|
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 |
$0.17 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna American Axle |
$61.75
|
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna American Axle |
$123.50
|
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Commercial |
$23.72
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Aetna Medicare |
$95.00
|
| Rate for Payer: Aetna Medicare |
$47.50
|
| 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: BCBS Complete |
$11.16
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: BCBS Complete |
$76.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$76.00
|
| 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 |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| 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 |
$142.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.72
|
| 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 |
$80.75
|
| Rate for Payer: PHP Commercial |
$161.50
|
| Rate for Payer: PHP Commercial |
$23.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| 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 SBD |
$17.58
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: Priority Health SBD |
$119.70
|
| 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 |
$20.92
|
| 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 |
$23.72
|
| 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 |
$20.92
|
| 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 |
$23.72
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: PHP Commercial |
$23.72
|
| 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 |
$20.92
|
|
|
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 |
$0.45 |
| 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 |
$69.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.56
|
| Rate for Payer: BCBS Complete |
$55.73
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$111.46
|
| 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 |
$19.58
|
| 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 |
$19.58
|
|
|
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 |
$0.17 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna American Axle |
$43.88
|
| Rate for Payer: Aetna American Axle |
$16.96
|
| Rate for Payer: Aetna American Axle |
$87.75
|
| Rate for Payer: Aetna Commercial |
$57.38
|
| Rate for Payer: Aetna Commercial |
$114.75
|
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Medicare |
$13.05
|
| Rate for Payer: Aetna Medicare |
$67.50
|
| Rate for Payer: Aetna Medicare |
$33.75
|
| 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: BCBS Complete |
$10.44
|
| Rate for Payer: BCBS Complete |
$27.00
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$54.00
|
| 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 |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$47.25
|
| Rate for Payer: Cofinity Commercial |
$58.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.00
|
| Rate for Payer: Healthscope Commercial |
$60.75
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Commercial |
$121.50
|
| 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 |
$101.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.58
|
| 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 |
$57.38
|
| Rate for Payer: PHP Commercial |
$114.75
|
| Rate for Payer: PHP Commercial |
$22.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| 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 SBD |
$16.44
|
| Rate for Payer: Priority Health SBD |
$42.52
|
| Rate for Payer: Priority Health SBD |
$85.05
|
| 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 |
$19.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.62
|
|
|
IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,016.25
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$914.62 |
| Rate for Payer: Aetna American Axle |
$660.56
|
| Rate for Payer: Aetna Commercial |
$863.81
|
| Rate for Payer: Aetna Medicare |
$508.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.56
|
| Rate for Payer: BCBS Complete |
$406.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cofinity Commercial |
$711.38
|
| Rate for Payer: Cofinity Commercial |
$873.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$711.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.00
|
| Rate for Payer: Healthscope Commercial |
$914.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$863.81
|
| Rate for Payer: PHP Commercial |
$863.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.56
|
| Rate for Payer: Priority Health SBD |
$640.24
|
| Rate for Payer: UMR Bronson Commercial |
$376.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.19
|
|
|
IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,016.25
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$447.15 |
| Max. Negotiated Rate |
$914.62 |
| Rate for Payer: Aetna American Axle |
$660.56
|
| Rate for Payer: Aetna Commercial |
$863.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.56
|
| Rate for Payer: Cash Price |
$813.00
|
| Rate for Payer: Cofinity Commercial |
$711.38
|
| Rate for Payer: Cofinity Commercial |
$873.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$711.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.00
|
| Rate for Payer: Healthscope Commercial |
$914.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$711.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$863.81
|
| Rate for Payer: PHP Commercial |
$863.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.56
|
| Rate for Payer: Priority Health SBD |
$640.24
|
| Rate for Payer: UMR Bronson Commercial |
$447.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.19
|
|
|
IOPAMIDOL 200 MG IODINE/ML (41 %) INTRATHECAL SOLUTION
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
10325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna American Axle |
$29.90
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
|
|
IOPAMIDOL 200 MG IODINE/ML (41 %) INTRATHECAL SOLUTION
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
10325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna American Axle |
$29.90
|
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
|
|
IOPAMIDOL 300 MG IODINE/ML (61 %) INTRATHECAL SOLUTION
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna American Axle |
$47.38
|
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Commercial |
$61.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.38
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Cofinity Commercial |
$62.69
|
| Rate for Payer: Cofinity Commercial |
$51.03
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.32
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$65.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: PHP Commercial |
$61.96
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.38
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: Priority Health SBD |
$45.93
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: UMR Bronson Commercial |
$32.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.68
|
|
|
IOPAMIDOL 300 MG IODINE/ML (61 %) INTRATHECAL SOLUTION
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna American Axle |
$47.38
|
| Rate for Payer: Aetna Commercial |
$61.96
|
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Aetna Medicare |
$36.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.38
|
| Rate for Payer: BCBS Complete |
$29.16
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Cash Price |
$58.32
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cofinity Commercial |
$62.69
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$51.03
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$65.61
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.96
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: PHP Commercial |
$61.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.38
|
| Rate for Payer: Priority Health SBD |
$45.93
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.74
|
| Rate for Payer: UMR Bronson Commercial |
$26.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
27737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna American Axle |
$27.30
|
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health SBD |
$26.46
|
| Rate for Payer: UMR Bronson Commercial |
$18.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
IOPAMIDOL 300 MG IODINE/ML (61 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
27737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna American Axle |
$27.30
|
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health SBD |
$26.46
|
| Rate for Payer: UMR Bronson Commercial |
$15.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10328
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna American Axle |
$1.16
|
| Rate for Payer: Aetna Commercial |
$1.51
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: Aetna Medicare |
$0.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.16
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$1.53
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$1.25
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.51
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: PHP Commercial |
$1.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.16
|
| Rate for Payer: Priority Health SBD |
$1.12
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UMR Bronson Commercial |
$64.75
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
IOPAMIDOL 370 MG IODINE/ML (76 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
10328
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna American Axle |
$1.16
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna Commercial |
$1.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.16
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.53
|
| Rate for Payer: Cofinity Commercial |
$1.25
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Healthscope Commercial |
$1.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.75
|
| Rate for Payer: PHP Commercial |
$1.51
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.16
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: Priority Health SBD |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$77.00
|
| Rate for Payer: UMR Bronson Commercial |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.34
|
|
|
IOPAMIDOL 61 % ORAL SOLUTION
|
Facility
|
IP
|
$11.20
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
180462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna American Axle |
$7.28
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.28
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
IOPAMIDOL 61 % ORAL SOLUTION
|
Facility
|
OP
|
$11.20
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
180462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$10.08 |
| Rate for Payer: Aetna American Axle |
$7.28
|
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: BCBS Complete |
$4.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cash Price |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Cofinity Commercial |
$9.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.96
|
| Rate for Payer: Healthscope Commercial |
$10.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.52
|
| Rate for Payer: PHP Commercial |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.28
|
| Rate for Payer: Priority Health SBD |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.40
|
|
|
IPILIMUMAB 200 MG/40 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$92,322.68
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.51 |
| Max. Negotiated Rate |
$83,090.41 |
| Rate for Payer: Aetna American Axle |
$60,009.74
|
| Rate for Payer: Aetna Commercial |
$78,474.28
|
| Rate for Payer: Aetna Medicare |
$187.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60,009.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.06
|
| Rate for Payer: BCBS Complete |
$101.33
|
| Rate for Payer: BCBS MAPPO |
$180.05
|
| Rate for Payer: BCBS Trust/PPO |
$485.46
|
| Rate for Payer: BCN Commercial |
$485.46
|
| Rate for Payer: BCN Medicare Advantage |
$180.05
|
| Rate for Payer: Cash Price |
$73,858.14
|
| Rate for Payer: Cash Price |
$73,858.14
|
| Rate for Payer: Cofinity Commercial |
$79,397.50
|
| Rate for Payer: Cofinity Commercial |
$64,625.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$64,625.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73,858.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.05
|
| Rate for Payer: Healthscope Commercial |
$83,090.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64,625.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69,242.01
|
| Rate for Payer: Mclaren Medicaid |
$96.51
|
| Rate for Payer: Mclaren Medicare |
$180.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.05
|
| Rate for Payer: Meridian Medicaid |
$101.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78,474.28
|
| Rate for Payer: Nomi Health Commercial |
$540.15
|
| Rate for Payer: PACE Medicare |
$171.05
|
| Rate for Payer: PACE SWMI |
$180.05
|
| Rate for Payer: PHP Commercial |
$78,474.28
|
| Rate for Payer: PHP Medicare Advantage |
$180.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60,009.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$509.08
|
| Rate for Payer: Priority Health Medicare |
$180.05
|
| Rate for Payer: Priority Health Narrow Network |
$407.26
|
| Rate for Payer: Priority Health SBD |
$58,163.29
|
| Rate for Payer: Railroad Medicare Medicare |
$180.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$506.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.05
|
| Rate for Payer: UHC Exchange |
$344.09
|
| Rate for Payer: UHC Medicare Advantage |
$180.05
|
| Rate for Payer: UHCCP Medicaid |
$96.51
|
| Rate for Payer: UMR Bronson Commercial |
$34,159.39
|
| Rate for Payer: VA VA |
$180.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69,242.01
|
|
|
IPILIMUMAB 200 MG/40 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$92,322.68
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40,621.98 |
| Max. Negotiated Rate |
$83,090.41 |
| Rate for Payer: Aetna American Axle |
$60,009.74
|
| Rate for Payer: Aetna Commercial |
$78,474.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60,009.74
|
| Rate for Payer: Cash Price |
$73,858.14
|
| Rate for Payer: Cofinity Commercial |
$64,625.88
|
| Rate for Payer: Cofinity Commercial |
$79,397.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$64,625.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73,858.14
|
| Rate for Payer: Healthscope Commercial |
$83,090.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64,625.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69,242.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78,474.28
|
| Rate for Payer: PHP Commercial |
$78,474.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60,009.74
|
| Rate for Payer: Priority Health SBD |
$58,163.29
|
| Rate for Payer: UMR Bronson Commercial |
$40,621.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69,242.01
|
|
|
IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23,080.72
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,155.52 |
| Max. Negotiated Rate |
$20,772.65 |
| Rate for Payer: Aetna American Axle |
$15,002.47
|
| Rate for Payer: Aetna Commercial |
$19,618.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,002.47
|
| Rate for Payer: Cash Price |
$18,464.58
|
| Rate for Payer: Cofinity Commercial |
$16,156.50
|
| Rate for Payer: Cofinity Commercial |
$19,849.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$16,156.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,464.58
|
| Rate for Payer: Healthscope Commercial |
$20,772.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,156.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,310.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,618.61
|
| Rate for Payer: PHP Commercial |
$19,618.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,002.47
|
| Rate for Payer: Priority Health SBD |
$14,540.85
|
| Rate for Payer: UMR Bronson Commercial |
$10,155.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,310.54
|
|
|
IPILIMUMAB 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23,080.72
|
|
|
Service Code
|
HCPCS J9228
|
| Hospital Charge Code |
152407
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.51 |
| Max. Negotiated Rate |
$20,772.65 |
| Rate for Payer: Aetna American Axle |
$15,002.47
|
| Rate for Payer: Aetna Commercial |
$19,618.61
|
| Rate for Payer: Aetna Medicare |
$187.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,002.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.06
|
| Rate for Payer: BCBS Complete |
$101.33
|
| Rate for Payer: BCBS MAPPO |
$180.05
|
| Rate for Payer: BCBS Trust/PPO |
$485.46
|
| Rate for Payer: BCN Commercial |
$485.46
|
| Rate for Payer: BCN Medicare Advantage |
$180.05
|
| Rate for Payer: Cash Price |
$18,464.58
|
| Rate for Payer: Cash Price |
$18,464.58
|
| Rate for Payer: Cofinity Commercial |
$19,849.42
|
| Rate for Payer: Cofinity Commercial |
$16,156.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$16,156.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,464.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.05
|
| Rate for Payer: Healthscope Commercial |
$20,772.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16,156.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17,310.54
|
| Rate for Payer: Mclaren Medicaid |
$96.51
|
| Rate for Payer: Mclaren Medicare |
$180.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.05
|
| Rate for Payer: Meridian Medicaid |
$101.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,618.61
|
| Rate for Payer: Nomi Health Commercial |
$540.15
|
| Rate for Payer: PACE Medicare |
$171.05
|
| Rate for Payer: PACE SWMI |
$180.05
|
| Rate for Payer: PHP Commercial |
$19,618.61
|
| Rate for Payer: PHP Medicare Advantage |
$180.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,002.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$509.08
|
| Rate for Payer: Priority Health Medicare |
$180.05
|
| Rate for Payer: Priority Health Narrow Network |
$407.26
|
| Rate for Payer: Priority Health SBD |
$14,540.85
|
| Rate for Payer: Railroad Medicare Medicare |
$180.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$506.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.05
|
| Rate for Payer: UHC Exchange |
$344.09
|
| Rate for Payer: UHC Medicare Advantage |
$180.05
|
| Rate for Payer: UHCCP Medicaid |
$96.51
|
| Rate for Payer: UMR Bronson Commercial |
$8,539.87
|
| Rate for Payer: VA VA |
$180.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17,310.54
|
|
|
IPL CHEEKS FIRST
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00126
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: UMR Bronson Commercial |
$58.88
|
|
|
IPL CHEST FIRST
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00128
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
IPL CHEST SECOND
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00129
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
