|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$351.09
|
|
|
Service Code
|
NDC 42658012204
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.48 |
| Max. Negotiated Rate |
$315.98 |
| Rate for Payer: Aetna American Axle |
$228.21
|
| Rate for Payer: Aetna Commercial |
$298.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.21
|
| Rate for Payer: Cash Price |
$280.87
|
| Rate for Payer: Cofinity Commercial |
$245.76
|
| Rate for Payer: Cofinity Commercial |
$301.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.87
|
| Rate for Payer: Healthscope Commercial |
$315.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.43
|
| Rate for Payer: PHP Commercial |
$298.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.21
|
| Rate for Payer: Priority Health SBD |
$221.19
|
| Rate for Payer: UMR Bronson Commercial |
$154.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.32
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
OP
|
$790.21
|
|
|
Service Code
|
NDC 00024585130
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.38 |
| Max. Negotiated Rate |
$711.19 |
| Rate for Payer: Aetna American Axle |
$513.64
|
| Rate for Payer: Aetna Commercial |
$671.68
|
| Rate for Payer: Aetna Medicare |
$395.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.64
|
| Rate for Payer: BCBS Complete |
$316.08
|
| Rate for Payer: Cash Price |
$632.17
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Cofinity Commercial |
$679.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.17
|
| Rate for Payer: Healthscope Commercial |
$711.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.68
|
| Rate for Payer: PHP Commercial |
$671.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.64
|
| Rate for Payer: Priority Health SBD |
$497.83
|
| Rate for Payer: UMR Bronson Commercial |
$292.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.66
|
|
|
IRBESARTAN 150 MG TABLET
|
Facility
|
IP
|
$790.21
|
|
|
Service Code
|
NDC 00024585130
|
| Hospital Charge Code |
21848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.69 |
| Max. Negotiated Rate |
$711.19 |
| Rate for Payer: Aetna American Axle |
$513.64
|
| Rate for Payer: Aetna Commercial |
$671.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.64
|
| Rate for Payer: Cash Price |
$632.17
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Cofinity Commercial |
$679.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.17
|
| Rate for Payer: Healthscope Commercial |
$711.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$553.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.68
|
| Rate for Payer: PHP Commercial |
$671.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.64
|
| Rate for Payer: Priority Health SBD |
$497.83
|
| Rate for Payer: UMR Bronson Commercial |
$347.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.66
|
|
|
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; PERIPHERAL FOR GLAUCOMA (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,261.32
|
|
|
Service Code
|
CPT 66625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,192.25 |
| Max. Negotiated Rate |
$6,261.32 |
| Rate for Payer: Aetna Medicare |
$2,313.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,780.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,780.44
|
| Rate for Payer: BCBS Complete |
$1,251.86
|
| Rate for Payer: BCBS MAPPO |
$2,224.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,224.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,224.35
|
| Rate for Payer: Mclaren Medicaid |
$1,192.25
|
| Rate for Payer: Mclaren Medicare |
$2,224.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,335.57
|
| Rate for Payer: Meridian Medicaid |
$1,251.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,558.00
|
| Rate for Payer: PACE Medicare |
$2,113.13
|
| Rate for Payer: PACE SWMI |
$2,224.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,224.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,192.25
|
| Rate for Payer: Priority Health Medicare |
$2,224.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,224.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,261.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,224.35
|
| Rate for Payer: UHC Exchange |
$4,250.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,224.35
|
| Rate for Payer: UHCCP Medicaid |
$1,192.25
|
| Rate for Payer: VA VA |
$2,224.35
|
|
|
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; SECTOR FOR GLAUCOMA (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,261.32
|
|
|
Service Code
|
CPT 66630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,192.25 |
| Max. Negotiated Rate |
$6,261.32 |
| Rate for Payer: Aetna Medicare |
$2,313.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,780.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,780.44
|
| Rate for Payer: BCBS Complete |
$1,251.86
|
| Rate for Payer: BCBS MAPPO |
$2,224.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,224.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,224.35
|
| Rate for Payer: Mclaren Medicaid |
$1,192.25
|
| Rate for Payer: Mclaren Medicare |
$2,224.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,335.57
|
| Rate for Payer: Meridian Medicaid |
$1,251.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,558.00
|
| Rate for Payer: PACE Medicare |
$2,113.13
|
| Rate for Payer: PACE SWMI |
$2,224.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,224.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,192.25
|
| Rate for Payer: Priority Health Medicare |
$2,224.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,224.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,261.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,224.35
|
| Rate for Payer: UHC Exchange |
$4,250.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,224.35
|
| Rate for Payer: UHCCP Medicaid |
$1,192.25
|
| Rate for Payer: VA VA |
$2,224.35
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
17450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.28 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna American Axle |
$154.05
|
| Rate for Payer: Aetna American Axle |
$217.07
|
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna Commercial |
$283.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.07
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$267.16
|
| Rate for Payer: Cofinity Commercial |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$233.76
|
| Rate for Payer: Cofinity Commercial |
$165.90
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.16
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Healthscope Commercial |
$300.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.45
|
| Rate for Payer: PHP Commercial |
$283.86
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.07
|
| Rate for Payer: Priority Health SBD |
$149.31
|
| Rate for Payer: Priority Health SBD |
$210.39
|
| Rate for Payer: UMR Bronson Commercial |
$104.28
|
| Rate for Payer: UMR Bronson Commercial |
$146.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.46
|
|
|
IRINOTECAN 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$205.82
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
17450
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.15 |
| Max. Negotiated Rate |
$185.24 |
| Rate for Payer: Aetna American Axle |
$133.78
|
| Rate for Payer: Aetna American Axle |
$86.75
|
| Rate for Payer: Aetna American Axle |
$128.13
|
| Rate for Payer: Aetna American Axle |
$217.07
|
| Rate for Payer: Aetna American Axle |
$72.89
|
| Rate for Payer: Aetna American Axle |
$154.05
|
| Rate for Payer: Aetna American Axle |
$173.49
|
| Rate for Payer: Aetna American Axle |
$142.71
|
| Rate for Payer: Aetna American Axle |
$147.71
|
| Rate for Payer: Aetna Commercial |
$186.63
|
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna Commercial |
$113.44
|
| Rate for Payer: Aetna Commercial |
$193.16
|
| Rate for Payer: Aetna Commercial |
$95.32
|
| Rate for Payer: Aetna Commercial |
$283.86
|
| Rate for Payer: Aetna Commercial |
$226.87
|
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna Commercial |
$174.95
|
| Rate for Payer: Aetna Medicare |
$133.46
|
| Rate for Payer: Aetna Medicare |
$166.97
|
| Rate for Payer: Aetna Medicare |
$98.56
|
| Rate for Payer: Aetna Medicare |
$56.07
|
| Rate for Payer: Aetna Medicare |
$102.91
|
| Rate for Payer: Aetna Medicare |
$66.73
|
| Rate for Payer: Aetna Medicare |
$113.62
|
| Rate for Payer: Aetna Medicare |
$118.50
|
| Rate for Payer: Aetna Medicare |
$109.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.71
|
| Rate for Payer: BCBS Complete |
$90.90
|
| Rate for Payer: BCBS Complete |
$53.38
|
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: BCBS Complete |
$78.85
|
| Rate for Payer: BCBS Complete |
$87.82
|
| Rate for Payer: BCBS Complete |
$133.58
|
| Rate for Payer: BCBS Complete |
$106.76
|
| Rate for Payer: BCBS Complete |
$82.33
|
| Rate for Payer: BCBS Complete |
$44.86
|
| Rate for Payer: Cash Price |
$267.16
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cash Price |
$89.71
|
| Rate for Payer: Cash Price |
$106.77
|
| Rate for Payer: Cash Price |
$164.66
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$175.65
|
| Rate for Payer: Cofinity Commercial |
$114.78
|
| Rate for Payer: Cofinity Commercial |
$153.69
|
| Rate for Payer: Cofinity Commercial |
$188.82
|
| Rate for Payer: Cofinity Commercial |
$177.01
|
| Rate for Payer: Cofinity Commercial |
$78.50
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Cofinity Commercial |
$186.84
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Cofinity Commercial |
$165.90
|
| Rate for Payer: Cofinity Commercial |
$195.44
|
| Rate for Payer: Cofinity Commercial |
$159.07
|
| Rate for Payer: Cofinity Commercial |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$137.99
|
| Rate for Payer: Cofinity Commercial |
$96.44
|
| Rate for Payer: Cofinity Commercial |
$144.07
|
| Rate for Payer: Cofinity Commercial |
$233.76
|
| Rate for Payer: Cofinity Commercial |
$93.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.80
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Healthscope Commercial |
$185.24
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: Healthscope Commercial |
$100.93
|
| Rate for Payer: Healthscope Commercial |
$204.53
|
| Rate for Payer: Healthscope Commercial |
$240.22
|
| Rate for Payer: Healthscope Commercial |
$120.11
|
| Rate for Payer: Healthscope Commercial |
$300.56
|
| Rate for Payer: Healthscope Commercial |
$197.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.95
|
| Rate for Payer: PHP Commercial |
$95.32
|
| Rate for Payer: PHP Commercial |
$226.87
|
| Rate for Payer: PHP Commercial |
$283.86
|
| Rate for Payer: PHP Commercial |
$193.16
|
| Rate for Payer: PHP Commercial |
$186.63
|
| Rate for Payer: PHP Commercial |
$174.95
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: PHP Commercial |
$113.44
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.07
|
| Rate for Payer: Priority Health SBD |
$143.17
|
| Rate for Payer: Priority Health SBD |
$138.32
|
| Rate for Payer: Priority Health SBD |
$129.67
|
| Rate for Payer: Priority Health SBD |
$210.39
|
| Rate for Payer: Priority Health SBD |
$168.15
|
| Rate for Payer: Priority Health SBD |
$149.31
|
| Rate for Payer: Priority Health SBD |
$124.19
|
| Rate for Payer: Priority Health SBD |
$70.65
|
| Rate for Payer: Priority Health SBD |
$84.08
|
| Rate for Payer: UMR Bronson Commercial |
$84.08
|
| Rate for Payer: UMR Bronson Commercial |
$41.49
|
| Rate for Payer: UMR Bronson Commercial |
$49.38
|
| Rate for Payer: UMR Bronson Commercial |
$98.76
|
| Rate for Payer: UMR Bronson Commercial |
$81.24
|
| Rate for Payer: UMR Bronson Commercial |
$87.69
|
| Rate for Payer: UMR Bronson Commercial |
$76.15
|
| Rate for Payer: UMR Bronson Commercial |
$72.94
|
| Rate for Payer: UMR Bronson Commercial |
$123.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.18
|
|
|
IRINOTECAN 40 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$134.40
|
|
|
Service Code
|
HCPCS J9206
|
| Hospital Charge Code |
91055
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna American Axle |
$87.36
|
| Rate for Payer: Aetna American Axle |
$111.53
|
| Rate for Payer: Aetna American Axle |
$82.08
|
| Rate for Payer: Aetna American Axle |
$103.27
|
| Rate for Payer: Aetna Commercial |
$145.85
|
| Rate for Payer: Aetna Commercial |
$114.24
|
| Rate for Payer: Aetna Commercial |
$135.05
|
| Rate for Payer: Aetna Commercial |
$107.34
|
| Rate for Payer: Aetna Medicare |
$79.44
|
| Rate for Payer: Aetna Medicare |
$63.14
|
| Rate for Payer: Aetna Medicare |
$85.80
|
| Rate for Payer: Aetna Medicare |
$67.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.08
|
| Rate for Payer: BCBS Complete |
$50.51
|
| Rate for Payer: BCBS Complete |
$68.64
|
| Rate for Payer: BCBS Complete |
$63.55
|
| Rate for Payer: BCBS Complete |
$53.76
|
| Rate for Payer: Cash Price |
$107.52
|
| Rate for Payer: Cash Price |
$127.10
|
| Rate for Payer: Cash Price |
$101.02
|
| Rate for Payer: Cash Price |
$137.27
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Cofinity Commercial |
$147.57
|
| Rate for Payer: Cofinity Commercial |
$108.60
|
| Rate for Payer: Cofinity Commercial |
$136.64
|
| Rate for Payer: Cofinity Commercial |
$111.22
|
| Rate for Payer: Cofinity Commercial |
$120.11
|
| Rate for Payer: Cofinity Commercial |
$88.40
|
| Rate for Payer: Cofinity Commercial |
$115.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$120.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.52
|
| Rate for Payer: Healthscope Commercial |
$142.99
|
| Rate for Payer: Healthscope Commercial |
$113.65
|
| Rate for Payer: Healthscope Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$154.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.05
|
| Rate for Payer: PHP Commercial |
$135.05
|
| Rate for Payer: PHP Commercial |
$114.24
|
| Rate for Payer: PHP Commercial |
$145.85
|
| Rate for Payer: PHP Commercial |
$107.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.08
|
| Rate for Payer: Priority Health SBD |
$100.09
|
| Rate for Payer: Priority Health SBD |
$108.10
|
| Rate for Payer: Priority Health SBD |
$84.67
|
| Rate for Payer: Priority Health SBD |
$79.56
|
| Rate for Payer: UMR Bronson Commercial |
$58.79
|
| Rate for Payer: UMR Bronson Commercial |
$49.73
|
| Rate for Payer: UMR Bronson Commercial |
$63.49
|
| Rate for Payer: UMR Bronson Commercial |
$46.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.80
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS
|
Facility
|
IP
|
$13,047.94
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
176129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,741.09 |
| Max. Negotiated Rate |
$11,743.15 |
| Rate for Payer: Aetna American Axle |
$8,481.16
|
| Rate for Payer: Aetna Commercial |
$11,090.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,481.16
|
| Rate for Payer: Cash Price |
$10,438.35
|
| Rate for Payer: Cofinity Commercial |
$11,221.23
|
| Rate for Payer: Cofinity Commercial |
$9,133.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,133.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,438.35
|
| Rate for Payer: Healthscope Commercial |
$11,743.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,133.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,785.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,090.75
|
| Rate for Payer: PHP Commercial |
$11,090.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,481.16
|
| Rate for Payer: Priority Health SBD |
$8,220.20
|
| Rate for Payer: UMR Bronson Commercial |
$5,741.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,785.95
|
|
|
IRINOTECAN LIPOSOMAL 4.3 MG/ML INTRAVENOUS
|
Facility
|
OP
|
$13,047.94
|
|
|
Service Code
|
HCPCS J9205
|
| Hospital Charge Code |
176129
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.38 |
| Max. Negotiated Rate |
$11,743.15 |
| Rate for Payer: Aetna American Axle |
$8,481.16
|
| Rate for Payer: Aetna Commercial |
$11,090.75
|
| Rate for Payer: Aetna Medicare |
$68.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,481.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.50
|
| Rate for Payer: BCBS Complete |
$37.14
|
| Rate for Payer: BCBS MAPPO |
$66.00
|
| Rate for Payer: BCN Medicare Advantage |
$66.00
|
| Rate for Payer: Cash Price |
$10,438.35
|
| Rate for Payer: Cash Price |
$10,438.35
|
| Rate for Payer: Cofinity Commercial |
$9,133.56
|
| Rate for Payer: Cofinity Commercial |
$11,221.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,133.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,438.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.00
|
| Rate for Payer: Healthscope Commercial |
$11,743.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,133.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,785.95
|
| Rate for Payer: Mclaren Medicaid |
$35.38
|
| Rate for Payer: Mclaren Medicare |
$66.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.30
|
| Rate for Payer: Meridian Medicaid |
$37.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,090.75
|
| Rate for Payer: PACE Medicare |
$62.70
|
| Rate for Payer: PACE SWMI |
$66.00
|
| Rate for Payer: PHP Commercial |
$11,090.75
|
| Rate for Payer: PHP Medicare Advantage |
$66.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,481.16
|
| Rate for Payer: Priority Health Medicare |
$66.00
|
| Rate for Payer: Priority Health SBD |
$8,220.20
|
| Rate for Payer: Railroad Medicare Medicare |
$66.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.00
|
| Rate for Payer: UHC Exchange |
$126.13
|
| Rate for Payer: UHC Medicare Advantage |
$66.00
|
| Rate for Payer: UHCCP Medicaid |
$35.38
|
| Rate for Payer: UMR Bronson Commercial |
$4,827.74
|
| Rate for Payer: VA VA |
$66.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,785.95
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$161.68
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$145.51 |
| Rate for Payer: Aetna American Axle |
$105.09
|
| Rate for Payer: Aetna Commercial |
$137.43
|
| Rate for Payer: Aetna Medicare |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.64
|
| Rate for Payer: BCBS Complete |
$10.19
|
| Rate for Payer: BCBS MAPPO |
$18.11
|
| Rate for Payer: BCN Medicare Advantage |
$18.11
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cofinity Commercial |
$139.04
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$145.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.26
|
| Rate for Payer: Mclaren Medicaid |
$9.71
|
| Rate for Payer: Mclaren Medicare |
$18.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.02
|
| Rate for Payer: Meridian Medicaid |
$10.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.43
|
| Rate for Payer: PACE Medicare |
$17.20
|
| Rate for Payer: PACE SWMI |
$18.11
|
| Rate for Payer: PHP Commercial |
$137.43
|
| Rate for Payer: PHP Medicare Advantage |
$18.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.09
|
| Rate for Payer: Priority Health Medicare |
$18.11
|
| Rate for Payer: Priority Health SBD |
$101.86
|
| Rate for Payer: Railroad Medicare Medicare |
$18.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.11
|
| Rate for Payer: UHC Exchange |
$34.61
|
| Rate for Payer: UHC Medicare Advantage |
$18.11
|
| Rate for Payer: UHCCP Medicaid |
$9.71
|
| Rate for Payer: UMR Bronson Commercial |
$59.82
|
| Rate for Payer: VA VA |
$18.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.26
|
|
|
IRON DEXTRAN 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$161.68
|
|
|
Service Code
|
HCPCS J1750
|
| Hospital Charge Code |
186569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$145.51 |
| Rate for Payer: Aetna American Axle |
$105.09
|
| Rate for Payer: Aetna Commercial |
$137.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.09
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Cofinity Commercial |
$139.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.34
|
| Rate for Payer: Healthscope Commercial |
$145.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.43
|
| Rate for Payer: PHP Commercial |
$137.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.09
|
| Rate for Payer: Priority Health SBD |
$101.86
|
| Rate for Payer: UMR Bronson Commercial |
$71.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.26
|
|
|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 51991019899
|
| Hospital Charge Code |
28034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
OP
|
$198.55
|
|
|
Service Code
|
NDC 60258018600
|
| Hospital Charge Code |
28034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.46 |
| Max. Negotiated Rate |
$178.69 |
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Medicare |
$99.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: BCBS Complete |
$79.42
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$138.99
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.06
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: UMR Bronson Commercial |
$73.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 63044019862
|
| Hospital Charge Code |
28034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.86 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UMR Bronson Commercial |
$120.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 63044019862
|
| Hospital Charge Code |
28034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.73 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna American Axle |
$212.32
|
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Commercial |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.32
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UMR Bronson Commercial |
$143.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.99
|
|
|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 51991019899
|
| Hospital Charge Code |
28034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
IP
|
$198.55
|
|
|
Service Code
|
NDC 60258018600
|
| Hospital Charge Code |
28034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$178.69 |
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$138.99
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.06
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: UMR Bronson Commercial |
$87.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 51991019811
|
| Hospital Charge Code |
28034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$117.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
IRON POLYSACCH CPLX 150 MG IRON-VIT B12 25 MCG-FOLIC ACID 1 MG CAPSULE
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 51991019811
|
| Hospital Charge Code |
28034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.13
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$133.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$99.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.93
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$154.04
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.99 |
| Max. Negotiated Rate |
$138.64 |
| Rate for Payer: Aetna American Axle |
$100.13
|
| Rate for Payer: Aetna Commercial |
$130.93
|
| Rate for Payer: Aetna Medicare |
$77.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.13
|
| Rate for Payer: BCBS Complete |
$61.62
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cofinity Commercial |
$107.83
|
| Rate for Payer: Cofinity Commercial |
$132.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.23
|
| Rate for Payer: Healthscope Commercial |
$138.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.93
|
| Rate for Payer: PHP Commercial |
$130.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.13
|
| Rate for Payer: Priority Health SBD |
$97.05
|
| Rate for Payer: UMR Bronson Commercial |
$56.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.53
|
|
|
IRON SUCROSE 100 MG IRON/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$154.04
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
29132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$138.64 |
| Rate for Payer: Aetna American Axle |
$100.13
|
| Rate for Payer: Aetna Commercial |
$130.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.13
|
| Rate for Payer: Cash Price |
$123.23
|
| Rate for Payer: Cofinity Commercial |
$107.83
|
| Rate for Payer: Cofinity Commercial |
$132.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.23
|
| Rate for Payer: Healthscope Commercial |
$138.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.93
|
| Rate for Payer: PHP Commercial |
$130.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.13
|
| Rate for Payer: Priority Health SBD |
$97.05
|
| Rate for Payer: UMR Bronson Commercial |
$67.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.53
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$246.62
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.25 |
| Max. Negotiated Rate |
$221.96 |
| Rate for Payer: Aetna American Axle |
$160.30
|
| Rate for Payer: Aetna Commercial |
$209.63
|
| Rate for Payer: Aetna Medicare |
$123.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.30
|
| Rate for Payer: BCBS Complete |
$98.65
|
| Rate for Payer: Cash Price |
$197.30
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$212.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.30
|
| Rate for Payer: Healthscope Commercial |
$221.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.63
|
| Rate for Payer: PHP Commercial |
$209.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.30
|
| Rate for Payer: Priority Health SBD |
$155.37
|
| Rate for Payer: UMR Bronson Commercial |
$91.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.97
|
|
|
IRON SUCROSE 200 MG IRON/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$246.62
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152314
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.51 |
| Max. Negotiated Rate |
$221.96 |
| Rate for Payer: Aetna American Axle |
$160.30
|
| Rate for Payer: Aetna Commercial |
$209.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.30
|
| Rate for Payer: Cash Price |
$197.30
|
| Rate for Payer: Cofinity Commercial |
$172.63
|
| Rate for Payer: Cofinity Commercial |
$212.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.30
|
| Rate for Payer: Healthscope Commercial |
$221.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.63
|
| Rate for Payer: PHP Commercial |
$209.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.30
|
| Rate for Payer: Priority Health SBD |
$155.37
|
| Rate for Payer: UMR Bronson Commercial |
$108.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.97
|
|
|
IRON SUCROSE 50 MG IRON/2.5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$82.79
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
152263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$74.51 |
| Rate for Payer: Aetna American Axle |
$53.81
|
| Rate for Payer: Aetna Commercial |
$70.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.81
|
| Rate for Payer: Cash Price |
$66.23
|
| Rate for Payer: Cofinity Commercial |
$57.95
|
| Rate for Payer: Cofinity Commercial |
$71.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.23
|
| Rate for Payer: Healthscope Commercial |
$74.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.37
|
| Rate for Payer: PHP Commercial |
$70.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.81
|
| Rate for Payer: Priority Health SBD |
$52.16
|
| Rate for Payer: UMR Bronson Commercial |
$36.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.09
|
|
