|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$199.59
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$179.63 |
| Rate for Payer: Aetna American Axle |
$129.73
|
| Rate for Payer: Aetna American Axle |
$92.88
|
| Rate for Payer: Aetna Commercial |
$121.46
|
| Rate for Payer: Aetna Commercial |
$169.65
|
| Rate for Payer: Aetna Medicare |
$99.80
|
| Rate for Payer: Aetna Medicare |
$71.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.88
|
| Rate for Payer: BCBS Complete |
$57.16
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCN Commercial |
$0.76
|
| Rate for Payer: BCN Commercial |
$0.76
|
| Rate for Payer: Cash Price |
$159.67
|
| Rate for Payer: Cash Price |
$114.31
|
| Rate for Payer: Cash Price |
$114.31
|
| Rate for Payer: Cash Price |
$159.67
|
| Rate for Payer: Cofinity Advantage |
$139.71
|
| Rate for Payer: Cofinity Advantage |
$100.02
|
| Rate for Payer: Cofinity Commercial |
$122.89
|
| Rate for Payer: Cofinity Commercial |
$171.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.67
|
| Rate for Payer: Healthscope Commercial |
$179.63
|
| Rate for Payer: Healthscope Commercial |
$128.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.17
|
| Rate for Payer: PHP Commercial |
$121.46
|
| Rate for Payer: PHP Commercial |
$169.65
|
| Rate for Payer: Priority Health SBD |
$125.74
|
| Rate for Payer: Priority Health SBD |
$90.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC Core |
$0.40
|
| Rate for Payer: UHC Core |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.40
|
| Rate for Payer: UMR Bronson Commercial |
$73.85
|
| Rate for Payer: UMR Bronson Commercial |
$52.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.69
|
|
|
IRON SUCROSE 50 MG IRON/2.5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$71.59
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$64.43 |
| Rate for Payer: Aetna American Axle |
$46.53
|
| Rate for Payer: Aetna Commercial |
$60.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.53
|
| Rate for Payer: Cash Price |
$57.27
|
| Rate for Payer: Cofinity Advantage |
$50.11
|
| Rate for Payer: Cofinity Commercial |
$61.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.27
|
| Rate for Payer: Healthscope Commercial |
$64.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.69
|
| Rate for Payer: PHP Commercial |
$60.85
|
| Rate for Payer: Priority Health SBD |
$45.10
|
| Rate for Payer: UMR Bronson Commercial |
$31.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.69
|
|
|
IRON SUCROSE 50 MG IRON/2.5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$71.59
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$64.43 |
| Rate for Payer: Aetna American Axle |
$46.53
|
| Rate for Payer: Aetna Commercial |
$60.85
|
| Rate for Payer: Aetna Medicare |
$35.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.53
|
| Rate for Payer: BCBS Complete |
$28.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.76
|
| Rate for Payer: BCN Commercial |
$0.76
|
| Rate for Payer: Cash Price |
$57.27
|
| Rate for Payer: Cash Price |
$57.27
|
| Rate for Payer: Cofinity Advantage |
$50.11
|
| Rate for Payer: Cofinity Commercial |
$61.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.27
|
| Rate for Payer: Healthscope Commercial |
$64.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.69
|
| Rate for Payer: PHP Commercial |
$60.85
|
| Rate for Payer: Priority Health SBD |
$45.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.40
|
| Rate for Payer: UHC Core |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.40
|
| Rate for Payer: UMR Bronson Commercial |
$26.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.69
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
IP
|
$5,574.31
|
|
|
Service Code
|
NDC 00469052002
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,452.70 |
| Max. Negotiated Rate |
$5,016.88 |
| Rate for Payer: Aetna American Axle |
$3,623.30
|
| Rate for Payer: Aetna Commercial |
$4,738.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,623.30
|
| Rate for Payer: Cash Price |
$4,459.45
|
| Rate for Payer: Cofinity Advantage |
$3,902.02
|
| Rate for Payer: Cofinity Commercial |
$4,793.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,459.45
|
| Rate for Payer: Healthscope Commercial |
$5,016.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,902.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,180.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,738.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,180.73
|
| Rate for Payer: PHP Commercial |
$4,738.16
|
| Rate for Payer: Priority Health SBD |
$3,511.82
|
| Rate for Payer: UMR Bronson Commercial |
$2,452.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,180.73
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
OP
|
$5,574.31
|
|
|
Service Code
|
NDC 00469052002
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,062.49 |
| Max. Negotiated Rate |
$5,016.88 |
| Rate for Payer: Aetna American Axle |
$3,623.30
|
| Rate for Payer: Aetna Commercial |
$4,738.16
|
| Rate for Payer: Aetna Medicare |
$2,787.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,623.30
|
| Rate for Payer: BCBS Complete |
$2,229.72
|
| Rate for Payer: Cash Price |
$4,459.45
|
| Rate for Payer: Cofinity Advantage |
$3,902.02
|
| Rate for Payer: Cofinity Commercial |
$4,793.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,459.45
|
| Rate for Payer: Healthscope Commercial |
$5,016.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,902.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,180.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,459.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,738.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,180.73
|
| Rate for Payer: PHP Commercial |
$4,738.16
|
| Rate for Payer: Priority Health SBD |
$3,511.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,623.30
|
| Rate for Payer: UHC Core |
$2,904.22
|
| Rate for Payer: UHC Exchange |
$2,190.70
|
| Rate for Payer: UMR Bronson Commercial |
$2,062.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,180.73
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
OP
|
$398.17
|
|
|
Service Code
|
NDC 00469052001
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.32 |
| Max. Negotiated Rate |
$358.35 |
| Rate for Payer: Aetna American Axle |
$258.81
|
| Rate for Payer: Aetna Commercial |
$338.44
|
| Rate for Payer: Aetna Medicare |
$199.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.81
|
| Rate for Payer: BCBS Complete |
$159.27
|
| Rate for Payer: Cash Price |
$318.54
|
| Rate for Payer: Cofinity Advantage |
$278.72
|
| Rate for Payer: Cofinity Commercial |
$342.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.54
|
| Rate for Payer: Healthscope Commercial |
$358.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.63
|
| Rate for Payer: PHP Commercial |
$338.44
|
| Rate for Payer: Priority Health SBD |
$250.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.81
|
| Rate for Payer: UHC Core |
$207.45
|
| Rate for Payer: UHC Exchange |
$156.48
|
| Rate for Payer: UMR Bronson Commercial |
$147.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.63
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
OP
|
$4,889.98
|
|
|
Service Code
|
NDC 00469052014
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,809.29 |
| Max. Negotiated Rate |
$4,400.98 |
| Rate for Payer: Aetna American Axle |
$3,178.49
|
| Rate for Payer: Aetna Commercial |
$4,156.48
|
| Rate for Payer: Aetna Medicare |
$2,444.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,178.49
|
| Rate for Payer: BCBS Complete |
$1,955.99
|
| Rate for Payer: Cash Price |
$3,911.98
|
| Rate for Payer: Cofinity Advantage |
$3,422.99
|
| Rate for Payer: Cofinity Commercial |
$4,205.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,911.98
|
| Rate for Payer: Healthscope Commercial |
$4,400.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,422.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,667.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,911.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,156.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,667.49
|
| Rate for Payer: PHP Commercial |
$4,156.48
|
| Rate for Payer: Priority Health SBD |
$3,080.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,178.49
|
| Rate for Payer: UHC Core |
$2,547.68
|
| Rate for Payer: UHC Exchange |
$1,921.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,809.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,667.49
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
IP
|
$4,889.98
|
|
|
Service Code
|
NDC 00469052014
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,151.59 |
| Max. Negotiated Rate |
$4,400.98 |
| Rate for Payer: Aetna American Axle |
$3,178.49
|
| Rate for Payer: Aetna Commercial |
$4,156.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,178.49
|
| Rate for Payer: Cash Price |
$3,911.98
|
| Rate for Payer: Cofinity Advantage |
$3,422.99
|
| Rate for Payer: Cofinity Commercial |
$4,205.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,911.98
|
| Rate for Payer: Healthscope Commercial |
$4,400.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,422.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,667.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,156.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,667.49
|
| Rate for Payer: PHP Commercial |
$4,156.48
|
| Rate for Payer: Priority Health SBD |
$3,080.69
|
| Rate for Payer: UMR Bronson Commercial |
$2,151.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,667.49
|
|
|
ISAVUCONAZONIUM SULFATE 186 MG CAPSULE
|
Facility
|
IP
|
$398.17
|
|
|
Service Code
|
NDC 00469052001
|
| Hospital Charge Code |
174376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.19 |
| Max. Negotiated Rate |
$358.35 |
| Rate for Payer: Aetna American Axle |
$258.81
|
| Rate for Payer: Aetna Commercial |
$338.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.81
|
| Rate for Payer: Cash Price |
$318.54
|
| Rate for Payer: Cofinity Advantage |
$278.72
|
| Rate for Payer: Cofinity Commercial |
$342.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.54
|
| Rate for Payer: Healthscope Commercial |
$358.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.63
|
| Rate for Payer: PHP Commercial |
$338.44
|
| Rate for Payer: Priority Health SBD |
$250.85
|
| Rate for Payer: UMR Bronson Commercial |
$175.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.63
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE
|
Facility
|
IP
|
$159.60
|
|
|
Service Code
|
NDC 00469286001
|
| Hospital Charge Code |
205375
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.22 |
| Max. Negotiated Rate |
$143.64 |
| Rate for Payer: Aetna American Axle |
$103.74
|
| Rate for Payer: Aetna Commercial |
$135.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.74
|
| Rate for Payer: Cash Price |
$127.68
|
| Rate for Payer: Cofinity Advantage |
$111.72
|
| Rate for Payer: Cofinity Commercial |
$137.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.68
|
| Rate for Payer: Healthscope Commercial |
$143.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.70
|
| Rate for Payer: PHP Commercial |
$135.66
|
| Rate for Payer: Priority Health SBD |
$100.55
|
| Rate for Payer: UMR Bronson Commercial |
$70.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.70
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE
|
Facility
|
IP
|
$5,585.99
|
|
|
Service Code
|
NDC 00469286035
|
| Hospital Charge Code |
205375
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,457.84 |
| Max. Negotiated Rate |
$5,027.39 |
| Rate for Payer: Aetna American Axle |
$3,630.89
|
| Rate for Payer: Aetna Commercial |
$4,748.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,630.89
|
| Rate for Payer: Cash Price |
$4,468.79
|
| Rate for Payer: Cofinity Advantage |
$3,910.19
|
| Rate for Payer: Cofinity Commercial |
$4,803.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,468.79
|
| Rate for Payer: Healthscope Commercial |
$5,027.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,910.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,189.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,748.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,189.49
|
| Rate for Payer: PHP Commercial |
$4,748.09
|
| Rate for Payer: Priority Health SBD |
$3,519.17
|
| Rate for Payer: UMR Bronson Commercial |
$2,457.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,189.49
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE
|
Facility
|
OP
|
$159.60
|
|
|
Service Code
|
NDC 00469286001
|
| Hospital Charge Code |
205375
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.05 |
| Max. Negotiated Rate |
$143.64 |
| Rate for Payer: Aetna American Axle |
$103.74
|
| Rate for Payer: Aetna Commercial |
$135.66
|
| Rate for Payer: Aetna Medicare |
$79.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.74
|
| Rate for Payer: BCBS Complete |
$63.84
|
| Rate for Payer: Cash Price |
$127.68
|
| Rate for Payer: Cofinity Advantage |
$111.72
|
| Rate for Payer: Cofinity Commercial |
$137.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.68
|
| Rate for Payer: Healthscope Commercial |
$143.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.70
|
| Rate for Payer: PHP Commercial |
$135.66
|
| Rate for Payer: Priority Health SBD |
$100.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.74
|
| Rate for Payer: UHC Core |
$83.15
|
| Rate for Payer: UHC Exchange |
$62.72
|
| Rate for Payer: UMR Bronson Commercial |
$59.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.70
|
|
|
ISAVUCONAZONIUM SULFATE 74.5 MG CAPSULE
|
Facility
|
OP
|
$5,585.99
|
|
|
Service Code
|
NDC 00469286035
|
| Hospital Charge Code |
205375
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,066.82 |
| Max. Negotiated Rate |
$5,027.39 |
| Rate for Payer: Aetna American Axle |
$3,630.89
|
| Rate for Payer: Aetna Commercial |
$4,748.09
|
| Rate for Payer: Aetna Medicare |
$2,792.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,630.89
|
| Rate for Payer: BCBS Complete |
$2,234.40
|
| Rate for Payer: Cash Price |
$4,468.79
|
| Rate for Payer: Cofinity Advantage |
$3,910.19
|
| Rate for Payer: Cofinity Commercial |
$4,803.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,468.79
|
| Rate for Payer: Healthscope Commercial |
$5,027.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,910.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,189.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,468.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,748.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,189.49
|
| Rate for Payer: PHP Commercial |
$4,748.09
|
| Rate for Payer: Priority Health SBD |
$3,519.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,630.89
|
| Rate for Payer: UHC Core |
$2,910.30
|
| Rate for Payer: UHC Exchange |
$2,195.29
|
| Rate for Payer: UMR Bronson Commercial |
$2,066.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,189.49
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC
|
Facility
|
IP
|
$40,756.50
|
|
|
Service Code
|
MSDRG 062
|
| Min. Negotiated Rate |
$14,523.50 |
| Max. Negotiated Rate |
$40,756.50 |
| Rate for Payer: Aetna Medicare |
$15,899.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,109.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,109.86
|
| Rate for Payer: BCBS MAPPO |
$15,287.89
|
| Rate for Payer: BCBS Trust/PPO |
$40,756.50
|
| Rate for Payer: BCN Commercial |
$40,756.50
|
| Rate for Payer: BCN Medicare Advantage |
$15,287.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,287.89
|
| Rate for Payer: Mclaren Medicare |
$15,287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,052.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,581.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,816.68
|
| Rate for Payer: Nomi Health Commercial |
$22,667.88
|
| Rate for Payer: PACE Medicare |
$14,523.50
|
| Rate for Payer: PACE SWMI |
$15,287.89
|
| Rate for Payer: PHP Medicare Advantage |
$15,287.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,329.82
|
| Rate for Payer: Priority Health Medicare |
$15,287.89
|
| Rate for Payer: Priority Health Tiered Network |
$22,663.86
|
| Rate for Payer: Railroad Medicare Medicare |
$15,287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,642.36
|
| Rate for Payer: UHC Core |
$23,962.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,287.89
|
| Rate for Payer: UHC Exchange |
$19,569.94
|
| Rate for Payer: VA VA |
$15,287.89
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC
|
Facility
|
IP
|
$65,028.67
|
|
|
Service Code
|
MSDRG 061
|
| Min. Negotiated Rate |
$22,467.26 |
| Max. Negotiated Rate |
$65,028.67 |
| Rate for Payer: Aetna Medicare |
$24,595.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,562.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,562.19
|
| Rate for Payer: BCBS MAPPO |
$23,649.75
|
| Rate for Payer: BCBS Trust/PPO |
$65,028.67
|
| Rate for Payer: BCN Commercial |
$65,028.67
|
| Rate for Payer: BCN Medicare Advantage |
$23,649.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,649.75
|
| Rate for Payer: Mclaren Medicare |
$23,649.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,832.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,197.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$26,014.72
|
| Rate for Payer: Nomi Health Commercial |
$35,566.59
|
| Rate for Payer: PACE Medicare |
$22,467.26
|
| Rate for Payer: PACE SWMI |
$23,649.75
|
| Rate for Payer: PHP Medicare Advantage |
$23,649.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44,450.35
|
| Rate for Payer: Priority Health Medicare |
$23,649.75
|
| Rate for Payer: Priority Health Tiered Network |
$35,560.28
|
| Rate for Payer: Railroad Medicare Medicare |
$23,649.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,940.73
|
| Rate for Payer: UHC Core |
$37,598.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,649.75
|
| Rate for Payer: UHC Exchange |
$30,705.82
|
| Rate for Payer: VA VA |
$23,649.75
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC
|
Facility
|
IP
|
$40,451.79
|
|
|
Service Code
|
MSDRG 063
|
| Min. Negotiated Rate |
$11,715.89 |
| Max. Negotiated Rate |
$40,451.79 |
| Rate for Payer: Aetna Medicare |
$12,825.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,415.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,415.65
|
| Rate for Payer: BCBS MAPPO |
$12,332.52
|
| Rate for Payer: BCBS Trust/PPO |
$40,451.79
|
| Rate for Payer: BCN Commercial |
$40,451.79
|
| Rate for Payer: BCN Medicare Advantage |
$12,332.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,332.52
|
| Rate for Payer: Mclaren Medicare |
$12,332.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,949.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,182.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,565.77
|
| Rate for Payer: Nomi Health Commercial |
$18,109.02
|
| Rate for Payer: PACE Medicare |
$11,715.89
|
| Rate for Payer: PACE SWMI |
$12,332.52
|
| Rate for Payer: PHP Medicare Advantage |
$12,332.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,632.26
|
| Rate for Payer: Priority Health Medicare |
$12,332.52
|
| Rate for Payer: Priority Health Tiered Network |
$18,105.81
|
| Rate for Payer: Railroad Medicare Medicare |
$12,332.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,881.94
|
| Rate for Payer: UHC Core |
$19,143.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,332.52
|
| Rate for Payer: UHC Exchange |
$15,634.12
|
| Rate for Payer: VA VA |
$12,332.52
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$197.95
|
|
|
Service Code
|
NDC 10019036060
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.24 |
| Max. Negotiated Rate |
$178.16 |
| Rate for Payer: Aetna American Axle |
$128.67
|
| Rate for Payer: Aetna Commercial |
$168.26
|
| Rate for Payer: Aetna Medicare |
$98.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.67
|
| Rate for Payer: BCBS Complete |
$79.18
|
| Rate for Payer: Cash Price |
$158.36
|
| Rate for Payer: Cofinity Advantage |
$138.56
|
| Rate for Payer: Cofinity Commercial |
$170.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.36
|
| Rate for Payer: Healthscope Commercial |
$178.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.46
|
| Rate for Payer: PHP Commercial |
$168.26
|
| Rate for Payer: Priority Health SBD |
$124.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.67
|
| Rate for Payer: UHC Core |
$103.13
|
| Rate for Payer: UHC Exchange |
$77.79
|
| Rate for Payer: UMR Bronson Commercial |
$73.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.46
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$197.95
|
|
|
Service Code
|
NDC 10019036060
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$178.16 |
| Rate for Payer: Aetna American Axle |
$128.67
|
| Rate for Payer: Aetna Commercial |
$168.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.67
|
| Rate for Payer: Cash Price |
$158.36
|
| Rate for Payer: Cofinity Advantage |
$138.56
|
| Rate for Payer: Cofinity Commercial |
$170.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.36
|
| Rate for Payer: Healthscope Commercial |
$178.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.46
|
| Rate for Payer: PHP Commercial |
$168.26
|
| Rate for Payer: Priority Health SBD |
$124.71
|
| Rate for Payer: UMR Bronson Commercial |
$87.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.46
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$106.38
|
|
|
Service Code
|
NDC 66794001925
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.36 |
| Max. Negotiated Rate |
$95.74 |
| Rate for Payer: Aetna American Axle |
$69.15
|
| Rate for Payer: Aetna Commercial |
$90.42
|
| Rate for Payer: Aetna Medicare |
$53.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.15
|
| Rate for Payer: BCBS Complete |
$42.55
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cofinity Advantage |
$74.47
|
| Rate for Payer: Cofinity Commercial |
$91.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$95.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.78
|
| Rate for Payer: PHP Commercial |
$90.42
|
| Rate for Payer: Priority Health SBD |
$67.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.15
|
| Rate for Payer: UHC Core |
$55.42
|
| Rate for Payer: UHC Exchange |
$41.81
|
| Rate for Payer: UMR Bronson Commercial |
$39.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.78
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$106.38
|
|
|
Service Code
|
NDC 66794001925
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$95.74 |
| Rate for Payer: Aetna American Axle |
$69.15
|
| Rate for Payer: Aetna Commercial |
$90.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.15
|
| Rate for Payer: Cash Price |
$85.10
|
| Rate for Payer: Cofinity Advantage |
$74.47
|
| Rate for Payer: Cofinity Commercial |
$91.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.10
|
| Rate for Payer: Healthscope Commercial |
$95.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.78
|
| Rate for Payer: PHP Commercial |
$90.42
|
| Rate for Payer: Priority Health SBD |
$67.02
|
| Rate for Payer: UMR Bronson Commercial |
$46.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.78
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
IP
|
$103.60
|
|
|
Service Code
|
NDC 66794001725
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$93.24 |
| Rate for Payer: Aetna American Axle |
$67.34
|
| Rate for Payer: Aetna Commercial |
$88.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.34
|
| Rate for Payer: Cash Price |
$82.88
|
| Rate for Payer: Cofinity Advantage |
$72.52
|
| Rate for Payer: Cofinity Commercial |
$89.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.88
|
| Rate for Payer: Healthscope Commercial |
$93.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.70
|
| Rate for Payer: PHP Commercial |
$88.06
|
| Rate for Payer: Priority Health SBD |
$65.27
|
| Rate for Payer: UMR Bronson Commercial |
$45.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.70
|
|
|
ISOFLURANE 99.9 % INHALATION LIQUID
|
Facility
|
OP
|
$103.60
|
|
|
Service Code
|
NDC 66794001725
|
| Hospital Charge Code |
159360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$93.24 |
| Rate for Payer: Aetna American Axle |
$67.34
|
| Rate for Payer: Aetna Commercial |
$88.06
|
| Rate for Payer: Aetna Medicare |
$51.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.34
|
| Rate for Payer: BCBS Complete |
$41.44
|
| Rate for Payer: Cash Price |
$82.88
|
| Rate for Payer: Cofinity Advantage |
$72.52
|
| Rate for Payer: Cofinity Commercial |
$89.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.88
|
| Rate for Payer: Healthscope Commercial |
$93.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.70
|
| Rate for Payer: PHP Commercial |
$88.06
|
| Rate for Payer: Priority Health SBD |
$65.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.34
|
| Rate for Payer: UHC Core |
$53.98
|
| Rate for Payer: UHC Exchange |
$40.71
|
| Rate for Payer: UMR Bronson Commercial |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.70
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
NDC 60687055311
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna American Axle |
$2.78
|
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Aetna Medicare |
$2.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: BCBS Complete |
$1.71
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Advantage |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$3.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.20
|
| Rate for Payer: PHP Commercial |
$3.63
|
| Rate for Payer: Priority Health SBD |
$2.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.78
|
| Rate for Payer: UHC Core |
$2.22
|
| Rate for Payer: UHC Exchange |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$1,118.51
|
|
|
Service Code
|
NDC 81665010810
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$492.14 |
| Max. Negotiated Rate |
$1,006.66 |
| Rate for Payer: Aetna American Axle |
$727.03
|
| Rate for Payer: Aetna Commercial |
$950.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.03
|
| Rate for Payer: Cash Price |
$894.81
|
| Rate for Payer: Cofinity Advantage |
$782.96
|
| Rate for Payer: Cofinity Commercial |
$961.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$894.81
|
| Rate for Payer: Healthscope Commercial |
$1,006.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$782.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$838.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$838.88
|
| Rate for Payer: PHP Commercial |
$950.73
|
| Rate for Payer: Priority Health SBD |
$704.66
|
| Rate for Payer: UMR Bronson Commercial |
$492.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$838.88
|
|
|
ISONIAZID 300 MG TABLET
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 60687055311
|
| Hospital Charge Code |
4027
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna American Axle |
$2.78
|
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Advantage |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$3.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.20
|
| Rate for Payer: PHP Commercial |
$3.63
|
| Rate for Payer: Priority Health SBD |
$2.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
