|
INVESTIGATIONAL DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLN
|
Facility
|
OP
|
$82.70
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
181605
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$82.70 |
| Rate for Payer: Aetna Medicare |
$30.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.73
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Mclaren Medicare |
$29.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$16.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.79
|
| Rate for Payer: PACE Medicare |
$27.91
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Exchange |
$56.15
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: VA VA |
$29.38
|
|
|
INVESTIGATIONAL HALOPERIDOL OR KETOROLAC INJECTION
|
Facility
|
OP
|
$47.91
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
301801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$47.91 |
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.27
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$17.02
|
| Rate for Payer: BCN Medicare Advantage |
$17.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.02
|
| Rate for Payer: Mclaren Medicaid |
$9.12
|
| Rate for Payer: Mclaren Medicare |
$17.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.87
|
| Rate for Payer: Meridian Medicaid |
$9.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.57
|
| Rate for Payer: PACE Medicare |
$16.17
|
| Rate for Payer: PACE SWMI |
$17.02
|
| Rate for Payer: PHP Medicare Advantage |
$17.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.12
|
| Rate for Payer: Priority Health Medicare |
$17.02
|
| Rate for Payer: Railroad Medicare Medicare |
$17.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.02
|
| Rate for Payer: UHC Exchange |
$32.53
|
| Rate for Payer: UHC Medicare Advantage |
$17.02
|
| Rate for Payer: UHCCP Medicaid |
$9.12
|
| Rate for Payer: VA VA |
$17.02
|
|
|
INVESTIGATIONAL NIVOLUMAB INJECTION (EA2176 STUDY SUPPLED) 100 MG/10 ML SOLUTION
|
Facility
|
OP
|
$92.78
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
301135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$92.78 |
| Rate for Payer: Aetna Medicare |
$34.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.20
|
| Rate for Payer: BCBS Complete |
$18.55
|
| Rate for Payer: BCBS MAPPO |
$32.96
|
| Rate for Payer: BCN Medicare Advantage |
$32.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.96
|
| Rate for Payer: Mclaren Medicaid |
$17.67
|
| Rate for Payer: Mclaren Medicare |
$32.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.61
|
| Rate for Payer: Meridian Medicaid |
$18.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.90
|
| Rate for Payer: PACE Medicare |
$31.31
|
| Rate for Payer: PACE SWMI |
$32.96
|
| Rate for Payer: PHP Medicare Advantage |
$32.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.67
|
| Rate for Payer: Priority Health Medicare |
$32.96
|
| Rate for Payer: Railroad Medicare Medicare |
$32.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.96
|
| Rate for Payer: UHC Exchange |
$62.99
|
| Rate for Payer: UHC Medicare Advantage |
$32.96
|
| Rate for Payer: UHCCP Medicaid |
$17.67
|
| Rate for Payer: VA VA |
$32.96
|
|
|
INVESTIGATIONAL NIVOLUMAB INJECTION (TAPUR STUDY SUPPLIED) 100 MG/10 ML SOLUTION
|
Facility
|
OP
|
$92.78
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
300896
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$92.78 |
| Rate for Payer: Aetna Medicare |
$34.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.20
|
| Rate for Payer: BCBS Complete |
$18.55
|
| Rate for Payer: BCBS MAPPO |
$32.96
|
| Rate for Payer: BCN Medicare Advantage |
$32.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.96
|
| Rate for Payer: Mclaren Medicaid |
$17.67
|
| Rate for Payer: Mclaren Medicare |
$32.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.61
|
| Rate for Payer: Meridian Medicaid |
$18.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.90
|
| Rate for Payer: PACE Medicare |
$31.31
|
| Rate for Payer: PACE SWMI |
$32.96
|
| Rate for Payer: PHP Medicare Advantage |
$32.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.67
|
| Rate for Payer: Priority Health Medicare |
$32.96
|
| Rate for Payer: Railroad Medicare Medicare |
$32.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.96
|
| Rate for Payer: UHC Exchange |
$62.99
|
| Rate for Payer: UHC Medicare Advantage |
$32.96
|
| Rate for Payer: UHCCP Medicaid |
$17.67
|
| Rate for Payer: VA VA |
$32.96
|
|
|
INVESTIGATIONAL PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION PRAGMATICA-LUNG STUDY SUPPLIED
|
Facility
|
OP
|
$169.71
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
301603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$169.71 |
| Rate for Payer: Aetna Medicare |
$62.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.36
|
| Rate for Payer: BCBS Complete |
$33.93
|
| Rate for Payer: BCBS MAPPO |
$60.29
|
| Rate for Payer: BCN Medicare Advantage |
$60.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.29
|
| Rate for Payer: Mclaren Medicaid |
$32.32
|
| Rate for Payer: Mclaren Medicare |
$60.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.30
|
| Rate for Payer: Meridian Medicaid |
$33.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.33
|
| Rate for Payer: PACE Medicare |
$57.28
|
| Rate for Payer: PACE SWMI |
$60.29
|
| Rate for Payer: PHP Medicare Advantage |
$60.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.32
|
| Rate for Payer: Priority Health Medicare |
$60.29
|
| Rate for Payer: Railroad Medicare Medicare |
$60.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.29
|
| Rate for Payer: UHC Exchange |
$115.22
|
| Rate for Payer: UHC Medicare Advantage |
$60.29
|
| Rate for Payer: UHCCP Medicaid |
$32.32
|
| Rate for Payer: VA VA |
$60.29
|
|
|
INVESTIGATIONAL PEMBROLIZUMAB (MK-3475) 25 MG/ML INTRAVENOUS SOLUTION NRG-GY018 STUDY SUPPLIED
|
Facility
|
OP
|
$169.71
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
301126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$169.71 |
| Rate for Payer: Aetna Medicare |
$62.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.36
|
| Rate for Payer: BCBS Complete |
$33.93
|
| Rate for Payer: BCBS MAPPO |
$60.29
|
| Rate for Payer: BCN Medicare Advantage |
$60.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.29
|
| Rate for Payer: Mclaren Medicaid |
$32.32
|
| Rate for Payer: Mclaren Medicare |
$60.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.30
|
| Rate for Payer: Meridian Medicaid |
$33.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.33
|
| Rate for Payer: PACE Medicare |
$57.28
|
| Rate for Payer: PACE SWMI |
$60.29
|
| Rate for Payer: PHP Medicare Advantage |
$60.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.32
|
| Rate for Payer: Priority Health Medicare |
$60.29
|
| Rate for Payer: Railroad Medicare Medicare |
$60.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.29
|
| Rate for Payer: UHC Exchange |
$115.22
|
| Rate for Payer: UHC Medicare Advantage |
$60.29
|
| Rate for Payer: UHCCP Medicaid |
$32.32
|
| Rate for Payer: VA VA |
$60.29
|
|
|
INVESTIGATIONAL PLACEBO OR PEMBROLIZUMAB (MK-3475) 25 MG/ML INTRAVENOUS SOLUTION NRG-GY018 STUDY SUPPLIED
|
Facility
|
OP
|
$169.71
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
300991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$169.71 |
| Rate for Payer: Aetna Medicare |
$62.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.36
|
| Rate for Payer: BCBS Complete |
$33.93
|
| Rate for Payer: BCBS MAPPO |
$60.29
|
| Rate for Payer: BCN Medicare Advantage |
$60.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.29
|
| Rate for Payer: Mclaren Medicaid |
$32.32
|
| Rate for Payer: Mclaren Medicare |
$60.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.30
|
| Rate for Payer: Meridian Medicaid |
$33.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.33
|
| Rate for Payer: PACE Medicare |
$57.28
|
| Rate for Payer: PACE SWMI |
$60.29
|
| Rate for Payer: PHP Medicare Advantage |
$60.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.32
|
| Rate for Payer: Priority Health Medicare |
$60.29
|
| Rate for Payer: Railroad Medicare Medicare |
$60.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.29
|
| Rate for Payer: UHC Exchange |
$115.22
|
| Rate for Payer: UHC Medicare Advantage |
$60.29
|
| Rate for Payer: UHCCP Medicaid |
$32.32
|
| Rate for Payer: VA VA |
$60.29
|
|
|
INVESTIGATIONAL TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION TAPUR STUDY SUPPLIED
|
Facility
|
OP
|
$172.95
|
|
|
Service Code
|
HCPCS J9356
|
| Hospital Charge Code |
301760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$172.95 |
| Rate for Payer: Aetna Medicare |
$63.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.80
|
| Rate for Payer: BCBS Complete |
$34.58
|
| Rate for Payer: BCBS MAPPO |
$61.44
|
| Rate for Payer: BCN Medicare Advantage |
$61.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.44
|
| Rate for Payer: Mclaren Medicaid |
$32.93
|
| Rate for Payer: Mclaren Medicare |
$61.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.51
|
| Rate for Payer: Meridian Medicaid |
$34.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.66
|
| Rate for Payer: PACE Medicare |
$58.37
|
| Rate for Payer: PACE SWMI |
$61.44
|
| Rate for Payer: PHP Medicare Advantage |
$61.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.93
|
| Rate for Payer: Priority Health Medicare |
$61.44
|
| Rate for Payer: Railroad Medicare Medicare |
$61.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.44
|
| Rate for Payer: UHC Exchange |
$117.42
|
| Rate for Payer: UHC Medicare Advantage |
$61.44
|
| Rate for Payer: UHCCP Medicaid |
$32.93
|
| Rate for Payer: VA VA |
$61.44
|
|
|
INVETIGATIONAL RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION PRAGMATICA-LUNG STUDY SUPPLIED
|
Facility
|
OP
|
$209.32
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
301605
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$209.32 |
| Rate for Payer: Aetna Medicare |
$77.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.95
|
| Rate for Payer: BCBS Complete |
$41.85
|
| Rate for Payer: BCBS MAPPO |
$74.36
|
| Rate for Payer: BCN Medicare Advantage |
$74.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.36
|
| Rate for Payer: Mclaren Medicaid |
$39.86
|
| Rate for Payer: Mclaren Medicare |
$74.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.08
|
| Rate for Payer: Meridian Medicaid |
$41.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.51
|
| Rate for Payer: PACE Medicare |
$70.64
|
| Rate for Payer: PACE SWMI |
$74.36
|
| Rate for Payer: PHP Medicare Advantage |
$74.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.86
|
| Rate for Payer: Priority Health Medicare |
$74.36
|
| Rate for Payer: Railroad Medicare Medicare |
$74.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.36
|
| Rate for Payer: UHC Exchange |
$142.11
|
| Rate for Payer: UHC Medicare Advantage |
$74.36
|
| Rate for Payer: UHCCP Medicaid |
$39.86
|
| Rate for Payer: VA VA |
$74.36
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
IP
|
$87.75
|
|
|
Service Code
|
NDC 00395121316
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$78.97 |
| Rate for Payer: Aetna American Axle |
$57.04
|
| Rate for Payer: Aetna Commercial |
$74.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.04
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cofinity Commercial |
$61.42
|
| Rate for Payer: Cofinity Commercial |
$75.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$78.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.59
|
| Rate for Payer: PHP Commercial |
$74.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.04
|
| Rate for Payer: Priority Health SBD |
$55.28
|
| Rate for Payer: UMR Bronson Commercial |
$38.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.81
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 00990000077
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna American Axle |
$0.42
|
| Rate for Payer: Aetna Commercial |
$0.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.42
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cofinity Commercial |
$0.45
|
| Rate for Payer: Cofinity Commercial |
$0.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.51
|
| Rate for Payer: Healthscope Commercial |
$0.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.54
|
| Rate for Payer: PHP Commercial |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.42
|
| Rate for Payer: Priority Health SBD |
$0.40
|
| Rate for Payer: UMR Bronson Commercial |
$0.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.48
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 00990000077
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna American Axle |
$0.42
|
| Rate for Payer: Aetna Commercial |
$0.54
|
| Rate for Payer: Aetna Medicare |
$0.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.42
|
| Rate for Payer: BCBS Complete |
$0.26
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cofinity Commercial |
$0.45
|
| Rate for Payer: Cofinity Commercial |
$0.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.51
|
| Rate for Payer: Healthscope Commercial |
$0.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.54
|
| Rate for Payer: PHP Commercial |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.42
|
| Rate for Payer: Priority Health SBD |
$0.40
|
| Rate for Payer: UMR Bronson Commercial |
$0.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.48
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
IP
|
$12.69
|
|
|
Service Code
|
NDC 00869385110
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$11.42 |
| Rate for Payer: Aetna American Axle |
$8.25
|
| Rate for Payer: Aetna Commercial |
$10.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.25
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cofinity Commercial |
$10.91
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.15
|
| Rate for Payer: Healthscope Commercial |
$11.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.79
|
| Rate for Payer: PHP Commercial |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.25
|
| Rate for Payer: Priority Health SBD |
$7.99
|
| Rate for Payer: UMR Bronson Commercial |
$5.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.52
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
OP
|
$12.69
|
|
|
Service Code
|
NDC 00869385110
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$11.42 |
| Rate for Payer: Aetna American Axle |
$8.25
|
| Rate for Payer: Aetna Commercial |
$10.79
|
| Rate for Payer: Aetna Medicare |
$6.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.25
|
| Rate for Payer: BCBS Complete |
$5.08
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cofinity Commercial |
$10.91
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.15
|
| Rate for Payer: Healthscope Commercial |
$11.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.79
|
| Rate for Payer: PHP Commercial |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.25
|
| Rate for Payer: Priority Health SBD |
$7.99
|
| Rate for Payer: UMR Bronson Commercial |
$4.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.52
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
OP
|
$87.75
|
|
|
Service Code
|
NDC 00395121316
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$78.97 |
| Rate for Payer: Aetna American Axle |
$57.04
|
| Rate for Payer: Aetna Commercial |
$74.59
|
| Rate for Payer: Aetna Medicare |
$43.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.04
|
| Rate for Payer: BCBS Complete |
$35.10
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cofinity Commercial |
$61.42
|
| Rate for Payer: Cofinity Commercial |
$75.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$78.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.59
|
| Rate for Payer: PHP Commercial |
$74.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.04
|
| Rate for Payer: Priority Health SBD |
$55.28
|
| Rate for Payer: UMR Bronson Commercial |
$32.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.81
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
IP
|
$116.55
|
|
|
Service Code
|
NDC 48433023015
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.28 |
| Max. Negotiated Rate |
$104.89 |
| Rate for Payer: Aetna American Axle |
$75.76
|
| Rate for Payer: Aetna Commercial |
$99.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.76
|
| Rate for Payer: Cash Price |
$93.24
|
| Rate for Payer: Cofinity Commercial |
$100.23
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.24
|
| Rate for Payer: Healthscope Commercial |
$104.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.07
|
| Rate for Payer: PHP Commercial |
$99.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.76
|
| Rate for Payer: Priority Health SBD |
$73.43
|
| Rate for Payer: UMR Bronson Commercial |
$51.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.41
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
IP
|
$411.28
|
|
|
Service Code
|
NDC 00395277516
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$370.15 |
| Rate for Payer: Aetna American Axle |
$267.33
|
| Rate for Payer: Aetna Commercial |
$349.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.33
|
| Rate for Payer: Cash Price |
$329.02
|
| Rate for Payer: Cofinity Commercial |
$287.90
|
| Rate for Payer: Cofinity Commercial |
$353.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.02
|
| Rate for Payer: Healthscope Commercial |
$370.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.59
|
| Rate for Payer: PHP Commercial |
$349.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.33
|
| Rate for Payer: Priority Health SBD |
$259.11
|
| Rate for Payer: UMR Bronson Commercial |
$180.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.46
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
OP
|
$411.28
|
|
|
Service Code
|
NDC 00395277516
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.17 |
| Max. Negotiated Rate |
$370.15 |
| Rate for Payer: Aetna American Axle |
$267.33
|
| Rate for Payer: Aetna Commercial |
$349.59
|
| Rate for Payer: Aetna Medicare |
$205.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.33
|
| Rate for Payer: BCBS Complete |
$164.51
|
| Rate for Payer: Cash Price |
$329.02
|
| Rate for Payer: Cofinity Commercial |
$287.90
|
| Rate for Payer: Cofinity Commercial |
$353.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.02
|
| Rate for Payer: Healthscope Commercial |
$370.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.59
|
| Rate for Payer: PHP Commercial |
$349.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.33
|
| Rate for Payer: Priority Health SBD |
$259.11
|
| Rate for Payer: UMR Bronson Commercial |
$152.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.46
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
OP
|
$116.55
|
|
|
Service Code
|
NDC 48433023015
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$104.89 |
| Rate for Payer: Aetna American Axle |
$75.76
|
| Rate for Payer: Aetna Commercial |
$99.07
|
| Rate for Payer: Aetna Medicare |
$58.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.76
|
| Rate for Payer: BCBS Complete |
$46.62
|
| Rate for Payer: Cash Price |
$93.24
|
| Rate for Payer: Cofinity Commercial |
$100.23
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.24
|
| Rate for Payer: Healthscope Commercial |
$104.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.07
|
| Rate for Payer: PHP Commercial |
$99.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.76
|
| Rate for Payer: Priority Health SBD |
$73.43
|
| Rate for Payer: UMR Bronson Commercial |
$43.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.41
|
|
|
IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
17595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna American Axle |
$61.75
|
| Rate for Payer: Aetna American Axle |
$123.50
|
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Medicare |
$47.50
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Aetna Medicare |
$95.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.50
|
| Rate for Payer: BCBS Complete |
$76.00
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Cofinity Commercial |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$19.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.75
|
| Rate for Payer: PHP Commercial |
$161.50
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: Priority Health SBD |
$119.70
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: UMR Bronson Commercial |
$35.15
|
| Rate for Payer: UMR Bronson Commercial |
$70.30
|
| Rate for Payer: UMR Bronson Commercial |
$10.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
17595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna American Axle |
$123.50
|
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna American Axle |
$61.75
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: PHP Commercial |
$161.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: Priority Health SBD |
$119.70
|
| Rate for Payer: UMR Bronson Commercial |
$83.60
|
| Rate for Payer: UMR Bronson Commercial |
$41.80
|
| Rate for Payer: UMR Bronson Commercial |
$12.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$139.33
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
10321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.31 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna American Axle |
$90.56
|
| Rate for Payer: Aetna Commercial |
$118.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.56
|
| Rate for Payer: Cash Price |
$111.46
|
| Rate for Payer: Cofinity Commercial |
$119.82
|
| Rate for Payer: Cofinity Commercial |
$97.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.46
|
| Rate for Payer: Healthscope Commercial |
$125.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.43
|
| Rate for Payer: PHP Commercial |
$118.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.56
|
| Rate for Payer: Priority Health SBD |
$87.78
|
| Rate for Payer: UMR Bronson Commercial |
$61.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.50
|
|
|
IOHEXOL 240 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$139.33
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
10321
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna American Axle |
$90.56
|
| Rate for Payer: Aetna Commercial |
$118.43
|
| Rate for Payer: Aetna Medicare |
$69.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.56
|
| Rate for Payer: BCBS Complete |
$55.73
|
| Rate for Payer: Cash Price |
$111.46
|
| Rate for Payer: Cofinity Commercial |
$119.82
|
| Rate for Payer: Cofinity Commercial |
$97.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.46
|
| Rate for Payer: Healthscope Commercial |
$125.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.43
|
| Rate for Payer: PHP Commercial |
$118.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.56
|
| Rate for Payer: Priority Health SBD |
$87.78
|
| Rate for Payer: UMR Bronson Commercial |
$51.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.50
|
|
|
IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna American Axle |
$87.75
|
| Rate for Payer: Aetna American Axle |
$16.96
|
| Rate for Payer: Aetna American Axle |
$43.88
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: Aetna Commercial |
$57.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$94.50
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$58.05
|
| Rate for Payer: Cofinity Commercial |
$47.25
|
| Rate for Payer: Cofinity Commercial |
$116.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$121.50
|
| Rate for Payer: Healthscope Commercial |
$60.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$57.38
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$114.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health SBD |
$42.52
|
| Rate for Payer: Priority Health SBD |
$16.44
|
| Rate for Payer: Priority Health SBD |
$85.05
|
| Rate for Payer: UMR Bronson Commercial |
$59.40
|
| Rate for Payer: UMR Bronson Commercial |
$29.70
|
| Rate for Payer: UMR Bronson Commercial |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.57
|
|
|
IOHEXOL 300 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67.50
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna American Axle |
$43.88
|
| Rate for Payer: Aetna American Axle |
$87.75
|
| Rate for Payer: Aetna American Axle |
$16.96
|
| Rate for Payer: Aetna Commercial |
$57.38
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: Aetna Medicare |
$33.75
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Aetna Medicare |
$67.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.75
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS Complete |
$10.44
|
| Rate for Payer: BCBS Complete |
$27.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$22.45
|
| Rate for Payer: Cofinity Commercial |
$116.10
|
| Rate for Payer: Cofinity Commercial |
$94.50
|
| Rate for Payer: Cofinity Commercial |
$58.05
|
| Rate for Payer: Cofinity Commercial |
$47.25
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.00
|
| Rate for Payer: Healthscope Commercial |
$121.50
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$60.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.38
|
| Rate for Payer: PHP Commercial |
$114.75
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: PHP Commercial |
$57.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health SBD |
$16.44
|
| Rate for Payer: Priority Health SBD |
$85.05
|
| Rate for Payer: Priority Health SBD |
$42.52
|
| Rate for Payer: UMR Bronson Commercial |
$24.98
|
| Rate for Payer: UMR Bronson Commercial |
$49.95
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.62
|
|
