|
| Rate for Payer: Cash Price |
$400.64
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cash Price |
$612.68
|
| Rate for Payer: Cash Price |
$612.68
|
| Rate for Payer: Cofinity Advantage |
$629.57
|
| Rate for Payer: Cofinity Advantage |
$536.10
|
| Rate for Payer: Cofinity Advantage |
$350.56
|
| Rate for Payer: Cofinity Commercial |
$430.69
|
| Rate for Payer: Cofinity Commercial |
$658.63
|
| Rate for Payer: Cofinity Commercial |
$773.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.68
|
| Rate for Payer: Healthscope Commercial |
$450.72
|
| Rate for Payer: Healthscope Commercial |
$689.26
|
| Rate for Payer: Healthscope Commercial |
$809.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$612.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.53
|
| Rate for Payer: PHP Commercial |
$650.97
|
| Rate for Payer: PHP Commercial |
$425.68
|
| Rate for Payer: PHP Commercial |
$764.47
|
| Rate for Payer: Priority Health SBD |
$315.50
|
| Rate for Payer: Priority Health SBD |
$566.61
|
| Rate for Payer: Priority Health SBD |
$482.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.08
|
| Rate for Payer: UHC Core |
$66.08
|
| Rate for Payer: UHC Core |
$66.08
|
| Rate for Payer: UHC Core |
$66.08
|
| Rate for Payer: UHC Exchange |
$66.08
|
| Rate for Payer: UHC Exchange |
$66.08
|
| Rate for Payer: UHC Exchange |
$66.08
|
| Rate for Payer: UMR Bronson Commercial |
$332.77
|
| Rate for Payer: UMR Bronson Commercial |
$185.30
|
| Rate for Payer: UMR Bronson Commercial |
$283.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.53
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$765.85
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
22144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$336.97 |
| Max. Negotiated Rate |
$689.26 |
| Rate for Payer: Aetna American Axle |
$497.80
|
| Rate for Payer: Aetna American Axle |
$584.60
|
| 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 |
$612.68
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cofinity Advantage |
$629.57
|
| Rate for Payer: Cofinity Advantage |
$536.10
|
| Rate for Payer: Cofinity Commercial |
$773.47
|
| 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 |
$689.26
|
| Rate for Payer: Healthscope Commercial |
$809.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.53
|
| Rate for Payer: PHP Commercial |
$650.97
|
| Rate for Payer: PHP Commercial |
$764.47
|
| Rate for Payer: Priority Health SBD |
$566.61
|
| Rate for Payer: Priority Health SBD |
$482.49
|
| 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 |
$674.53
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,283.61
|
|
|
Service Code
|
NDC 00597019705
|
| Hospital Charge Code |
176112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,084.79 |
| Max. Negotiated Rate |
$8,355.25 |
| Rate for Payer: Aetna American Axle |
$6,034.35
|
| Rate for Payer: Aetna Commercial |
$7,891.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,034.35
|
| Rate for Payer: Cash Price |
$7,426.89
|
| Rate for Payer: Cofinity Advantage |
$6,498.53
|
| Rate for Payer: Cofinity Commercial |
$7,983.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,426.89
|
| Rate for Payer: Healthscope Commercial |
$8,355.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,498.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,962.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,891.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,962.71
|
| Rate for Payer: PHP Commercial |
$7,891.07
|
| Rate for Payer: Priority Health SBD |
$5,848.67
|
| Rate for Payer: UMR Bronson Commercial |
$4,084.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,962.71
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,283.61
|
|
|
Service Code
|
NDC 00597019705
|
| Hospital Charge Code |
176112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,434.94 |
| Max. Negotiated Rate |
$8,355.25 |
| Rate for Payer: Aetna American Axle |
$6,034.35
|
| Rate for Payer: Aetna Commercial |
$7,891.07
|
| Rate for Payer: Aetna Medicare |
$4,641.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,034.35
|
| Rate for Payer: BCBS Complete |
$3,713.44
|
| Rate for Payer: Cash Price |
$7,426.89
|
| Rate for Payer: Cofinity Advantage |
$6,498.53
|
| Rate for Payer: Cofinity Commercial |
$7,983.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,426.89
|
| Rate for Payer: Healthscope Commercial |
$8,355.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,498.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,962.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,426.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,891.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,962.71
|
| Rate for Payer: PHP Commercial |
$7,891.07
|
| Rate for Payer: Priority Health SBD |
$5,848.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,034.35
|
| Rate for Payer: UHC Core |
$4,836.76
|
| Rate for Payer: UHC Exchange |
$3,648.46
|
| Rate for Payer: UMR Bronson Commercial |
$3,434.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,962.71
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$284.24
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.07 |
| Max. Negotiated Rate |
$255.82 |
| Rate for Payer: Aetna American Axle |
$184.76
|
| Rate for Payer: Aetna American Axle |
$324.32
|
| Rate for Payer: Aetna Commercial |
$241.60
|
| Rate for Payer: Aetna Commercial |
$424.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.32
|
| Rate for Payer: Cash Price |
$227.39
|
| Rate for Payer: Cash Price |
$399.16
|
| Rate for Payer: Cofinity Advantage |
$349.26
|
| Rate for Payer: Cofinity Advantage |
$198.97
|
| Rate for Payer: Cofinity Commercial |
$429.10
|
| Rate for Payer: Cofinity Commercial |
$244.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.16
|
| Rate for Payer: Healthscope Commercial |
$255.82
|
| Rate for Payer: Healthscope Commercial |
$449.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$374.21
|
| Rate for Payer: PHP Commercial |
$241.60
|
| Rate for Payer: PHP Commercial |
$424.11
|
| Rate for Payer: Priority Health SBD |
$314.34
|
| Rate for Payer: Priority Health SBD |
$179.07
|
| Rate for Payer: UMR Bronson Commercial |
$125.07
|
| Rate for Payer: UMR Bronson Commercial |
$219.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.21
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$284.24
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.99 |
| Max. Negotiated Rate |
$255.82 |
| Rate for Payer: Aetna American Axle |
$184.76
|
| Rate for Payer: Aetna American Axle |
$324.32
|
| Rate for Payer: Aetna Commercial |
$241.60
|
| Rate for Payer: Aetna Commercial |
$424.11
|
| Rate for Payer: Aetna Medicare |
$142.12
|
| Rate for Payer: Aetna Medicare |
$249.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.32
|
| Rate for Payer: BCBS Complete |
$199.58
|
| Rate for Payer: BCBS Complete |
$113.70
|
| Rate for Payer: BCBS Trust/PPO |
$80.55
|
| Rate for Payer: BCBS Trust/PPO |
$80.55
|
| Rate for Payer: BCN Commercial |
$80.55
|
| Rate for Payer: BCN Commercial |
$80.55
|
| Rate for Payer: Cash Price |
$227.39
|
| Rate for Payer: Cash Price |
$399.16
|
| Rate for Payer: Cash Price |
$227.39
|
| Rate for Payer: Cash Price |
$399.16
|
| Rate for Payer: Cofinity Advantage |
$198.97
|
| Rate for Payer: Cofinity Advantage |
$349.26
|
| Rate for Payer: Cofinity Commercial |
$244.45
|
| Rate for Payer: Cofinity Commercial |
$429.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.16
|
| Rate for Payer: Healthscope Commercial |
$255.82
|
| Rate for Payer: Healthscope Commercial |
$449.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$374.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.18
|
| Rate for Payer: PHP Commercial |
$241.60
|
| Rate for Payer: PHP Commercial |
$424.11
|
| Rate for Payer: Priority Health SBD |
$179.07
|
| Rate for Payer: Priority Health SBD |
$314.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.99
|
| Rate for Payer: UHC Core |
$40.99
|
| Rate for Payer: UHC Core |
$40.99
|
| Rate for Payer: UHC Exchange |
$40.99
|
| Rate for Payer: UHC Exchange |
$40.99
|
| Rate for Payer: UMR Bronson Commercial |
$105.17
|
| Rate for Payer: UMR Bronson Commercial |
$184.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.21
|
|
|
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 |
$40.99 |
| Max. Negotiated Rate |
$832.67 |
| Rate for Payer: Aetna American Axle |
$601.37
|
| Rate for Payer: Aetna Commercial |
$786.41
|
| Rate for Payer: Aetna Medicare |
$462.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.37
|
| Rate for Payer: BCBS Complete |
$370.08
|
| Rate for Payer: BCBS Trust/PPO |
$80.55
|
| Rate for Payer: BCN Commercial |
$80.55
|
| Rate for Payer: Cash Price |
$740.15
|
| Rate for Payer: Cash Price |
$740.15
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$740.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$786.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.89
|
| Rate for Payer: PHP Commercial |
$786.41
|
| Rate for Payer: Priority Health SBD |
$582.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.99
|
| Rate for Payer: UHC Core |
$40.99
|
| Rate for Payer: UHC Exchange |
$40.99
|
| Rate for Payer: UMR Bronson Commercial |
$342.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.89
|
|
