|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 50268043111
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna American Axle |
$1.48
|
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.48
|
| Rate for Payer: BCBS Complete |
$0.91
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health SBD |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
IP
|
$293.75
|
|
|
Service Code
|
NDC 68462030201
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.25 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna American Axle |
$190.94
|
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Commercial |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.94
|
| Rate for Payer: Priority Health SBD |
$185.06
|
| Rate for Payer: UMR Bronson Commercial |
$129.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
OP
|
$113.53
|
|
|
Service Code
|
NDC 50268043115
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$102.18 |
| Rate for Payer: Aetna American Axle |
$73.79
|
| Rate for Payer: Aetna Commercial |
$96.50
|
| Rate for Payer: Aetna Medicare |
$56.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.79
|
| Rate for Payer: BCBS Complete |
$45.41
|
| Rate for Payer: Cash Price |
$90.82
|
| Rate for Payer: Cofinity Commercial |
$79.47
|
| Rate for Payer: Cofinity Commercial |
$97.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.82
|
| Rate for Payer: Healthscope Commercial |
$102.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.50
|
| Rate for Payer: PHP Commercial |
$96.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.79
|
| Rate for Payer: Priority Health SBD |
$71.52
|
| Rate for Payer: UMR Bronson Commercial |
$42.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.15
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
OP
|
$293.75
|
|
|
Service Code
|
NDC 68462030201
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.69 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna American Axle |
$190.94
|
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna Medicare |
$146.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: BCBS Complete |
$117.50
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Commercial |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.94
|
| Rate for Payer: Priority Health SBD |
$185.06
|
| Rate for Payer: UMR Bronson Commercial |
$108.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
IP
|
$113.53
|
|
|
Service Code
|
NDC 50268043115
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$102.18 |
| Rate for Payer: Aetna American Axle |
$73.79
|
| Rate for Payer: Aetna Commercial |
$96.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.79
|
| Rate for Payer: Cash Price |
$90.82
|
| Rate for Payer: Cofinity Commercial |
$79.47
|
| Rate for Payer: Cofinity Commercial |
$97.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.82
|
| Rate for Payer: Healthscope Commercial |
$102.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.50
|
| Rate for Payer: PHP Commercial |
$96.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.79
|
| Rate for Payer: Priority Health SBD |
$71.52
|
| Rate for Payer: UMR Bronson Commercial |
$49.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.15
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$22,366.50
|
|
|
Service Code
|
NDC 69344010233
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,275.60 |
| Max. Negotiated Rate |
$20,129.85 |
| Rate for Payer: Aetna American Axle |
$14,538.23
|
| Rate for Payer: Aetna Commercial |
$19,011.53
|
| Rate for Payer: Aetna Medicare |
$11,183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,538.23
|
| Rate for Payer: BCBS Complete |
$8,946.60
|
| Rate for Payer: Cash Price |
$17,893.20
|
| Rate for Payer: Cofinity Commercial |
$15,656.55
|
| Rate for Payer: Cofinity Commercial |
$19,235.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,656.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,893.20
|
| Rate for Payer: Healthscope Commercial |
$20,129.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,656.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,774.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,011.53
|
| Rate for Payer: PHP Commercial |
$19,011.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,538.23
|
| Rate for Payer: Priority Health SBD |
$14,090.90
|
| Rate for Payer: UMR Bronson Commercial |
$8,275.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,774.88
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$730.64
|
|
|
Service Code
|
NDC 70710185206
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.48 |
| Max. Negotiated Rate |
$657.58 |
| Rate for Payer: Aetna American Axle |
$474.92
|
| Rate for Payer: Aetna Commercial |
$621.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.92
|
| Rate for Payer: Cash Price |
$584.51
|
| Rate for Payer: Cofinity Commercial |
$511.45
|
| Rate for Payer: Cofinity Commercial |
$628.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$511.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.51
|
| Rate for Payer: Healthscope Commercial |
$657.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$511.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.04
|
| Rate for Payer: PHP Commercial |
$621.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.92
|
| Rate for Payer: Priority Health SBD |
$460.30
|
| Rate for Payer: UMR Bronson Commercial |
$321.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.98
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$730.64
|
|
|
Service Code
|
NDC 70710185206
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.34 |
| Max. Negotiated Rate |
$657.58 |
| Rate for Payer: Aetna American Axle |
$474.92
|
| Rate for Payer: Aetna Commercial |
$621.04
|
| Rate for Payer: Aetna Medicare |
$365.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.92
|
| Rate for Payer: BCBS Complete |
$292.26
|
| Rate for Payer: Cash Price |
$584.51
|
| Rate for Payer: Cofinity Commercial |
$511.45
|
| Rate for Payer: Cofinity Commercial |
$628.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$511.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.51
|
| Rate for Payer: Healthscope Commercial |
$657.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$511.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.04
|
| Rate for Payer: PHP Commercial |
$621.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.92
|
| Rate for Payer: Priority Health SBD |
$460.30
|
| Rate for Payer: UMR Bronson Commercial |
$270.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.98
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$22,366.50
|
|
|
Service Code
|
NDC 69344010233
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,841.26 |
| Max. Negotiated Rate |
$20,129.85 |
| Rate for Payer: Aetna American Axle |
$14,538.23
|
| Rate for Payer: Aetna Commercial |
$19,011.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,538.23
|
| Rate for Payer: Cash Price |
$17,893.20
|
| Rate for Payer: Cofinity Commercial |
$15,656.55
|
| Rate for Payer: Cofinity Commercial |
$19,235.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,656.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,893.20
|
| Rate for Payer: Healthscope Commercial |
$20,129.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,656.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,774.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,011.53
|
| Rate for Payer: PHP Commercial |
$19,011.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,538.23
|
| Rate for Payer: Priority Health SBD |
$14,090.90
|
| Rate for Payer: UMR Bronson Commercial |
$9,841.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,774.88
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$18,935.61
|
|
|
Service Code
|
NDC 00054195030
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,006.18 |
| Max. Negotiated Rate |
$17,042.05 |
| Rate for Payer: Aetna American Axle |
$12,308.15
|
| Rate for Payer: Aetna Commercial |
$16,095.27
|
| Rate for Payer: Aetna Medicare |
$9,467.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,308.15
|
| Rate for Payer: BCBS Complete |
$7,574.24
|
| Rate for Payer: Cash Price |
$15,148.49
|
| Rate for Payer: Cofinity Commercial |
$13,254.93
|
| Rate for Payer: Cofinity Commercial |
$16,284.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,254.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,148.49
|
| Rate for Payer: Healthscope Commercial |
$17,042.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,254.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,201.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,095.27
|
| Rate for Payer: PHP Commercial |
$16,095.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,308.15
|
| Rate for Payer: Priority Health SBD |
$11,929.43
|
| Rate for Payer: UMR Bronson Commercial |
$7,006.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,201.71
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$18,935.61
|
|
|
Service Code
|
NDC 00054195030
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,331.67 |
| Max. Negotiated Rate |
$17,042.05 |
| Rate for Payer: Aetna American Axle |
$12,308.15
|
| Rate for Payer: Aetna Commercial |
$16,095.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,308.15
|
| Rate for Payer: Cash Price |
$15,148.49
|
| Rate for Payer: Cofinity Commercial |
$13,254.93
|
| Rate for Payer: Cofinity Commercial |
$16,284.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,254.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,148.49
|
| Rate for Payer: Healthscope Commercial |
$17,042.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,254.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,201.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,095.27
|
| Rate for Payer: PHP Commercial |
$16,095.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,308.15
|
| Rate for Payer: Priority Health SBD |
$11,929.43
|
| Rate for Payer: UMR Bronson Commercial |
$8,331.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,201.71
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$21,919.17
|
|
|
Service Code
|
NDC 70710185207
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,110.09 |
| Max. Negotiated Rate |
$19,727.25 |
| Rate for Payer: Aetna American Axle |
$14,247.46
|
| Rate for Payer: Aetna Commercial |
$18,631.29
|
| Rate for Payer: Aetna Medicare |
$10,959.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,247.46
|
| Rate for Payer: BCBS Complete |
$8,767.67
|
| Rate for Payer: Cash Price |
$17,535.34
|
| Rate for Payer: Cofinity Commercial |
$15,343.42
|
| Rate for Payer: Cofinity Commercial |
$18,850.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,343.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,535.34
|
| Rate for Payer: Healthscope Commercial |
$19,727.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,343.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,439.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,631.29
|
| Rate for Payer: PHP Commercial |
$18,631.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,247.46
|
| Rate for Payer: Priority Health SBD |
$13,809.08
|
| Rate for Payer: UMR Bronson Commercial |
$8,110.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,439.38
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$21,919.17
|
|
|
Service Code
|
NDC 70710185207
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,644.43 |
| Max. Negotiated Rate |
$19,727.25 |
| Rate for Payer: Aetna American Axle |
$14,247.46
|
| Rate for Payer: Aetna Commercial |
$18,631.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,247.46
|
| Rate for Payer: Cash Price |
$17,535.34
|
| Rate for Payer: Cofinity Commercial |
$15,343.42
|
| Rate for Payer: Cofinity Commercial |
$18,850.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,343.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,535.34
|
| Rate for Payer: Healthscope Commercial |
$19,727.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,343.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,439.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,631.29
|
| Rate for Payer: PHP Commercial |
$18,631.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,247.46
|
| Rate for Payer: Priority Health SBD |
$13,809.08
|
| Rate for Payer: UMR Bronson Commercial |
$9,644.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,439.38
|
|
|
INDUCED ABORTION, BY DILATION AND CURETTAGE
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 59840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$5,926.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
INDUCED ABORTION, BY DILATION AND EVACUATION
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 59841
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$5,926.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
INEBILIZUMAB-CDON 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$118,815.92
|
|
|
Service Code
|
HCPCS J1823
|
| Hospital Charge Code |
194137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$265.61 |
| Max. Negotiated Rate |
$106,934.33 |
| Rate for Payer: Aetna American Axle |
$77,230.35
|
| Rate for Payer: Aetna Commercial |
$100,993.53
|
| Rate for Payer: Aetna Medicare |
$515.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77,230.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$619.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$619.44
|
| Rate for Payer: BCBS Complete |
$278.90
|
| Rate for Payer: BCBS MAPPO |
$495.55
|
| Rate for Payer: BCN Medicare Advantage |
$495.55
|
| Rate for Payer: Cash Price |
$95,052.74
|
| Rate for Payer: Cash Price |
$95,052.74
|
| Rate for Payer: Cofinity Commercial |
$102,181.69
|
| Rate for Payer: Cofinity Commercial |
$83,171.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$83,171.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95,052.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$495.55
|
| Rate for Payer: Healthscope Commercial |
$106,934.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83,171.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89,111.94
|
| Rate for Payer: Mclaren Medicaid |
$265.61
|
| Rate for Payer: Mclaren Medicare |
$495.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$520.33
|
| Rate for Payer: Meridian Medicaid |
$278.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$569.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100,993.53
|
| Rate for Payer: PACE Medicare |
$470.77
|
| Rate for Payer: PACE SWMI |
$495.55
|
| Rate for Payer: PHP Commercial |
$100,993.53
|
| Rate for Payer: PHP Medicare Advantage |
$495.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77,230.35
|
| Rate for Payer: Priority Health Medicare |
$495.55
|
| Rate for Payer: Priority Health SBD |
$74,854.03
|
| Rate for Payer: Railroad Medicare Medicare |
$495.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,394.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$495.55
|
| Rate for Payer: UHC Exchange |
$947.05
|
| Rate for Payer: UHC Medicare Advantage |
$495.55
|
| Rate for Payer: UHCCP Medicaid |
$265.61
|
| Rate for Payer: UMR Bronson Commercial |
$43,961.89
|
| Rate for Payer: VA VA |
$495.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89,111.94
|
|
|
INEBILIZUMAB-CDON 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$118,815.92
|
|
|
Service Code
|
HCPCS J1823
|
| Hospital Charge Code |
194137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52,279.00 |
| Max. Negotiated Rate |
$106,934.33 |
| Rate for Payer: Aetna American Axle |
$77,230.35
|
| Rate for Payer: Aetna Commercial |
$100,993.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77,230.35
|
| Rate for Payer: Cash Price |
$95,052.74
|
| Rate for Payer: Cofinity Commercial |
$102,181.69
|
| Rate for Payer: Cofinity Commercial |
$83,171.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$83,171.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95,052.74
|
| Rate for Payer: Healthscope Commercial |
$106,934.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83,171.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89,111.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100,993.53
|
| Rate for Payer: PHP Commercial |
$100,993.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77,230.35
|
| Rate for Payer: Priority Health SBD |
$74,854.03
|
| Rate for Payer: UMR Bronson Commercial |
$52,279.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89,111.94
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,641.80
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
23796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,602.39 |
| Max. Negotiated Rate |
$3,277.62 |
| Rate for Payer: Aetna American Axle |
$2,367.17
|
| Rate for Payer: Aetna American Axle |
$962.81
|
| Rate for Payer: Aetna Commercial |
$1,259.06
|
| Rate for Payer: Aetna Commercial |
$3,095.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$962.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,367.17
|
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cash Price |
$1,185.00
|
| Rate for Payer: Cofinity Commercial |
$1,036.88
|
| Rate for Payer: Cofinity Commercial |
$3,131.95
|
| Rate for Payer: Cofinity Commercial |
$2,549.26
|
| Rate for Payer: Cofinity Commercial |
$1,273.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,036.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,549.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.00
|
| Rate for Payer: Healthscope Commercial |
$1,333.12
|
| Rate for Payer: Healthscope Commercial |
$3,277.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,036.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,549.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,731.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,110.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,095.53
|
| Rate for Payer: PHP Commercial |
$3,095.53
|
| Rate for Payer: PHP Commercial |
$1,259.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$962.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,367.17
|
| Rate for Payer: Priority Health SBD |
$933.19
|
| Rate for Payer: Priority Health SBD |
$2,294.33
|
| Rate for Payer: UMR Bronson Commercial |
$651.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,602.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,110.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,731.35
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,641.80
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
23796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$3,277.62 |
| Rate for Payer: Aetna American Axle |
$2,367.17
|
| Rate for Payer: Aetna American Axle |
$962.81
|
| Rate for Payer: Aetna Commercial |
$1,259.06
|
| Rate for Payer: Aetna Commercial |
$3,095.53
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,367.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$962.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.86
|
| Rate for Payer: BCBS Complete |
$17.50
|
| Rate for Payer: BCBS Complete |
$17.50
|
| Rate for Payer: BCBS MAPPO |
$31.09
|
| Rate for Payer: BCBS MAPPO |
$31.09
|
| Rate for Payer: BCN Medicare Advantage |
$31.09
|
| Rate for Payer: BCN Medicare Advantage |
$31.09
|
| Rate for Payer: Cash Price |
$1,185.00
|
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cash Price |
$1,185.00
|
| Rate for Payer: Cofinity Commercial |
$1,036.88
|
| Rate for Payer: Cofinity Commercial |
$1,273.88
|
| Rate for Payer: Cofinity Commercial |
$2,549.26
|
| Rate for Payer: Cofinity Commercial |
$3,131.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,036.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,549.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.09
|
| Rate for Payer: Healthscope Commercial |
$3,277.62
|
| Rate for Payer: Healthscope Commercial |
$1,333.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,549.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,036.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,110.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,731.35
|
| Rate for Payer: Mclaren Medicaid |
$16.66
|
| Rate for Payer: Mclaren Medicaid |
$16.66
|
| Rate for Payer: Mclaren Medicare |
$31.09
|
| Rate for Payer: Mclaren Medicare |
$31.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.64
|
| Rate for Payer: Meridian Medicaid |
$17.50
|
| Rate for Payer: Meridian Medicaid |
$17.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,095.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.06
|
| Rate for Payer: PACE Medicare |
$29.54
|
| Rate for Payer: PACE Medicare |
$29.54
|
| Rate for Payer: PACE SWMI |
$31.09
|
| Rate for Payer: PACE SWMI |
$31.09
|
| Rate for Payer: PHP Commercial |
$1,259.06
|
| Rate for Payer: PHP Commercial |
$3,095.53
|
| Rate for Payer: PHP Medicare Advantage |
$31.09
|
| Rate for Payer: PHP Medicare Advantage |
$31.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$962.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,367.17
|
| Rate for Payer: Priority Health Medicare |
$31.09
|
| Rate for Payer: Priority Health Medicare |
$31.09
|
| Rate for Payer: Priority Health SBD |
$933.19
|
| Rate for Payer: Priority Health SBD |
$2,294.33
|
| Rate for Payer: Railroad Medicare Medicare |
$31.09
|
| Rate for Payer: Railroad Medicare Medicare |
$31.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.09
|
| Rate for Payer: UHC Exchange |
$59.42
|
| Rate for Payer: UHC Exchange |
$59.42
|
| Rate for Payer: UHC Medicare Advantage |
$31.09
|
| Rate for Payer: UHC Medicare Advantage |
$31.09
|
| Rate for Payer: UHCCP Medicaid |
$16.66
|
| Rate for Payer: UHCCP Medicaid |
$16.66
|
| Rate for Payer: UMR Bronson Commercial |
$548.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,347.47
|
| Rate for Payer: VA VA |
$31.09
|
| Rate for Payer: VA VA |
$31.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,731.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,110.94
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,253.12
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
184064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$1,127.81 |
| Rate for Payer: Aetna American Axle |
$814.53
|
| Rate for Payer: Aetna American Axle |
$963.31
|
| Rate for Payer: Aetna Commercial |
$1,065.15
|
| Rate for Payer: Aetna Commercial |
$1,259.72
|
| Rate for Payer: Aetna Medicare |
$28.08
|
| Rate for Payer: Aetna Medicare |
$28.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.75
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$27.00
|
| Rate for Payer: BCBS MAPPO |
$27.00
|
| Rate for Payer: BCN Medicare Advantage |
$27.00
|
| Rate for Payer: BCN Medicare Advantage |
$27.00
|
| Rate for Payer: Cash Price |
$1,002.50
|
| Rate for Payer: Cash Price |
$1,002.50
|
| Rate for Payer: Cash Price |
$1,185.62
|
| Rate for Payer: Cash Price |
$1,185.62
|
| Rate for Payer: Cofinity Commercial |
$1,077.68
|
| Rate for Payer: Cofinity Commercial |
$877.18
|
| Rate for Payer: Cofinity Commercial |
$1,037.41
|
| Rate for Payer: Cofinity Commercial |
$1,274.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$877.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,037.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.00
|
| Rate for Payer: Healthscope Commercial |
$1,333.82
|
| Rate for Payer: Healthscope Commercial |
$1,127.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$877.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,037.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$939.84
|
| Rate for Payer: Mclaren Medicaid |
$14.47
|
| Rate for Payer: Mclaren Medicaid |
$14.47
|
| Rate for Payer: Mclaren Medicare |
$27.00
|
| Rate for Payer: Mclaren Medicare |
$27.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.35
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.15
|
| Rate for Payer: PACE Medicare |
$25.65
|
| Rate for Payer: PACE Medicare |
$25.65
|
| Rate for Payer: PACE SWMI |
$27.00
|
| Rate for Payer: PACE SWMI |
$27.00
|
| Rate for Payer: PHP Commercial |
$1,259.72
|
| Rate for Payer: PHP Commercial |
$1,065.15
|
| Rate for Payer: PHP Medicare Advantage |
$27.00
|
| Rate for Payer: PHP Medicare Advantage |
$27.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.53
|
| Rate for Payer: Priority Health Medicare |
$27.00
|
| Rate for Payer: Priority Health Medicare |
$27.00
|
| Rate for Payer: Priority Health SBD |
$933.67
|
| Rate for Payer: Priority Health SBD |
$789.47
|
| Rate for Payer: Railroad Medicare Medicare |
$27.00
|
| Rate for Payer: Railroad Medicare Medicare |
$27.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.00
|
| Rate for Payer: UHC Exchange |
$51.60
|
| Rate for Payer: UHC Exchange |
$51.60
|
| Rate for Payer: UHC Medicare Advantage |
$27.00
|
| Rate for Payer: UHC Medicare Advantage |
$27.00
|
| Rate for Payer: UHCCP Medicaid |
$14.47
|
| Rate for Payer: UHCCP Medicaid |
$14.47
|
| Rate for Payer: UMR Bronson Commercial |
$463.65
|
| Rate for Payer: UMR Bronson Commercial |
$548.35
|
| Rate for Payer: VA VA |
$27.00
|
| Rate for Payer: VA VA |
$27.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$939.84
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,482.02
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
184064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$652.09 |
| Max. Negotiated Rate |
$1,333.82 |
| Rate for Payer: Aetna American Axle |
$963.31
|
| Rate for Payer: Aetna Commercial |
$1,259.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.31
|
| Rate for Payer: Cash Price |
$1,185.62
|
| Rate for Payer: Cofinity Commercial |
$1,037.41
|
| Rate for Payer: Cofinity Commercial |
$1,274.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,037.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.62
|
| Rate for Payer: Healthscope Commercial |
$1,333.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,037.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.72
|
| Rate for Payer: PHP Commercial |
$1,259.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.31
|
| Rate for Payer: Priority Health SBD |
$933.67
|
| Rate for Payer: UMR Bronson Commercial |
$652.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.52
|
|
|
INFLIXIMAB-AXXQ 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,201.22
|
|
|
Service Code
|
HCPCS Q5121
|
| Hospital Charge Code |
193365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$1,081.10 |
| Rate for Payer: Aetna American Axle |
$780.79
|
| Rate for Payer: Aetna Commercial |
$1,021.04
|
| Rate for Payer: Aetna Medicare |
$21.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.51
|
| Rate for Payer: BCBS Complete |
$11.49
|
| Rate for Payer: BCBS MAPPO |
$20.41
|
| Rate for Payer: BCN Medicare Advantage |
$20.41
|
| Rate for Payer: Cash Price |
$960.98
|
| Rate for Payer: Cash Price |
$960.98
|
| Rate for Payer: Cofinity Commercial |
$1,033.05
|
| Rate for Payer: Cofinity Commercial |
$840.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$840.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$960.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.41
|
| Rate for Payer: Healthscope Commercial |
$1,081.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$840.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$900.91
|
| Rate for Payer: Mclaren Medicaid |
$10.94
|
| Rate for Payer: Mclaren Medicare |
$20.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.43
|
| Rate for Payer: Meridian Medicaid |
$11.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.04
|
| Rate for Payer: PACE Medicare |
$19.39
|
| Rate for Payer: PACE SWMI |
$20.41
|
| Rate for Payer: PHP Commercial |
$1,021.04
|
| Rate for Payer: PHP Medicare Advantage |
$20.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.79
|
| Rate for Payer: Priority Health Medicare |
$20.41
|
| Rate for Payer: Priority Health SBD |
$756.77
|
| Rate for Payer: Railroad Medicare Medicare |
$20.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.41
|
| Rate for Payer: UHC Exchange |
$39.01
|
| Rate for Payer: UHC Medicare Advantage |
$20.41
|
| Rate for Payer: UHCCP Medicaid |
$10.94
|
| Rate for Payer: UMR Bronson Commercial |
$444.45
|
| Rate for Payer: VA VA |
$20.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$900.91
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,818.98
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
181037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$1,637.08 |
| Rate for Payer: Aetna American Axle |
$1,182.34
|
| Rate for Payer: Aetna Commercial |
$1,546.13
|
| Rate for Payer: Aetna Medicare |
$20.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.99
|
| Rate for Payer: BCBS Complete |
$11.25
|
| Rate for Payer: BCBS MAPPO |
$19.99
|
| Rate for Payer: BCN Medicare Advantage |
$19.99
|
| Rate for Payer: Cash Price |
$1,455.18
|
| Rate for Payer: Cash Price |
$1,455.18
|
| Rate for Payer: Cofinity Commercial |
$1,564.32
|
| Rate for Payer: Cofinity Commercial |
$1,273.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,273.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,455.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.99
|
| Rate for Payer: Healthscope Commercial |
$1,637.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,273.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,364.23
|
| Rate for Payer: Mclaren Medicaid |
$10.71
|
| Rate for Payer: Mclaren Medicare |
$19.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.99
|
| Rate for Payer: Meridian Medicaid |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,546.13
|
| Rate for Payer: PACE Medicare |
$18.99
|
| Rate for Payer: PACE SWMI |
$19.99
|
| Rate for Payer: PHP Commercial |
$1,546.13
|
| Rate for Payer: PHP Medicare Advantage |
$19.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,182.34
|
| Rate for Payer: Priority Health Medicare |
$19.99
|
| Rate for Payer: Priority Health SBD |
$1,145.96
|
| Rate for Payer: Railroad Medicare Medicare |
$19.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.99
|
| Rate for Payer: UHC Exchange |
$38.20
|
| Rate for Payer: UHC Medicare Advantage |
$19.99
|
| Rate for Payer: UHCCP Medicaid |
$10.71
|
| Rate for Payer: UMR Bronson Commercial |
$673.02
|
| Rate for Payer: VA VA |
$19.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,364.23
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,818.98
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
181037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$800.35 |
| Max. Negotiated Rate |
$1,637.08 |
| Rate for Payer: Aetna American Axle |
$1,182.34
|
| Rate for Payer: Aetna Commercial |
$1,546.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.34
|
| Rate for Payer: Cash Price |
$1,455.18
|
| Rate for Payer: Cofinity Commercial |
$1,273.29
|
| Rate for Payer: Cofinity Commercial |
$1,564.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,273.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,455.18
|
| Rate for Payer: Healthscope Commercial |
$1,637.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,273.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,364.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,546.13
|
| Rate for Payer: PHP Commercial |
$1,546.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,182.34
|
| Rate for Payer: Priority Health SBD |
$1,145.96
|
| Rate for Payer: UMR Bronson Commercial |
$800.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,364.23
|
|
|
INHALATIONAL SPACING DEVICE
|
Facility
|
OP
|
$29.35
|
|
|
Service Code
|
NDC 08373077478
|
| Hospital Charge Code |
113188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$26.41 |
| Rate for Payer: Aetna American Axle |
$19.08
|
| Rate for Payer: Aetna Commercial |
$24.95
|
| Rate for Payer: Aetna Medicare |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.08
|
| Rate for Payer: BCBS Complete |
$11.74
|
| Rate for Payer: Cash Price |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Cofinity Commercial |
$25.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.48
|
| Rate for Payer: Healthscope Commercial |
$26.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.95
|
| Rate for Payer: PHP Commercial |
$24.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.08
|
| Rate for Payer: Priority Health SBD |
$18.49
|
| Rate for Payer: UMR Bronson Commercial |
$10.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.01
|
|
