|
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 Commercial |
$117.22
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.59
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$333.70
|
|
|
Service Code
|
NDC 55111068401
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.83 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna American Axle |
$216.91
|
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.91
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$233.59
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.91
|
| Rate for Payer: Priority Health SBD |
$210.23
|
| Rate for Payer: UMR Bronson Commercial |
$146.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$333.70
|
|
|
Service Code
|
NDC 55111068401
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.47 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna American Axle |
$216.91
|
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna Medicare |
$166.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.91
|
| Rate for Payer: BCBS Complete |
$133.48
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$233.59
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.91
|
| Rate for Payer: Priority Health SBD |
$210.23
|
| Rate for Payer: UMR Bronson Commercial |
$123.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$14.60 |
| Rate for Payer: Aetna American Axle |
$10.54
|
| Rate for Payer: Aetna Commercial |
$13.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.54
|
| Rate for Payer: Cash Price |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$13.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$14.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.79
|
| Rate for Payer: PHP Commercial |
$13.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health SBD |
$10.22
|
| Rate for Payer: UMR Bronson Commercial |
$7.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.16
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
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 Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.53
|
| 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: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$99.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
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 |
$325.24 |
| 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: Cash Price |
$703.22
|
| Rate for Payer: Cash Price |
$708.18
|
| Rate for Payer: Cofinity Commercial |
$755.97
|
| Rate for Payer: Cofinity Commercial |
$615.32
|
| Rate for Payer: Cofinity Commercial |
$619.65
|
| Rate for Payer: Cofinity Commercial |
$761.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$619.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$615.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$703.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.18
|
| Rate for Payer: Healthscope Commercial |
$796.70
|
| Rate for Payer: Healthscope Commercial |
$791.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$615.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$619.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$659.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$663.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$747.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$752.44
|
| Rate for Payer: PHP Commercial |
$752.44
|
| Rate for Payer: PHP Commercial |
$747.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.39
|
| Rate for Payer: Priority Health SBD |
$557.69
|
| Rate for Payer: Priority Health SBD |
$553.79
|
| 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 |
$663.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$659.27
|
|
|
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 Commercial |
$761.29
|
| Rate for Payer: Cofinity Commercial |
$619.65
|
| Rate for Payer: Cofinity Commercial |
$615.32
|
| Rate for Payer: Cofinity Commercial |
$755.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$615.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$619.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$703.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.18
|
| Rate for Payer: Healthscope Commercial |
$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: Multiplan/Beech St/PHCS Commercial |
$752.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$747.18
|
| Rate for Payer: PHP Commercial |
$752.44
|
| Rate for Payer: PHP Commercial |
$747.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.39
|
| Rate for Payer: Priority Health SBD |
$553.79
|
| Rate for Payer: Priority Health SBD |
$557.69
|
| Rate for Payer: UMR Bronson Commercial |
$386.77
|
| Rate for Payer: UMR Bronson Commercial |
$389.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$659.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$663.91
|
|
|
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 Commercial |
$203.53
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.53
|
| 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: PHP Commercial |
$247.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.99
|
| 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
|
|
|
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 |
$92.36 |
| Max. Negotiated Rate |
$485.04 |
| Rate for Payer: Aetna American Axle |
$188.99
|
| Rate for Payer: Aetna Commercial |
$247.14
|
| Rate for Payer: Aetna Medicare |
$179.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.39
|
| Rate for Payer: BCBS Complete |
$96.98
|
| Rate for Payer: BCBS MAPPO |
$172.31
|
| Rate for Payer: BCN Medicare Advantage |
$172.31
|
| Rate for Payer: Cash Price |
$232.60
|
| Rate for Payer: Cash Price |
$232.60
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$203.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.31
|
| 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 |
$92.36
|
| Rate for Payer: Mclaren Medicare |
$172.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.93
|
| Rate for Payer: Meridian Medicaid |
$96.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.14
|
| Rate for Payer: PACE Medicare |
$163.69
|
| Rate for Payer: PACE SWMI |
$172.31
|
| Rate for Payer: PHP Commercial |
$247.14
|
| Rate for Payer: PHP Medicare Advantage |
$172.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.99
|
| Rate for Payer: Priority Health Medicare |
$172.31
|
| Rate for Payer: Priority Health SBD |
$183.17
|
| Rate for Payer: Railroad Medicare Medicare |
$172.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$485.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.31
|
| Rate for Payer: UHC Exchange |
$329.30
|
| Rate for Payer: UHC Medicare Advantage |
$172.31
|
| Rate for Payer: UHCCP Medicaid |
$92.36
|
| Rate for Payer: UMR Bronson Commercial |
$107.58
|
| Rate for Payer: VA VA |
$172.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.06
|
|
|
ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$7,681.06
|
|
|
Service Code
|
HCPCS J1744
|
| Hospital Charge Code |
153436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,379.67 |
| Max. Negotiated Rate |
$6,912.95 |
| Rate for Payer: Aetna American Axle |
$4,992.69
|
| Rate for Payer: Aetna American Axle |
$5,439.58
|
| Rate for Payer: Aetna Commercial |
$6,528.90
|
| Rate for Payer: Aetna Commercial |
$7,113.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,992.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,439.58
|
| Rate for Payer: Cash Price |
$6,144.85
|
| Rate for Payer: Cash Price |
$6,694.86
|
| Rate for Payer: Cofinity Commercial |
$7,196.98
|
| Rate for Payer: Cofinity Commercial |
$5,858.01
|
| Rate for Payer: Cofinity Commercial |
$5,376.74
|
| Rate for Payer: Cofinity Commercial |
$6,605.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,376.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,858.01
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$5,376.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,858.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,760.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,276.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,113.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,528.90
|
| Rate for Payer: PHP Commercial |
$7,113.29
|
| Rate for Payer: PHP Commercial |
$6,528.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,992.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,439.58
|
| Rate for Payer: Priority Health SBD |
$4,839.07
|
| Rate for Payer: Priority Health SBD |
$5,272.21
|
| Rate for Payer: UMR Bronson Commercial |
$3,379.67
|
| Rate for Payer: UMR Bronson Commercial |
$3,682.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,760.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,276.44
|
|
|
ICATIBANT 30 MG/3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$8,368.58
|
|
|
Service Code
|
HCPCS J1744
|
| Hospital Charge Code |
153436
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$7,531.72 |
| 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 |
$7,113.29
|
| Rate for Payer: Aetna Medicare |
$135.61
|
| Rate for Payer: Aetna Medicare |
$135.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,439.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,992.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.99
|
| Rate for Payer: BCBS Complete |
$73.38
|
| Rate for Payer: BCBS Complete |
$73.38
|
| Rate for Payer: BCBS MAPPO |
$130.39
|
| Rate for Payer: BCBS MAPPO |
$130.39
|
| Rate for Payer: BCN Medicare Advantage |
$130.39
|
| Rate for Payer: BCN Medicare Advantage |
$130.39
|
| 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 |
$6,144.85
|
| Rate for Payer: Cofinity Commercial |
$5,376.74
|
| Rate for Payer: Cofinity Commercial |
$6,605.71
|
| Rate for Payer: Cofinity Commercial |
$5,858.01
|
| Rate for Payer: Cofinity Commercial |
$7,196.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,376.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,858.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,694.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,144.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.39
|
| 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: Lakeland Regional Health Systems Commercial |
$5,760.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,276.44
|
| Rate for Payer: Mclaren Medicaid |
$69.89
|
| Rate for Payer: Mclaren Medicaid |
$69.89
|
| Rate for Payer: Mclaren Medicare |
$130.39
|
| Rate for Payer: Mclaren Medicare |
$130.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.91
|
| Rate for Payer: Meridian Medicaid |
$73.38
|
| Rate for Payer: Meridian Medicaid |
$73.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,113.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,528.90
|
| Rate for Payer: PACE Medicare |
$123.87
|
| Rate for Payer: PACE Medicare |
$123.87
|
| Rate for Payer: PACE SWMI |
$130.39
|
| Rate for Payer: PACE SWMI |
$130.39
|
| Rate for Payer: PHP Commercial |
$6,528.90
|
| Rate for Payer: PHP Commercial |
$7,113.29
|
| Rate for Payer: PHP Medicare Advantage |
$130.39
|
| Rate for Payer: PHP Medicare Advantage |
$130.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,992.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,439.58
|
| Rate for Payer: Priority Health Medicare |
$130.39
|
| Rate for Payer: Priority Health Medicare |
$130.39
|
| Rate for Payer: Priority Health SBD |
$4,839.07
|
| Rate for Payer: Priority Health SBD |
$5,272.21
|
| Rate for Payer: Railroad Medicare Medicare |
$130.39
|
| Rate for Payer: Railroad Medicare Medicare |
$130.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.39
|
| Rate for Payer: UHC Exchange |
$249.19
|
| Rate for Payer: UHC Exchange |
$249.19
|
| Rate for Payer: UHC Medicare Advantage |
$130.39
|
| Rate for Payer: UHC Medicare Advantage |
$130.39
|
| Rate for Payer: UHCCP Medicaid |
$69.89
|
| Rate for Payer: UHCCP Medicaid |
$69.89
|
| Rate for Payer: UMR Bronson Commercial |
$2,841.99
|
| Rate for Payer: UMR Bronson Commercial |
$3,096.37
|
| Rate for Payer: VA VA |
$130.39
|
| Rate for Payer: VA VA |
$130.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,276.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,760.80
|
|
|
IDARUBICIN 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$899.38
|
|
|
Service Code
|
HCPCS J9211
|
| Hospital Charge Code |
22144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$332.77 |
| Max. Negotiated Rate |
$809.44 |
| Rate for Payer: Aetna American Axle |
$584.60
|
| Rate for Payer: Aetna American Axle |
$309.89
|
| Rate for Payer: Aetna American Axle |
$497.80
|
| Rate for Payer: Aetna Commercial |
$764.47
|
| Rate for Payer: Aetna Commercial |
$650.97
|
| Rate for Payer: Aetna Commercial |
$405.24
|
| Rate for Payer: Aetna Medicare |
$449.69
|
| Rate for Payer: Aetna Medicare |
$382.93
|
| Rate for Payer: Aetna Medicare |
$238.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.89
|
| Rate for Payer: BCBS Complete |
$190.70
|
| Rate for Payer: BCBS Complete |
$306.34
|
| Rate for Payer: BCBS Complete |
$359.75
|
| Rate for Payer: Cash Price |
$719.50
|
| Rate for Payer: Cash Price |
$612.68
|
| Rate for Payer: Cash Price |
$381.40
|
| Rate for Payer: Cofinity Commercial |
$658.63
|
| Rate for Payer: Cofinity Commercial |
$333.73
|
| Rate for Payer: Cofinity Commercial |
$410.00
|
| Rate for Payer: Cofinity Commercial |
$773.47
|
| Rate for Payer: Cofinity Commercial |
$629.57
|
| Rate for Payer: Cofinity Commercial |
$536.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$333.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$629.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.50
|
| Rate for Payer: Healthscope Commercial |
$429.07
|
| Rate for Payer: Healthscope Commercial |
$689.26
|
| Rate for Payer: Healthscope Commercial |
$809.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$536.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.56
|
| 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 |
$405.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.47
|
| Rate for Payer: PHP Commercial |
$405.24
|
| Rate for Payer: PHP Commercial |
$650.97
|
| Rate for Payer: PHP Commercial |
$764.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.89
|
| Rate for Payer: Priority Health SBD |
$482.49
|
| Rate for Payer: Priority Health SBD |
$300.35
|
| Rate for Payer: Priority Health SBD |
$566.61
|
| Rate for Payer: UMR Bronson Commercial |
$332.77
|
| Rate for Payer: UMR Bronson Commercial |
$176.40
|
| Rate for Payer: UMR Bronson Commercial |
$283.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.39
|
| 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 Commercial |
$773.47
|
| Rate for Payer: Cofinity Commercial |
$629.57
|
| Rate for Payer: Cofinity Commercial |
$536.10
|
| Rate for Payer: Cofinity Commercial |
$658.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$536.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$629.57
|
| 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 |
$536.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.57
|
| 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 |
$764.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.97
|
| Rate for Payer: PHP Commercial |
$764.47
|
| Rate for Payer: PHP Commercial |
$650.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.60
|
| Rate for Payer: Priority Health SBD |
$482.49
|
| Rate for Payer: Priority Health SBD |
$566.61
|
| Rate for Payer: UMR Bronson Commercial |
$336.97
|
| Rate for Payer: UMR Bronson Commercial |
$395.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.53
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,101.67
|
|
|
Service Code
|
NDC 00597019705
|
| Hospital Charge Code |
176112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,367.62 |
| Max. Negotiated Rate |
$8,191.50 |
| Rate for Payer: Aetna American Axle |
$5,916.09
|
| Rate for Payer: Aetna Commercial |
$7,736.42
|
| Rate for Payer: Aetna Medicare |
$4,550.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,916.09
|
| Rate for Payer: BCBS Complete |
$3,640.67
|
| Rate for Payer: Cash Price |
$7,281.34
|
| Rate for Payer: Cofinity Commercial |
$6,371.17
|
| Rate for Payer: Cofinity Commercial |
$7,827.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,371.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,281.34
|
| Rate for Payer: Healthscope Commercial |
$8,191.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,371.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,826.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,736.42
|
| Rate for Payer: PHP Commercial |
$7,736.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,916.09
|
| Rate for Payer: Priority Health SBD |
$5,734.05
|
| Rate for Payer: UMR Bronson Commercial |
$3,367.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,826.25
|
|
|
IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,101.67
|
|
|
Service Code
|
NDC 00597019705
|
| Hospital Charge Code |
176112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4,004.73 |
| Max. Negotiated Rate |
$8,191.50 |
| Rate for Payer: Aetna American Axle |
$5,916.09
|
| Rate for Payer: Aetna Commercial |
$7,736.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,916.09
|
| Rate for Payer: Cash Price |
$7,281.34
|
| Rate for Payer: Cofinity Commercial |
$6,371.17
|
| Rate for Payer: Cofinity Commercial |
$7,827.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,371.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,281.34
|
| Rate for Payer: Healthscope Commercial |
$8,191.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,371.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,826.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,736.42
|
| Rate for Payer: PHP Commercial |
$7,736.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,916.09
|
| Rate for Payer: Priority Health SBD |
$5,734.05
|
| Rate for Payer: UMR Bronson Commercial |
$4,004.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,826.25
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$290.28
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.40 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Aetna American Axle |
$188.68
|
| Rate for Payer: Aetna American Axle |
$324.32
|
| Rate for Payer: Aetna Commercial |
$246.74
|
| Rate for Payer: Aetna Commercial |
$424.11
|
| Rate for Payer: Aetna Medicare |
$145.14
|
| Rate for Payer: Aetna Medicare |
$249.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.32
|
| Rate for Payer: BCBS Complete |
$199.58
|
| Rate for Payer: BCBS Complete |
$116.11
|
| Rate for Payer: Cash Price |
$232.22
|
| Rate for Payer: Cash Price |
$399.16
|
| Rate for Payer: Cofinity Commercial |
$249.64
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$349.26
|
| Rate for Payer: Cofinity Commercial |
$429.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.16
|
| Rate for Payer: Healthscope Commercial |
$449.06
|
| Rate for Payer: Healthscope Commercial |
$261.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.11
|
| Rate for Payer: PHP Commercial |
$424.11
|
| Rate for Payer: PHP Commercial |
$246.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.32
|
| Rate for Payer: Priority Health SBD |
$314.34
|
| Rate for Payer: Priority Health SBD |
$182.88
|
| Rate for Payer: UMR Bronson Commercial |
$107.40
|
| Rate for Payer: UMR Bronson Commercial |
$184.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$374.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.71
|
|
|
IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$290.28
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.72 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Aetna American Axle |
$188.68
|
| Rate for Payer: Aetna American Axle |
$324.32
|
| Rate for Payer: Aetna Commercial |
$246.74
|
| Rate for Payer: Aetna Commercial |
$424.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.32
|
| Rate for Payer: Cash Price |
$232.22
|
| Rate for Payer: Cash Price |
$399.16
|
| Rate for Payer: Cofinity Commercial |
$429.10
|
| Rate for Payer: Cofinity Commercial |
$349.26
|
| Rate for Payer: Cofinity Commercial |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$249.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$349.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$399.16
|
| Rate for Payer: Healthscope Commercial |
$261.25
|
| Rate for Payer: Healthscope Commercial |
$449.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$349.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$374.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.74
|
| Rate for Payer: PHP Commercial |
$424.11
|
| Rate for Payer: PHP Commercial |
$246.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.32
|
| Rate for Payer: Priority Health SBD |
$182.88
|
| Rate for Payer: Priority Health SBD |
$314.34
|
| Rate for Payer: UMR Bronson Commercial |
$127.72
|
| Rate for Payer: UMR Bronson Commercial |
$219.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.71
|
| 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 |
$342.32 |
| 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: Cash Price |
$740.15
|
| Rate for Payer: Cofinity Commercial |
$647.63
|
| Rate for Payer: Cofinity Commercial |
$795.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$647.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.15
|
| Rate for Payer: Healthscope Commercial |
$832.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$647.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$693.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$786.41
|
| Rate for Payer: PHP Commercial |
$786.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.37
|
| Rate for Payer: Priority Health SBD |
$582.87
|
| Rate for Payer: UMR Bronson Commercial |
$342.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$693.89
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$775.62
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$286.98 |
| Max. Negotiated Rate |
$698.06 |
| Rate for Payer: Aetna American Axle |
$504.15
|
| Rate for Payer: Aetna Commercial |
$659.28
|
| Rate for Payer: Aetna Medicare |
$387.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.15
|
| Rate for Payer: BCBS Complete |
$310.25
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cofinity Commercial |
$542.93
|
| Rate for Payer: Cofinity Commercial |
$667.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.50
|
| Rate for Payer: Healthscope Commercial |
$698.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.28
|
| Rate for Payer: PHP Commercial |
$659.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.15
|
| Rate for Payer: Priority Health SBD |
$488.64
|
| Rate for Payer: UMR Bronson Commercial |
$286.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.72
|
|
|
IFOSFAMIDE 3 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$775.62
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
10249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$341.27 |
| Max. Negotiated Rate |
$698.06 |
| Rate for Payer: Aetna American Axle |
$504.15
|
| Rate for Payer: Aetna Commercial |
$659.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.15
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cofinity Commercial |
$542.93
|
| Rate for Payer: Cofinity Commercial |
$667.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.50
|
| Rate for Payer: Healthscope Commercial |
$698.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.28
|
| Rate for Payer: PHP Commercial |
$659.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.15
|
| Rate for Payer: Priority Health SBD |
$488.64
|
| Rate for Payer: UMR Bronson Commercial |
$341.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.72
|
|
|
ILEOSCOPY, THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,573.89
|
|
|
Service Code
|
CPT 44380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,747.47
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,573.89
|
|
|
Service Code
|
CPT 44382
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,747.47
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
IMATINIB 100 MG TABLET
|
Facility
|
IP
|
$1,014.99
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
32979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$446.60 |
| Max. Negotiated Rate |
$913.49 |
| Rate for Payer: Aetna American Axle |
$659.74
|
| Rate for Payer: Aetna American Axle |
$196.56
|
| Rate for Payer: Aetna American Axle |
$19,761.24
|
| Rate for Payer: Aetna Commercial |
$257.04
|
| Rate for Payer: Aetna Commercial |
$862.74
|
| Rate for Payer: Aetna Commercial |
$25,841.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,761.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.56
|
| Rate for Payer: Cash Price |
$24,321.53
|
| Rate for Payer: Cash Price |
$241.92
|
| Rate for Payer: Cash Price |
$811.99
|
| Rate for Payer: Cofinity Commercial |
$872.89
|
| Rate for Payer: Cofinity Commercial |
$260.06
|
| Rate for Payer: Cofinity Commercial |
$211.68
|
| Rate for Payer: Cofinity Commercial |
$26,145.64
|
| Rate for Payer: Cofinity Commercial |
$21,281.34
|
| Rate for Payer: Cofinity Commercial |
$710.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$710.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,281.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,321.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.92
|
| Rate for Payer: Healthscope Commercial |
$272.16
|
| Rate for Payer: Healthscope Commercial |
$913.49
|
| Rate for Payer: Healthscope Commercial |
$27,361.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$710.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,281.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$761.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,801.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$862.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,841.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.04
|
| Rate for Payer: PHP Commercial |
$25,841.62
|
| Rate for Payer: PHP Commercial |
$257.04
|
| Rate for Payer: PHP Commercial |
$862.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,761.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.74
|
| Rate for Payer: Priority Health SBD |
$19,153.20
|
| Rate for Payer: Priority Health SBD |
$190.51
|
| Rate for Payer: Priority Health SBD |
$639.44
|
| Rate for Payer: UMR Bronson Commercial |
$446.60
|
| Rate for Payer: UMR Bronson Commercial |
$13,376.84
|
| Rate for Payer: UMR Bronson Commercial |
$133.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,801.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$761.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.80
|
|
|
IMATINIB 100 MG TABLET
|
Facility
|
OP
|
$30,401.91
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
32979
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,248.71 |
| Max. Negotiated Rate |
$27,361.72 |
| Rate for Payer: Aetna American Axle |
$19,761.24
|
| Rate for Payer: Aetna American Axle |
$659.74
|
| Rate for Payer: Aetna American Axle |
$196.56
|
| Rate for Payer: Aetna Commercial |
$25,841.62
|
| Rate for Payer: Aetna Commercial |
$257.04
|
| Rate for Payer: Aetna Commercial |
$862.74
|
| Rate for Payer: Aetna Medicare |
$15,200.95
|
| Rate for Payer: Aetna Medicare |
$151.20
|
| Rate for Payer: Aetna Medicare |
$507.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,761.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.74
|
| Rate for Payer: BCBS Complete |
$406.00
|
| Rate for Payer: BCBS Complete |
$120.96
|
| Rate for Payer: BCBS Complete |
$12,160.76
|
| Rate for Payer: Cash Price |
$24,321.53
|
| Rate for Payer: Cash Price |
$241.92
|
| Rate for Payer: Cash Price |
$811.99
|
| Rate for Payer: Cofinity Commercial |
$260.06
|
| Rate for Payer: Cofinity Commercial |
$710.49
|
| Rate for Payer: Cofinity Commercial |
$872.89
|
| Rate for Payer: Cofinity Commercial |
$26,145.64
|
| Rate for Payer: Cofinity Commercial |
$21,281.34
|
| Rate for Payer: Cofinity Commercial |
$211.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$710.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$21,281.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$811.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,321.53
|
| Rate for Payer: Healthscope Commercial |
$913.49
|
| Rate for Payer: Healthscope Commercial |
$272.16
|
| Rate for Payer: Healthscope Commercial |
$27,361.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$710.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,281.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$761.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,801.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$862.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,841.62
|
| Rate for Payer: PHP Commercial |
$862.74
|
| Rate for Payer: PHP Commercial |
$257.04
|
| Rate for Payer: PHP Commercial |
$25,841.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,761.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.74
|
| Rate for Payer: Priority Health SBD |
$190.51
|
| Rate for Payer: Priority Health SBD |
$639.44
|
| Rate for Payer: Priority Health SBD |
$19,153.20
|
| Rate for Payer: UMR Bronson Commercial |
$11,248.71
|
| Rate for Payer: UMR Bronson Commercial |
$375.55
|
| Rate for Payer: UMR Bronson Commercial |
$111.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$761.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,801.43
|
|
|
IMIPENEM-CILASTATIN 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$135.13
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
9603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.46 |
| Max. Negotiated Rate |
$121.62 |
| Rate for Payer: Aetna American Axle |
$87.83
|
| Rate for Payer: Aetna American Axle |
$28.70
|
| Rate for Payer: Aetna Commercial |
$114.86
|
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.70
|
| Rate for Payer: Cash Price |
$108.10
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cofinity Commercial |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$30.91
|
| Rate for Payer: Cofinity Commercial |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$94.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.33
|
| Rate for Payer: Healthscope Commercial |
$121.62
|
| Rate for Payer: Healthscope Commercial |
$39.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.86
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$114.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.70
|
| Rate for Payer: Priority Health SBD |
$85.13
|
| Rate for Payer: Priority Health SBD |
$27.82
|
| Rate for Payer: UMR Bronson Commercial |
$59.46
|
| Rate for Payer: UMR Bronson Commercial |
$19.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.12
|
|
