|
INTRODUCTION OF NEEDLE OR INTRACATHETER, UPPER OR LOWER EXTREMITY ARTERY
|
Facility
|
OP
|
$1,514.91
|
|
|
Service Code
|
CPT 36140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.78 |
| Max. Negotiated Rate |
$1,514.91 |
| Rate for Payer: BCBS Trust/PPO |
$1,514.91
|
| Rate for Payer: BCN Commercial |
$1,514.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.36
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$85.78
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT;
|
Facility
|
OP
|
$4,783.71
|
|
|
Service Code
|
CPT 36901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$160.33 |
| Max. Negotiated Rate |
$4,783.71 |
| Rate for Payer: Aetna Medicare |
$1,582.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,902.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,902.54
|
| Rate for Payer: BCBS Complete |
$856.60
|
| Rate for Payer: BCBS MAPPO |
$1,522.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,668.77
|
| Rate for Payer: BCN Commercial |
$1,668.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,522.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,522.03
|
| Rate for Payer: Mclaren Medicaid |
$815.81
|
| Rate for Payer: Mclaren Medicare |
$1,522.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,598.13
|
| Rate for Payer: Meridian Medicaid |
$856.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,750.33
|
| Rate for Payer: Nomi Health Commercial |
$3,196.26
|
| Rate for Payer: PACE Medicare |
$1,445.93
|
| Rate for Payer: PACE SWMI |
$1,522.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,522.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$815.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,783.71
|
| Rate for Payer: Priority Health Medicare |
$1,522.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,826.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,522.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.36
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,522.03
|
| Rate for Payer: UHC Exchange |
$160.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.03
|
| Rate for Payer: UHCCP Medicaid |
$815.81
|
| Rate for Payer: VA VA |
$1,522.03
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT; WITH TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE STENTING, AND ALL ANGIOPLASTY WITHIN THE PERIPHERAL DIALYSIS SEGMENT
|
Facility
|
OP
|
$34,922.52
|
|
|
Service Code
|
CPT 36903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$301.60 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$10,266.41
|
| Rate for Payer: BCN Commercial |
$10,266.41
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.76
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$301.60
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$5,955.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT; WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY
|
Facility
|
OP
|
$17,557.45
|
|
|
Service Code
|
CPT 36902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$17,557.45 |
| Rate for Payer: Aetna Medicare |
$5,809.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,982.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,982.80
|
| Rate for Payer: BCBS Complete |
$3,143.94
|
| Rate for Payer: BCBS MAPPO |
$5,586.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,711.80
|
| Rate for Payer: BCN Commercial |
$3,711.80
|
| Rate for Payer: BCN Medicare Advantage |
$5,586.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,586.24
|
| Rate for Payer: Mclaren Medicaid |
$2,994.22
|
| Rate for Payer: Mclaren Medicare |
$5,586.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,865.55
|
| Rate for Payer: Meridian Medicaid |
$3,143.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,424.18
|
| Rate for Payer: Nomi Health Commercial |
$11,731.10
|
| Rate for Payer: PACE Medicare |
$5,306.93
|
| Rate for Payer: PACE SWMI |
$5,586.24
|
| Rate for Payer: PHP Medicare Advantage |
$5,586.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,994.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,557.45
|
| Rate for Payer: Priority Health Medicare |
$5,586.24
|
| Rate for Payer: Priority Health Narrow Network |
$14,045.96
|
| Rate for Payer: Railroad Medicare Medicare |
$5,586.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.64
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,586.24
|
| Rate for Payer: UHC Exchange |
$228.76
|
| Rate for Payer: UHC Medicare Advantage |
$5,586.24
|
| Rate for Payer: UHCCP Medicaid |
$2,994.22
|
| Rate for Payer: VA VA |
$5,586.24
|
|
|
INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE
|
Facility
|
OP
|
$715.11
|
|
|
Service Code
|
CPT 31500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.95 |
| Max. Negotiated Rate |
$715.11 |
| Rate for Payer: Aetna Medicare |
$236.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$284.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$284.40
|
| Rate for Payer: BCBS Complete |
$128.05
|
| Rate for Payer: BCBS MAPPO |
$227.52
|
| Rate for Payer: BCBS Trust/PPO |
$233.10
|
| Rate for Payer: BCN Commercial |
$233.10
|
| Rate for Payer: BCN Medicare Advantage |
$227.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.52
|
| Rate for Payer: Mclaren Medicaid |
$121.95
|
| Rate for Payer: Mclaren Medicare |
$227.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.90
|
| Rate for Payer: Meridian Medicaid |
$128.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.65
|
| Rate for Payer: Nomi Health Commercial |
$477.79
|
| Rate for Payer: PACE Medicare |
$216.14
|
| Rate for Payer: PACE SWMI |
$227.52
|
| Rate for Payer: PHP Medicare Advantage |
$227.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.11
|
| Rate for Payer: Priority Health Medicare |
$227.52
|
| Rate for Payer: Priority Health Narrow Network |
$572.09
|
| Rate for Payer: Railroad Medicare Medicare |
$227.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.50
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.52
|
| Rate for Payer: UHC Exchange |
$136.82
|
| Rate for Payer: UHC Medicare Advantage |
$227.52
|
| Rate for Payer: UHCCP Medicaid |
$121.95
|
| Rate for Payer: VA VA |
$227.52
|
|
|
INVESTIGATIONAL DAUNORUBICIN 44 MG AND CYTARABINE 100 MG IN LIPOSOME (CPX-351) INJECTION
|
Facility
|
OP
|
$745.23
|
|
|
Service Code
|
HCPCS J9153
|
| Hospital Charge Code |
300818
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.15 |
| Max. Negotiated Rate |
$745.23 |
| Rate for Payer: Aetna Medicare |
$258.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$310.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$310.51
|
| Rate for Payer: BCBS Complete |
$139.81
|
| Rate for Payer: BCBS MAPPO |
$248.41
|
| Rate for Payer: BCBS Trust/PPO |
$669.78
|
| Rate for Payer: BCN Commercial |
$669.78
|
| Rate for Payer: BCN Medicare Advantage |
$248.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.41
|
| Rate for Payer: Mclaren Medicaid |
$133.15
|
| Rate for Payer: Mclaren Medicare |
$248.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.83
|
| Rate for Payer: Meridian Medicaid |
$139.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.67
|
| Rate for Payer: Nomi Health Commercial |
$745.23
|
| Rate for Payer: PACE Medicare |
$235.99
|
| Rate for Payer: PACE SWMI |
$248.41
|
| Rate for Payer: PHP Medicare Advantage |
$248.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$133.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$697.91
|
| Rate for Payer: Priority Health Medicare |
$248.41
|
| Rate for Payer: Priority Health Narrow Network |
$558.33
|
| Rate for Payer: Railroad Medicare Medicare |
$248.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.41
|
| Rate for Payer: UHC Exchange |
$474.74
|
| Rate for Payer: UHC Medicare Advantage |
$248.41
|
| Rate for Payer: UHCCP Medicaid |
$133.15
|
| Rate for Payer: VA VA |
$248.41
|
|
|
INVESTIGATIONAL DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLN
|
Facility
|
OP
|
$82.98
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
181605
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$82.98 |
| Rate for Payer: Aetna Medicare |
$28.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.58
|
| Rate for Payer: BCBS Complete |
$15.57
|
| Rate for Payer: BCBS MAPPO |
$27.66
|
| Rate for Payer: BCBS Trust/PPO |
$72.67
|
| Rate for Payer: BCN Commercial |
$72.67
|
| Rate for Payer: BCN Medicare Advantage |
$27.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.66
|
| Rate for Payer: Mclaren Medicaid |
$14.83
|
| Rate for Payer: Mclaren Medicare |
$27.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.04
|
| Rate for Payer: Meridian Medicaid |
$15.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.81
|
| Rate for Payer: Nomi Health Commercial |
$82.98
|
| Rate for Payer: PACE Medicare |
$26.28
|
| Rate for Payer: PACE SWMI |
$27.66
|
| Rate for Payer: PHP Medicare Advantage |
$27.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.58
|
| Rate for Payer: Priority Health Medicare |
$27.66
|
| Rate for Payer: Priority Health Narrow Network |
$62.06
|
| Rate for Payer: Railroad Medicare Medicare |
$27.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.66
|
| Rate for Payer: UHC Exchange |
$52.86
|
| Rate for Payer: UHC Medicare Advantage |
$27.66
|
| Rate for Payer: UHCCP Medicaid |
$14.83
|
| Rate for Payer: VA VA |
$27.66
|
|
|
INVESTIGATIONAL HALOPERIDOL OR KETOROLAC INJECTION
|
Facility
|
OP
|
$48.57
|
|
|
Service Code
|
HCPCS J9306
|
| Hospital Charge Code |
301801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$48.57 |
| Rate for Payer: Aetna Medicare |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.24
|
| Rate for Payer: BCBS Complete |
$9.11
|
| Rate for Payer: BCBS MAPPO |
$16.19
|
| Rate for Payer: BCBS Trust/PPO |
$42.63
|
| Rate for Payer: BCN Commercial |
$42.63
|
| Rate for Payer: BCN Medicare Advantage |
$16.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.19
|
| Rate for Payer: Mclaren Medicaid |
$8.68
|
| Rate for Payer: Mclaren Medicare |
$16.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.00
|
| Rate for Payer: Meridian Medicaid |
$9.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.62
|
| Rate for Payer: Nomi Health Commercial |
$48.57
|
| Rate for Payer: PACE Medicare |
$15.38
|
| Rate for Payer: PACE SWMI |
$16.19
|
| Rate for Payer: PHP Medicare Advantage |
$16.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.40
|
| Rate for Payer: Priority Health Medicare |
$16.19
|
| Rate for Payer: Priority Health Narrow Network |
$37.12
|
| Rate for Payer: Railroad Medicare Medicare |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.19
|
| Rate for Payer: UHC Exchange |
$30.94
|
| Rate for Payer: UHC Medicare Advantage |
$16.19
|
| Rate for Payer: UHCCP Medicaid |
$8.68
|
| Rate for Payer: VA VA |
$16.19
|
|
|
INVESTIGATIONAL NIVOLUMAB INJECTION (EA2176 STUDY SUPPLED) 100 MG/10 ML SOLUTION
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
301135
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.38
|
| Rate for Payer: BCBS Complete |
$18.18
|
| Rate for Payer: BCBS MAPPO |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$87.07
|
| Rate for Payer: BCN Commercial |
$87.07
|
| Rate for Payer: BCN Medicare Advantage |
$32.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.30
|
| Rate for Payer: Mclaren Medicaid |
$17.31
|
| Rate for Payer: Mclaren Medicare |
$32.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.92
|
| Rate for Payer: Meridian Medicaid |
$18.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.14
|
| Rate for Payer: Nomi Health Commercial |
$96.90
|
| Rate for Payer: PACE Medicare |
$30.68
|
| Rate for Payer: PACE SWMI |
$32.30
|
| Rate for Payer: PHP Medicare Advantage |
$32.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.39
|
| Rate for Payer: Priority Health Medicare |
$32.30
|
| Rate for Payer: Priority Health Narrow Network |
$73.11
|
| Rate for Payer: Railroad Medicare Medicare |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.30
|
| Rate for Payer: UHC Exchange |
$61.73
|
| Rate for Payer: UHC Medicare Advantage |
$32.30
|
| Rate for Payer: UHCCP Medicaid |
$17.31
|
| Rate for Payer: VA VA |
$32.30
|
|
|
INVESTIGATIONAL NIVOLUMAB INJECTION (TAPUR STUDY SUPPLIED) 100 MG/10 ML SOLUTION
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
300896
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.38
|
| Rate for Payer: BCBS Complete |
$18.18
|
| Rate for Payer: BCBS MAPPO |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$87.07
|
| Rate for Payer: BCN Commercial |
$87.07
|
| Rate for Payer: BCN Medicare Advantage |
$32.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.30
|
| Rate for Payer: Mclaren Medicaid |
$17.31
|
| Rate for Payer: Mclaren Medicare |
$32.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.92
|
| Rate for Payer: Meridian Medicaid |
$18.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.14
|
| Rate for Payer: Nomi Health Commercial |
$96.90
|
| Rate for Payer: PACE Medicare |
$30.68
|
| Rate for Payer: PACE SWMI |
$32.30
|
| Rate for Payer: PHP Medicare Advantage |
$32.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.39
|
| Rate for Payer: Priority Health Medicare |
$32.30
|
| Rate for Payer: Priority Health Narrow Network |
$73.11
|
| Rate for Payer: Railroad Medicare Medicare |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.30
|
| Rate for Payer: UHC Exchange |
$61.73
|
| Rate for Payer: UHC Medicare Advantage |
$32.30
|
| Rate for Payer: UHCCP Medicaid |
$17.31
|
| Rate for Payer: VA VA |
$32.30
|
|
|
INVESTIGATIONAL PEMBROLIZUMAB 25 MG/ML INTRAVENOUS SOLUTION PRAGMATICA-LUNG STUDY SUPPLIED
|
Facility
|
OP
|
$172.80
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
301603
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Medicare |
$59.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.00
|
| Rate for Payer: BCBS Complete |
$32.42
|
| Rate for Payer: BCBS MAPPO |
$57.60
|
| Rate for Payer: BCBS Trust/PPO |
$156.96
|
| Rate for Payer: BCN Commercial |
$156.96
|
| Rate for Payer: BCN Medicare Advantage |
$57.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.60
|
| Rate for Payer: Mclaren Medicaid |
$30.87
|
| Rate for Payer: Mclaren Medicare |
$57.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.48
|
| Rate for Payer: Meridian Medicaid |
$32.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.24
|
| Rate for Payer: Nomi Health Commercial |
$172.80
|
| Rate for Payer: PACE Medicare |
$54.72
|
| Rate for Payer: PACE SWMI |
$57.60
|
| Rate for Payer: PHP Medicare Advantage |
$57.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.55
|
| Rate for Payer: Priority Health Medicare |
$57.60
|
| Rate for Payer: Priority Health Narrow Network |
$134.04
|
| Rate for Payer: Railroad Medicare Medicare |
$57.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.60
|
| Rate for Payer: UHC Exchange |
$110.08
|
| Rate for Payer: UHC Medicare Advantage |
$57.60
|
| Rate for Payer: UHCCP Medicaid |
$30.87
|
| Rate for Payer: VA VA |
$57.60
|
|
|
INVESTIGATIONAL PEMBROLIZUMAB (MK-3475) 25 MG/ML INTRAVENOUS SOLUTION NRG-GY018 STUDY SUPPLIED
|
Facility
|
OP
|
$172.80
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
301126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Medicare |
$59.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.00
|
| Rate for Payer: BCBS Complete |
$32.42
|
| Rate for Payer: BCBS MAPPO |
$57.60
|
| Rate for Payer: BCBS Trust/PPO |
$156.96
|
| Rate for Payer: BCN Commercial |
$156.96
|
| Rate for Payer: BCN Medicare Advantage |
$57.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.60
|
| Rate for Payer: Mclaren Medicaid |
$30.87
|
| Rate for Payer: Mclaren Medicare |
$57.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.48
|
| Rate for Payer: Meridian Medicaid |
$32.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.24
|
| Rate for Payer: Nomi Health Commercial |
$172.80
|
| Rate for Payer: PACE Medicare |
$54.72
|
| Rate for Payer: PACE SWMI |
$57.60
|
| Rate for Payer: PHP Medicare Advantage |
$57.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.55
|
| Rate for Payer: Priority Health Medicare |
$57.60
|
| Rate for Payer: Priority Health Narrow Network |
$134.04
|
| Rate for Payer: Railroad Medicare Medicare |
$57.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.60
|
| Rate for Payer: UHC Exchange |
$110.08
|
| Rate for Payer: UHC Medicare Advantage |
$57.60
|
| Rate for Payer: UHCCP Medicaid |
$30.87
|
| Rate for Payer: VA VA |
$57.60
|
|
|
INVESTIGATIONAL PLACEBO OR PEMBROLIZUMAB (MK-3475) 25 MG/ML INTRAVENOUS SOLUTION NRG-GY018 STUDY SUPPLIED
|
Facility
|
OP
|
$172.80
|
|
|
Service Code
|
HCPCS J9271
|
| Hospital Charge Code |
300991
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Medicare |
$59.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.00
|
| Rate for Payer: BCBS Complete |
$32.42
|
| Rate for Payer: BCBS MAPPO |
$57.60
|
| Rate for Payer: BCBS Trust/PPO |
$156.96
|
| Rate for Payer: BCN Commercial |
$156.96
|
| Rate for Payer: BCN Medicare Advantage |
$57.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.60
|
| Rate for Payer: Mclaren Medicaid |
$30.87
|
| Rate for Payer: Mclaren Medicare |
$57.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.48
|
| Rate for Payer: Meridian Medicaid |
$32.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.24
|
| Rate for Payer: Nomi Health Commercial |
$172.80
|
| Rate for Payer: PACE Medicare |
$54.72
|
| Rate for Payer: PACE SWMI |
$57.60
|
| Rate for Payer: PHP Medicare Advantage |
$57.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.55
|
| Rate for Payer: Priority Health Medicare |
$57.60
|
| Rate for Payer: Priority Health Narrow Network |
$134.04
|
| Rate for Payer: Railroad Medicare Medicare |
$57.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.60
|
| Rate for Payer: UHC Exchange |
$110.08
|
| Rate for Payer: UHC Medicare Advantage |
$57.60
|
| Rate for Payer: UHCCP Medicaid |
$30.87
|
| Rate for Payer: VA VA |
$57.60
|
|
|
INVESTIGATIONAL TRASTUZUMAB 600 MG-HYALURONIDASE-OYSK 10,000 UNIT/5 ML SUBCUT SOLUTION TAPUR STUDY SUPPLIED
|
Facility
|
OP
|
$189.18
|
|
|
Service Code
|
HCPCS J9356
|
| Hospital Charge Code |
301760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$189.18 |
| Rate for Payer: Aetna Medicare |
$65.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.82
|
| Rate for Payer: BCBS Complete |
$35.49
|
| Rate for Payer: BCBS MAPPO |
$63.06
|
| Rate for Payer: BCBS Trust/PPO |
$171.99
|
| Rate for Payer: BCN Commercial |
$171.99
|
| Rate for Payer: BCN Medicare Advantage |
$63.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.06
|
| Rate for Payer: Mclaren Medicaid |
$33.80
|
| Rate for Payer: Mclaren Medicare |
$63.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.21
|
| Rate for Payer: Meridian Medicaid |
$35.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.52
|
| Rate for Payer: Nomi Health Commercial |
$189.18
|
| Rate for Payer: PACE Medicare |
$59.91
|
| Rate for Payer: PACE SWMI |
$63.06
|
| Rate for Payer: PHP Medicare Advantage |
$63.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.57
|
| Rate for Payer: Priority Health Medicare |
$63.06
|
| Rate for Payer: Priority Health Narrow Network |
$146.86
|
| Rate for Payer: Railroad Medicare Medicare |
$63.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.06
|
| Rate for Payer: UHC Exchange |
$120.51
|
| Rate for Payer: UHC Medicare Advantage |
$63.06
|
| Rate for Payer: UHCCP Medicaid |
$33.80
|
| Rate for Payer: VA VA |
$63.06
|
|
|
INVETIGATIONAL RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION PRAGMATICA-LUNG STUDY SUPPLIED
|
Facility
|
OP
|
$218.73
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
301605
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.08 |
| Max. Negotiated Rate |
$218.73 |
| Rate for Payer: Aetna Medicare |
$75.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.14
|
| Rate for Payer: BCBS Complete |
$41.03
|
| Rate for Payer: BCBS MAPPO |
$72.91
|
| Rate for Payer: BCBS Trust/PPO |
$188.08
|
| Rate for Payer: BCN Commercial |
$188.08
|
| Rate for Payer: BCN Medicare Advantage |
$72.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.91
|
| Rate for Payer: Mclaren Medicaid |
$39.08
|
| Rate for Payer: Mclaren Medicare |
$72.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.56
|
| Rate for Payer: Meridian Medicaid |
$41.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.85
|
| Rate for Payer: Nomi Health Commercial |
$218.73
|
| Rate for Payer: PACE Medicare |
$69.26
|
| Rate for Payer: PACE SWMI |
$72.91
|
| Rate for Payer: PHP Medicare Advantage |
$72.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.53
|
| Rate for Payer: Priority Health Medicare |
$72.91
|
| Rate for Payer: Priority Health Narrow Network |
$163.62
|
| Rate for Payer: Railroad Medicare Medicare |
$72.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.91
|
| Rate for Payer: UHC Exchange |
$139.34
|
| Rate for Payer: UHC Medicare Advantage |
$72.91
|
| Rate for Payer: UHCCP Medicaid |
$39.08
|
| Rate for Payer: VA VA |
$72.91
|
|
|
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
|
IP
|
$87.75
|
|
|
Service Code
|
NDC 00395121316
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.61 |
| Max. Negotiated Rate |
$78.98 |
| 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 |
$75.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$78.98
|
| 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
|
$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 |
$78.98 |
| 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 |
$75.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$78.98
|
| 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
|
OP
|
$116.55
|
|
|
Service Code
|
NDC 48433023015
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$104.90 |
| Rate for Payer: Aetna American Axle |
$75.76
|
| Rate for Payer: Aetna Commercial |
$99.07
|
| Rate for Payer: Aetna Medicare |
$58.28
|
| 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 |
$104.90
|
| 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
|
|
|
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
|
IP
|
$116.55
|
|
|
Service Code
|
NDC 48433023015
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.28 |
| Max. Negotiated Rate |
$104.90 |
| 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 |
$104.90
|
| 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
|
|
