|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
OP
|
$128.05
|
|
|
Service Code
|
NDC 48433023015
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.38 |
| Max. Negotiated Rate |
$115.25 |
| Rate for Payer: Aetna American Axle |
$83.23
|
| Rate for Payer: Aetna Commercial |
$108.84
|
| Rate for Payer: Aetna Medicare |
$64.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.23
|
| Rate for Payer: BCBS Complete |
$51.22
|
| Rate for Payer: Cash Price |
$102.44
|
| Rate for Payer: Cofinity Advantage |
$89.64
|
| Rate for Payer: Cofinity Commercial |
$110.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.44
|
| Rate for Payer: Healthscope Commercial |
$115.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.04
|
| Rate for Payer: PHP Commercial |
$108.84
|
| Rate for Payer: Priority Health SBD |
$80.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.23
|
| Rate for Payer: UHC Core |
$66.71
|
| Rate for Payer: UHC Exchange |
$50.32
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.04
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
IP
|
$411.28
|
|
|
Service Code
|
NDC 00395277516
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$370.15 |
| Rate for Payer: Aetna American Axle |
$267.33
|
| Rate for Payer: Aetna Commercial |
$349.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.33
|
| Rate for Payer: Cash Price |
$329.02
|
| Rate for Payer: Cofinity Advantage |
$287.90
|
| Rate for Payer: Cofinity Commercial |
$353.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.02
|
| Rate for Payer: Healthscope Commercial |
$370.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.46
|
| Rate for Payer: PHP Commercial |
$349.59
|
| Rate for Payer: Priority Health SBD |
$259.11
|
| Rate for Payer: UMR Bronson Commercial |
$180.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.46
|
|
|
IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
17595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna American Axle |
$123.50
|
| Rate for Payer: Aetna American Axle |
$61.75
|
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Advantage |
$66.50
|
| Rate for Payer: Cofinity Advantage |
$133.00
|
| Rate for Payer: Cofinity Advantage |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: PHP Commercial |
$161.50
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health SBD |
$119.70
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: UMR Bronson Commercial |
$83.60
|
| Rate for Payer: UMR Bronson Commercial |
$41.80
|
| Rate for Payer: UMR Bronson Commercial |
$12.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
17595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna American Axle |
$123.50
|
| Rate for Payer: Aetna American Axle |
$61.75
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Aetna Medicare |
$95.00
|
| Rate for Payer: Aetna Medicare |
$47.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: BCBS Complete |
$76.00
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Advantage |
$66.50
|
| Rate for Payer: Cofinity Advantage |
$19.53
|
| Rate for Payer: Cofinity Advantage |
$133.00
|
| Rate for Payer: Cofinity Commercial |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: PHP Commercial |
$161.50
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health SBD |
$119.70
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UMR Bronson Commercial |
$35.15
|
| Rate for Payer: UMR Bronson Commercial |
$70.30
|
| Rate for Payer: UMR Bronson Commercial |
$10.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$139.33
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
10321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna American Axle |
$90.56
|
| Rate for Payer: Aetna Commercial |
$118.43
|
| Rate for Payer: Aetna Medicare |
$69.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.56
|
| Rate for Payer: BCBS Complete |
$55.73
|
| Rate for Payer: BCBS Trust/PPO |
$1.27
|
| Rate for Payer: BCN Commercial |
$1.27
|
| Rate for Payer: Cash Price |
$111.46
|
| Rate for Payer: Cash Price |
$111.46
|
| Rate for Payer: Cofinity Advantage |
$97.53
|
| Rate for Payer: Cofinity Commercial |
$119.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.46
|
| Rate for Payer: Healthscope Commercial |
$125.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.50
|
| Rate for Payer: PHP Commercial |
$118.43
|
| Rate for Payer: Priority Health SBD |
$87.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.66
|
| Rate for Payer: UHC Core |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.66
|
| Rate for Payer: UMR Bronson Commercial |
$51.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.50
|
|
|
IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$139.33
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
10321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.31 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna American Axle |
$90.56
|
| Rate for Payer: Aetna Commercial |
$118.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.56
|
| Rate for Payer: Cash Price |
$111.46
|
| Rate for Payer: Cofinity Advantage |
$97.53
|
| Rate for Payer: Cofinity Commercial |
$119.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.46
|
| Rate for Payer: Healthscope Commercial |
$125.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.50
|
| Rate for Payer: PHP Commercial |
$118.43
|
| Rate for Payer: Priority Health SBD |
$87.78
|
| Rate for Payer: UMR Bronson Commercial |
$61.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.50
|
|
|
IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.10
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$23.49 |
| Rate for Payer: Aetna American Axle |
$16.96
|
| Rate for Payer: Aetna American Axle |
$87.75
|
| Rate for Payer: Aetna American Axle |
$43.88
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$57.38
|
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Aetna Medicare |
$67.50
|
| Rate for Payer: Aetna Medicare |
$33.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.88
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS Complete |
$10.44
|
| Rate for Payer: BCBS Complete |
$27.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cofinity Advantage |
$47.25
|
| Rate for Payer: Cofinity Advantage |
$18.27
|
| Rate for Payer: Cofinity Advantage |
$94.50
|
| Rate for Payer: Cofinity Commercial |
$116.10
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Cofinity Commercial |
$58.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$121.50
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$60.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.62
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$114.75
|
| Rate for Payer: PHP Commercial |
$57.38
|
| Rate for Payer: Priority Health SBD |
$85.05
|
| Rate for Payer: Priority Health SBD |
$42.52
|
| Rate for Payer: Priority Health SBD |
$16.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UMR Bronson Commercial |
$24.98
|
| Rate for Payer: UMR Bronson Commercial |
$49.95
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.62
|
|
|
IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna American Axle |
$87.75
|
| Rate for Payer: Aetna American Axle |
$43.88
|
| Rate for Payer: Aetna American Axle |
$16.96
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: Aetna Commercial |
$57.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cofinity Advantage |
$47.25
|
| Rate for Payer: Cofinity Advantage |
$94.50
|
| Rate for Payer: Cofinity Advantage |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$58.05
|
| Rate for Payer: Cofinity Commercial |
$116.10
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.00
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$60.75
|
| Rate for Payer: Healthscope Commercial |
$121.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.62
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$114.75
|
| Rate for Payer: PHP Commercial |
$57.38
|
| Rate for Payer: Priority Health SBD |
$85.05
|
| Rate for Payer: Priority Health SBD |
$16.44
|
| Rate for Payer: Priority Health SBD |
$42.52
|
| Rate for Payer: UMR Bronson Commercial |
$59.40
|
| Rate for Payer: UMR Bronson Commercial |
$29.70
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.62
|
|
|
IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,016.25
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$447.15 |
| Max. Negotiated Rate |
$914.62 |
| Rate for Payer: Aetna American Axle |
$660.56
|
| Rate for Payer: Aetna Commercial |
$863.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.56
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cofinity Advantage |
$711.38
|
| Rate for Payer: Cofinity Commercial |
$873.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.00
|
| Rate for Payer: Healthscope Commercial |
$914.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$863.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.19
|
| Rate for Payer: PHP Commercial |
$863.81
|
| Rate for Payer: Priority Health SBD |
$640.24
|
| Rate for Payer: UMR Bronson Commercial |
$447.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.19
|
|
|
IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,016.25
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$914.62 |
| Rate for Payer: Aetna American Axle |
$660.56
|
| Rate for Payer: Aetna Commercial |
$863.81
|
| Rate for Payer: Aetna Medicare |
$508.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.56
|
| Rate for Payer: BCBS Complete |
$406.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cofinity Advantage |
$711.38
|
| Rate for Payer: Cofinity Commercial |
$873.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.00
|
| Rate for Payer: Healthscope Commercial |
$914.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$813.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$863.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.19
|
| Rate for Payer: PHP Commercial |
$863.81
|
| Rate for Payer: Priority Health SBD |
$640.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UMR Bronson Commercial |
$376.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.19
|
|
|
IOPAMIDOL 200 MG IODINE/ML (41 %) INTRATHECAL SOLUTION
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
10325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna American Axle |
$29.90
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.27
|
| Rate for Payer: BCN Commercial |
$1.27
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Advantage |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.66
|
| Rate for Payer: UHC Core |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.66
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
|
|
IOPAMIDOL 200 MG IODINE/ML (41 %) INTRATHECAL SOLUTION
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
10325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna American Axle |
$29.90
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Advantage |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
|
|
IOPAMIDOL 300 MG IODINE/ML (61 %) INTRATHECAL SOLUTION
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna American Axle |
$47.38
|
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Commercial |
$61.97
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Aetna Medicare |
$36.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.38
|
| Rate for Payer: BCBS Complete |
$29.16
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Cofinity Advantage |
$1.39
|
| Rate for Payer: Cofinity Advantage |
$51.03
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Cofinity Commercial |
$62.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.32
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$65.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: PHP Commercial |
$61.97
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: Priority Health SBD |
$45.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.74
|
| Rate for Payer: UMR Bronson Commercial |
$26.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.67
|
|
|
IOPAMIDOL 300 MG IODINE/ML (61 %) INTRATHECAL SOLUTION
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna American Axle |
$47.38
|
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Commercial |
$61.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.38
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Cofinity Advantage |
$51.03
|
| Rate for Payer: Cofinity Advantage |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$62.69
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.32
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$65.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.67
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: PHP Commercial |
$61.97
|
| Rate for Payer: Priority Health SBD |
$45.93
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: UMR Bronson Commercial |
$32.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.67
|
|
|
IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
27737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna American Axle |
$9.10
|
| Rate for Payer: Aetna American Axle |
$27.30
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Medicare |
$70.00
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Advantage |
$29.40
|
| Rate for Payer: Cofinity Advantage |
$98.00
|
| Rate for Payer: Cofinity Advantage |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| Rate for Payer: Priority Health SBD |
$26.46
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UMR Bronson Commercial |
$15.54
|
| Rate for Payer: UMR Bronson Commercial |
$5.18
|
| Rate for Payer: UMR Bronson Commercial |
$51.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
27737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna American Axle |
$9.10
|
| Rate for Payer: Aetna American Axle |
$27.30
|
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Advantage |
$29.40
|
| Rate for Payer: Cofinity Advantage |
$9.80
|
| Rate for Payer: Cofinity Advantage |
$98.00
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| Rate for Payer: Priority Health SBD |
$26.46
|
| Rate for Payer: UMR Bronson Commercial |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$61.60
|
| Rate for Payer: UMR Bronson Commercial |
$18.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
|
|
IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10328
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| 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 Medicare |
$87.50
|
| Rate for Payer: Aetna Medicare |
$0.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.16
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Advantage |
$122.50
|
| Rate for Payer: Cofinity Advantage |
$1.25
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$1.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| 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 |
$1.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.25
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: PHP Commercial |
$1.51
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: Priority Health SBD |
$1.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UMR Bronson Commercial |
$64.75
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.33
|
|
|
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) |
$113.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.16
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Advantage |
$1.25
|
| Rate for Payer: Cofinity Advantage |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$1.53
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Healthscope Commercial |
$1.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.33
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: PHP Commercial |
$1.51
|
| 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 |
$131.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.33
|
|
|
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 Advantage |
$7.84
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| 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 Commercial |
$9.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.40
|
| Rate for Payer: PHP Commercial |
$9.52
|
| 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
|
|
|
IOPAMIDOL 61 % ORAL SOLUTION
|
Facility
|
OP
|
$11.20
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
180462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna American Axle |
$7.28
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: BCBS Complete |
$4.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.48
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Advantage |
$7.84
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| 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: MI Amish Medical Board Commercial |
$8.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.40
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UMR Bronson Commercial |
$4.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
IPILIMUMAB 200 MG/40 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$96,052.53
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.89 |
| Max. Negotiated Rate |
$86,447.28 |
| Rate for Payer: Aetna American Axle |
$62,434.14
|
| Rate for Payer: Aetna Commercial |
$81,644.65
|
| Rate for Payer: Aetna Medicare |
$194.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62,434.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$233.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$233.96
|
| Rate for Payer: BCBS Complete |
$102.79
|
| Rate for Payer: BCBS MAPPO |
$187.17
|
| Rate for Payer: BCBS Trust/PPO |
$606.09
|
| Rate for Payer: BCN Commercial |
$606.09
|
| Rate for Payer: BCN Medicare Advantage |
$187.17
|
| Rate for Payer: Cash Price |
$76,842.02
|
| Rate for Payer: Cash Price |
$76,842.02
|
| Rate for Payer: Cofinity Advantage |
$67,236.77
|
| Rate for Payer: Cofinity Commercial |
$82,605.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76,842.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.17
|
| Rate for Payer: Healthscope Commercial |
$86,447.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67,236.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72,039.40
|
| Rate for Payer: Mclaren Medicaid |
$187.17
|
| Rate for Payer: Mclaren Medicare |
$187.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.53
|
| Rate for Payer: Meridian Medicaid |
$196.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$205.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81,644.65
|
| Rate for Payer: Nomi Health Commercial |
$561.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72,039.40
|
| Rate for Payer: PACE Medicare |
$177.81
|
| Rate for Payer: PACE SWMI |
$187.17
|
| Rate for Payer: PHP Commercial |
$81,644.65
|
| Rate for Payer: PHP Medicare Advantage |
$187.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$578.69
|
| Rate for Payer: Priority Health Medicare |
$187.17
|
| Rate for Payer: Priority Health SBD |
$60,513.09
|
| Rate for Payer: Priority Health Tiered Network |
$462.95
|
| Rate for Payer: Railroad Medicare Medicare |
$187.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.40
|
| Rate for Payer: UHC Core |
$308.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$187.17
|
| Rate for Payer: UHC Exchange |
$308.40
|
| Rate for Payer: UHC Medicaid |
$97.89
|
| Rate for Payer: UHCCP Medicaid |
$97.89
|
| Rate for Payer: UMR Bronson Commercial |
$35,539.44
|
| Rate for Payer: VA VA |
$187.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72,039.40
|
|
|
IPILIMUMAB 200 MG/40 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$96,052.53
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42,263.11 |
| Max. Negotiated Rate |
$86,447.28 |
| Rate for Payer: Aetna American Axle |
$62,434.14
|
| Rate for Payer: Aetna Commercial |
$81,644.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62,434.14
|
| Rate for Payer: Cash Price |
$76,842.02
|
| Rate for Payer: Cofinity Advantage |
$67,236.77
|
| Rate for Payer: Cofinity Commercial |
$82,605.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76,842.02
|
| Rate for Payer: Healthscope Commercial |
$86,447.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67,236.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72,039.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81,644.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72,039.40
|
| Rate for Payer: PHP Commercial |
$81,644.65
|
| Rate for Payer: Priority Health SBD |
$60,513.09
|
| Rate for Payer: UMR Bronson Commercial |
$42,263.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72,039.40
|
|
|
IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,013.16
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.89 |
| Max. Negotiated Rate |
$21,611.84 |
| Rate for Payer: Aetna American Axle |
$15,608.55
|
| Rate for Payer: Aetna Commercial |
$20,411.19
|
| Rate for Payer: Aetna Medicare |
$194.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,608.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$233.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$233.96
|
| Rate for Payer: BCBS Complete |
$102.79
|
| Rate for Payer: BCBS MAPPO |
$187.17
|
| Rate for Payer: BCBS Trust/PPO |
$606.09
|
| Rate for Payer: BCN Commercial |
$606.09
|
| Rate for Payer: BCN Medicare Advantage |
$187.17
|
| Rate for Payer: Cash Price |
$19,210.53
|
| Rate for Payer: Cash Price |
$19,210.53
|
| Rate for Payer: Cofinity Advantage |
$16,809.21
|
| Rate for Payer: Cofinity Commercial |
$20,651.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,210.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.17
|
| Rate for Payer: Healthscope Commercial |
$21,611.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,809.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,009.87
|
| Rate for Payer: Mclaren Medicaid |
$187.17
|
| Rate for Payer: Mclaren Medicare |
$187.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.53
|
| Rate for Payer: Meridian Medicaid |
$196.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$205.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,411.19
|
| Rate for Payer: Nomi Health Commercial |
$561.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,009.87
|
| Rate for Payer: PACE Medicare |
$177.81
|
| Rate for Payer: PACE SWMI |
$187.17
|
| Rate for Payer: PHP Commercial |
$20,411.19
|
| Rate for Payer: PHP Medicare Advantage |
$187.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$578.69
|
| Rate for Payer: Priority Health Medicare |
$187.17
|
| Rate for Payer: Priority Health SBD |
$15,128.29
|
| Rate for Payer: Priority Health Tiered Network |
$462.95
|
| Rate for Payer: Railroad Medicare Medicare |
$187.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.40
|
| Rate for Payer: UHC Core |
$308.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$187.17
|
| Rate for Payer: UHC Exchange |
$308.40
|
| Rate for Payer: UHC Medicaid |
$97.89
|
| Rate for Payer: UHCCP Medicaid |
$97.89
|
| Rate for Payer: UMR Bronson Commercial |
$8,884.87
|
| Rate for Payer: VA VA |
$187.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,009.87
|
|
|
IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,013.16
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,565.79 |
| Max. Negotiated Rate |
$21,611.84 |
| Rate for Payer: Aetna American Axle |
$15,608.55
|
| Rate for Payer: Aetna Commercial |
$20,411.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,608.55
|
| Rate for Payer: Cash Price |
$19,210.53
|
| Rate for Payer: Cofinity Advantage |
$16,809.21
|
| Rate for Payer: Cofinity Commercial |
$20,651.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,210.53
|
| Rate for Payer: Healthscope Commercial |
$21,611.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,809.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,009.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,411.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,009.87
|
| Rate for Payer: PHP Commercial |
$20,411.19
|
| Rate for Payer: Priority Health SBD |
$15,128.29
|
| Rate for Payer: UMR Bronson Commercial |
$10,565.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,009.87
|
|
|
IPL CHEEKS FIRST
|
Professional
|
Both
|
$132.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
