|
BUTYLATED HYDROXYTOLUENE POWDER
|
Facility
|
IP
|
$359.55
|
|
|
Service Code
|
NDC 38779006505
|
| Hospital Charge Code |
17041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna American Axle |
$233.71
|
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.71
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Advantage |
$251.69
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.66
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health SBD |
$226.52
|
| Rate for Payer: UMR Bronson Commercial |
$158.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT
|
Facility
|
IP
|
$11,850.08
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
158850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,214.04 |
| Max. Negotiated Rate |
$10,665.07 |
| Rate for Payer: Aetna American Axle |
$7,702.55
|
| Rate for Payer: Aetna Commercial |
$10,072.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,702.55
|
| Rate for Payer: Cash Price |
$9,480.06
|
| Rate for Payer: Cofinity Advantage |
$8,295.06
|
| Rate for Payer: Cofinity Commercial |
$10,191.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,480.06
|
| Rate for Payer: Healthscope Commercial |
$10,665.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,295.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,887.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,072.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,887.56
|
| Rate for Payer: PHP Commercial |
$10,072.57
|
| Rate for Payer: Priority Health SBD |
$7,465.55
|
| Rate for Payer: UMR Bronson Commercial |
$5,214.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,887.56
|
|
|
C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT
|
Facility
|
OP
|
$11,850.08
|
|
|
Service Code
|
HCPCS J0597
|
| Hospital Charge Code |
158850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.77 |
| Max. Negotiated Rate |
$10,665.07 |
| Rate for Payer: Aetna American Axle |
$7,702.55
|
| Rate for Payer: Aetna Commercial |
$10,072.57
|
| Rate for Payer: Aetna Medicare |
$79.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,702.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.06
|
| Rate for Payer: BCBS Complete |
$41.77
|
| Rate for Payer: BCBS MAPPO |
$76.05
|
| Rate for Payer: BCBS Trust/PPO |
$245.98
|
| Rate for Payer: BCN Commercial |
$245.98
|
| Rate for Payer: BCN Medicare Advantage |
$76.05
|
| Rate for Payer: Cash Price |
$9,480.06
|
| Rate for Payer: Cash Price |
$9,480.06
|
| Rate for Payer: Cofinity Advantage |
$8,295.06
|
| Rate for Payer: Cofinity Commercial |
$10,191.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,480.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.05
|
| Rate for Payer: Healthscope Commercial |
$10,665.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,295.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,887.56
|
| Rate for Payer: Mclaren Medicaid |
$76.05
|
| Rate for Payer: Mclaren Medicare |
$76.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.85
|
| Rate for Payer: Meridian Medicaid |
$79.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,072.57
|
| Rate for Payer: Nomi Health Commercial |
$228.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,887.56
|
| Rate for Payer: PACE Medicare |
$72.25
|
| Rate for Payer: PACE SWMI |
$76.05
|
| Rate for Payer: PHP Commercial |
$10,072.57
|
| Rate for Payer: PHP Medicare Advantage |
$76.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$239.25
|
| Rate for Payer: Priority Health Medicare |
$76.05
|
| Rate for Payer: Priority Health SBD |
$7,465.55
|
| Rate for Payer: Priority Health Tiered Network |
$191.40
|
| Rate for Payer: Railroad Medicare Medicare |
$76.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.17
|
| Rate for Payer: UHC Core |
$125.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$76.05
|
| Rate for Payer: UHC Exchange |
$125.17
|
| Rate for Payer: UHC Medicaid |
$39.77
|
| Rate for Payer: UHCCP Medicaid |
$39.77
|
| Rate for Payer: UMR Bronson Commercial |
$4,384.53
|
| Rate for Payer: VA VA |
$76.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,887.56
|
|
|
CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$66,092.12
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
105644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.84 |
| Max. Negotiated Rate |
$59,482.91 |
| Rate for Payer: Aetna American Axle |
$42,959.88
|
| Rate for Payer: Aetna Commercial |
$56,178.30
|
| Rate for Payer: Aetna Medicare |
$240.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42,959.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$288.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$288.81
|
| Rate for Payer: BCBS Complete |
$126.89
|
| Rate for Payer: BCBS MAPPO |
$231.05
|
| Rate for Payer: BCBS Trust/PPO |
$748.39
|
| Rate for Payer: BCN Commercial |
$748.39
|
| Rate for Payer: BCN Medicare Advantage |
$231.05
|
| Rate for Payer: Cash Price |
$52,873.70
|
| Rate for Payer: Cash Price |
$52,873.70
|
| Rate for Payer: Cofinity Advantage |
$46,264.48
|
| Rate for Payer: Cofinity Commercial |
$56,839.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52,873.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.05
|
| Rate for Payer: Healthscope Commercial |
$59,482.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46,264.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49,569.09
|
| Rate for Payer: Mclaren Medicaid |
$231.05
|
| Rate for Payer: Mclaren Medicare |
$231.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.60
|
| Rate for Payer: Meridian Medicaid |
$242.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$254.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56,178.30
|
| Rate for Payer: Nomi Health Commercial |
$693.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49,569.09
|
| Rate for Payer: PACE Medicare |
$219.50
|
| Rate for Payer: PACE SWMI |
$231.05
|
| Rate for Payer: PHP Commercial |
$56,178.30
|
| Rate for Payer: PHP Medicare Advantage |
$231.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$716.82
|
| Rate for Payer: Priority Health Medicare |
$231.05
|
| Rate for Payer: Priority Health SBD |
$41,638.04
|
| Rate for Payer: Priority Health Tiered Network |
$573.46
|
| Rate for Payer: Railroad Medicare Medicare |
$231.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.82
|
| Rate for Payer: UHC Core |
$380.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$231.05
|
| Rate for Payer: UHC Exchange |
$380.82
|
| Rate for Payer: UHC Medicaid |
$120.84
|
| Rate for Payer: UHCCP Medicaid |
$120.84
|
| Rate for Payer: UMR Bronson Commercial |
$24,454.08
|
| Rate for Payer: VA VA |
$231.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49,569.09
|
|
|
CABAZITAXEL 10 MG/ML (FIRST DILUTION) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$66,092.12
|
|
|
Service Code
|
HCPCS J9043
|
| Hospital Charge Code |
105644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29,080.53 |
| Max. Negotiated Rate |
$59,482.91 |
| Rate for Payer: Aetna American Axle |
$42,959.88
|
| Rate for Payer: Aetna Commercial |
$56,178.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42,959.88
|
| Rate for Payer: Cash Price |
$52,873.70
|
| Rate for Payer: Cofinity Advantage |
$46,264.48
|
| Rate for Payer: Cofinity Commercial |
$56,839.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52,873.70
|
| Rate for Payer: Healthscope Commercial |
$59,482.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46,264.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49,569.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56,178.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49,569.09
|
| Rate for Payer: PHP Commercial |
$56,178.30
|
| Rate for Payer: Priority Health SBD |
$41,638.04
|
| Rate for Payer: UMR Bronson Commercial |
$29,080.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49,569.09
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
NDC 59762100501
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna American Axle |
$104.65
|
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna Medicare |
$80.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Advantage |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: Priority Health SBD |
$101.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.65
|
| Rate for Payer: UHC Core |
$83.88
|
| Rate for Payer: UHC Exchange |
$63.27
|
| Rate for Payer: UMR Bronson Commercial |
$59.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.75
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$80.40
|
|
|
Service Code
|
NDC 50742011808
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.38 |
| Max. Negotiated Rate |
$72.36 |
| Rate for Payer: Aetna American Axle |
$52.26
|
| Rate for Payer: Aetna Commercial |
$68.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.26
|
| Rate for Payer: Cash Price |
$64.32
|
| Rate for Payer: Cofinity Advantage |
$56.28
|
| Rate for Payer: Cofinity Commercial |
$69.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.32
|
| Rate for Payer: Healthscope Commercial |
$72.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.30
|
| Rate for Payer: PHP Commercial |
$68.34
|
| Rate for Payer: Priority Health SBD |
$50.65
|
| Rate for Payer: UMR Bronson Commercial |
$35.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.30
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$172.07
|
|
|
Service Code
|
NDC 00093542088
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$154.86 |
| Rate for Payer: Aetna American Axle |
$111.85
|
| Rate for Payer: Aetna Commercial |
$146.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.85
|
| Rate for Payer: Cash Price |
$137.66
|
| Rate for Payer: Cofinity Advantage |
$120.45
|
| Rate for Payer: Cofinity Commercial |
$147.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.66
|
| Rate for Payer: Healthscope Commercial |
$154.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.05
|
| Rate for Payer: PHP Commercial |
$146.26
|
| Rate for Payer: Priority Health SBD |
$108.40
|
| Rate for Payer: UMR Bronson Commercial |
$75.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.05
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
NDC 59762100501
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna American Axle |
$104.65
|
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.65
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Advantage |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: Priority Health SBD |
$101.43
|
| Rate for Payer: UMR Bronson Commercial |
$70.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.75
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
OP
|
$172.07
|
|
|
Service Code
|
NDC 00093542088
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.67 |
| Max. Negotiated Rate |
$154.86 |
| Rate for Payer: Aetna American Axle |
$111.85
|
| Rate for Payer: Aetna Commercial |
$146.26
|
| Rate for Payer: Aetna Medicare |
$86.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.85
|
| Rate for Payer: BCBS Complete |
$68.83
|
| Rate for Payer: Cash Price |
$137.66
|
| Rate for Payer: Cofinity Advantage |
$120.45
|
| Rate for Payer: Cofinity Commercial |
$147.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.66
|
| Rate for Payer: Healthscope Commercial |
$154.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.05
|
| Rate for Payer: PHP Commercial |
$146.26
|
| Rate for Payer: Priority Health SBD |
$108.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.85
|
| Rate for Payer: UHC Core |
$89.65
|
| Rate for Payer: UHC Exchange |
$67.62
|
| Rate for Payer: UMR Bronson Commercial |
$63.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.05
|
|
|
CABERGOLINE 0.5 MG TABLET
|
Facility
|
OP
|
$80.40
|
|
|
Service Code
|
NDC 50742011808
|
| Hospital Charge Code |
19226
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$72.36 |
| Rate for Payer: Aetna American Axle |
$52.26
|
| Rate for Payer: Aetna Commercial |
$68.34
|
| Rate for Payer: Aetna Medicare |
$40.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.26
|
| Rate for Payer: BCBS Complete |
$32.16
|
| Rate for Payer: Cash Price |
$64.32
|
| Rate for Payer: Cofinity Advantage |
$56.28
|
| Rate for Payer: Cofinity Commercial |
$69.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.32
|
| Rate for Payer: Healthscope Commercial |
$72.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.30
|
| Rate for Payer: PHP Commercial |
$68.34
|
| Rate for Payer: Priority Health SBD |
$50.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.26
|
| Rate for Payer: UHC Core |
$41.89
|
| Rate for Payer: UHC Exchange |
$31.60
|
| Rate for Payer: UMR Bronson Commercial |
$29.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.30
|
|
|
CABOTEGRAVIR ER 400 MG/2 ML-RILPIVIRINE ER 600 MG/2ML IM SUSPENSION,ER
|
Facility
|
OP
|
$20,048.54
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$18,043.69 |
| Rate for Payer: Aetna American Axle |
$13,031.55
|
| Rate for Payer: Aetna Commercial |
$17,041.26
|
| Rate for Payer: Aetna Medicare |
$25.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,031.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.23
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS MAPPO |
$24.18
|
| Rate for Payer: BCBS Trust/PPO |
$78.32
|
| Rate for Payer: BCN Commercial |
$78.32
|
| Rate for Payer: BCN Medicare Advantage |
$24.18
|
| Rate for Payer: Cash Price |
$16,038.83
|
| Rate for Payer: Cash Price |
$16,038.83
|
| Rate for Payer: Cofinity Advantage |
$14,033.98
|
| Rate for Payer: Cofinity Commercial |
$17,241.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,038.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$18,043.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,033.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,036.41
|
| Rate for Payer: Mclaren Medicaid |
$24.18
|
| Rate for Payer: Mclaren Medicare |
$24.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.39
|
| Rate for Payer: Meridian Medicaid |
$25.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,041.26
|
| Rate for Payer: Nomi Health Commercial |
$72.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,036.41
|
| Rate for Payer: PACE Medicare |
$22.97
|
| Rate for Payer: PACE SWMI |
$24.18
|
| Rate for Payer: PHP Commercial |
$17,041.26
|
| Rate for Payer: PHP Medicare Advantage |
$24.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$74.59
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health SBD |
$12,630.58
|
| Rate for Payer: Priority Health Tiered Network |
$59.67
|
| Rate for Payer: Railroad Medicare Medicare |
$24.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.86
|
| Rate for Payer: UHC Core |
$39.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.18
|
| Rate for Payer: UHC Exchange |
$39.86
|
| Rate for Payer: UHC Medicaid |
$12.65
|
| Rate for Payer: UHCCP Medicaid |
$12.65
|
| Rate for Payer: UMR Bronson Commercial |
$7,417.96
|
| Rate for Payer: VA VA |
$24.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,036.41
|
|
|
CABOTEGRAVIR ER 400 MG/2 ML-RILPIVIRINE ER 600 MG/2ML IM SUSPENSION,ER
|
Facility
|
IP
|
$20,048.54
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,821.36 |
| Max. Negotiated Rate |
$18,043.69 |
| Rate for Payer: Aetna American Axle |
$13,031.55
|
| Rate for Payer: Aetna Commercial |
$17,041.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,031.55
|
| Rate for Payer: Cash Price |
$16,038.83
|
| Rate for Payer: Cofinity Advantage |
$14,033.98
|
| Rate for Payer: Cofinity Commercial |
$17,241.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,038.83
|
| Rate for Payer: Healthscope Commercial |
$18,043.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,033.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,036.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,041.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,036.41
|
| Rate for Payer: PHP Commercial |
$17,041.26
|
| Rate for Payer: Priority Health SBD |
$12,630.58
|
| Rate for Payer: UMR Bronson Commercial |
$8,821.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,036.41
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML (200 MG/ML) IM SUSPENSION,EXTENDED RELEASE
|
Facility
|
OP
|
$18,291.09
|
|
|
Service Code
|
HCPCS J0739
|
| Hospital Charge Code |
198975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$16,461.98 |
| Rate for Payer: Aetna American Axle |
$11,889.21
|
| Rate for Payer: Aetna Commercial |
$15,547.43
|
| Rate for Payer: Aetna Medicare |
$7.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,889.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.94
|
| Rate for Payer: BCBS Complete |
$3.93
|
| Rate for Payer: BCBS MAPPO |
$7.15
|
| Rate for Payer: BCBS Trust/PPO |
$23.17
|
| Rate for Payer: BCN Commercial |
$23.17
|
| Rate for Payer: BCN Medicare Advantage |
$7.15
|
| Rate for Payer: Cash Price |
$14,632.87
|
| Rate for Payer: Cash Price |
$14,632.87
|
| Rate for Payer: Cofinity Advantage |
$12,803.76
|
| Rate for Payer: Cofinity Commercial |
$15,730.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,632.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.15
|
| Rate for Payer: Healthscope Commercial |
$16,461.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,803.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,718.32
|
| Rate for Payer: Mclaren Medicaid |
$7.15
|
| Rate for Payer: Mclaren Medicare |
$7.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.51
|
| Rate for Payer: Meridian Medicaid |
$7.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,547.43
|
| Rate for Payer: Nomi Health Commercial |
$21.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,718.32
|
| Rate for Payer: PACE Medicare |
$6.79
|
| Rate for Payer: PACE SWMI |
$7.15
|
| Rate for Payer: PHP Commercial |
$15,547.43
|
| Rate for Payer: PHP Medicare Advantage |
$7.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.14
|
| Rate for Payer: Priority Health Medicare |
$7.15
|
| Rate for Payer: Priority Health SBD |
$11,523.39
|
| Rate for Payer: Priority Health Tiered Network |
$17.71
|
| Rate for Payer: Railroad Medicare Medicare |
$7.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.80
|
| Rate for Payer: UHC Core |
$11.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.15
|
| Rate for Payer: UHC Exchange |
$11.80
|
| Rate for Payer: UHC Medicaid |
$3.74
|
| Rate for Payer: UHCCP Medicaid |
$3.74
|
| Rate for Payer: UMR Bronson Commercial |
$6,767.70
|
| Rate for Payer: VA VA |
$7.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,718.32
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML (200 MG/ML) IM SUSPENSION,EXTENDED RELEASE
|
Facility
|
IP
|
$18,291.09
|
|
|
Service Code
|
HCPCS J0739
|
| Hospital Charge Code |
198975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,048.08 |
| Max. Negotiated Rate |
$16,461.98 |
| Rate for Payer: Aetna American Axle |
$11,889.21
|
| Rate for Payer: Aetna Commercial |
$15,547.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,889.21
|
| Rate for Payer: Cash Price |
$14,632.87
|
| Rate for Payer: Cofinity Advantage |
$12,803.76
|
| Rate for Payer: Cofinity Commercial |
$15,730.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,632.87
|
| Rate for Payer: Healthscope Commercial |
$16,461.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,803.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,718.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,547.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13,718.32
|
| Rate for Payer: PHP Commercial |
$15,547.43
|
| Rate for Payer: Priority Health SBD |
$11,523.39
|
| Rate for Payer: UMR Bronson Commercial |
$8,048.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,718.32
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER
|
Facility
|
IP
|
$30,072.00
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,231.68 |
| Max. Negotiated Rate |
$27,064.80 |
| Rate for Payer: Aetna American Axle |
$19,546.80
|
| Rate for Payer: Aetna Commercial |
$25,561.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,546.80
|
| Rate for Payer: Cash Price |
$24,057.60
|
| Rate for Payer: Cofinity Advantage |
$21,050.40
|
| Rate for Payer: Cofinity Commercial |
$25,861.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,057.60
|
| Rate for Payer: Healthscope Commercial |
$27,064.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,050.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,554.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,561.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,554.00
|
| Rate for Payer: PHP Commercial |
$25,561.20
|
| Rate for Payer: Priority Health SBD |
$18,945.36
|
| Rate for Payer: UMR Bronson Commercial |
$13,231.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,554.00
|
|
|
CABOTEGRAVIR ER 600 MG/3 ML-RILPIVIRINE ER 900 MG/3ML IM SUSPENSION,ER
|
Facility
|
OP
|
$30,072.00
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
196915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$27,064.80 |
| Rate for Payer: Aetna American Axle |
$19,546.80
|
| Rate for Payer: Aetna Commercial |
$25,561.20
|
| Rate for Payer: Aetna Medicare |
$25.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,546.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.23
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS MAPPO |
$24.18
|
| Rate for Payer: BCBS Trust/PPO |
$78.32
|
| Rate for Payer: BCN Commercial |
$78.32
|
| Rate for Payer: BCN Medicare Advantage |
$24.18
|
| Rate for Payer: Cash Price |
$24,057.60
|
| Rate for Payer: Cash Price |
$24,057.60
|
| Rate for Payer: Cofinity Advantage |
$21,050.40
|
| Rate for Payer: Cofinity Commercial |
$25,861.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,057.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.18
|
| Rate for Payer: Healthscope Commercial |
$27,064.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,050.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22,554.00
|
| Rate for Payer: Mclaren Medicaid |
$24.18
|
| Rate for Payer: Mclaren Medicare |
$24.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.39
|
| Rate for Payer: Meridian Medicaid |
$25.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,561.20
|
| Rate for Payer: Nomi Health Commercial |
$72.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22,554.00
|
| Rate for Payer: PACE Medicare |
$22.97
|
| Rate for Payer: PACE SWMI |
$24.18
|
| Rate for Payer: PHP Commercial |
$25,561.20
|
| Rate for Payer: PHP Medicare Advantage |
$24.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$74.59
|
| Rate for Payer: Priority Health Medicare |
$24.18
|
| Rate for Payer: Priority Health SBD |
$18,945.36
|
| Rate for Payer: Priority Health Tiered Network |
$59.67
|
| Rate for Payer: Railroad Medicare Medicare |
$24.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.86
|
| Rate for Payer: UHC Core |
$39.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.18
|
| Rate for Payer: UHC Exchange |
$39.86
|
| Rate for Payer: UHC Medicaid |
$12.65
|
| Rate for Payer: UHCCP Medicaid |
$12.65
|
| Rate for Payer: UMR Bronson Commercial |
$11,126.64
|
| Rate for Payer: VA VA |
$24.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22,554.00
|
|
|
CAFFEINE 200 MG TABLET
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
NDC 09900000881
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna American Axle |
$1.06
|
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.06
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cofinity Advantage |
$1.14
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.30
|
| Rate for Payer: Healthscope Commercial |
$1.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.22
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health SBD |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.22
|
|
|
CAFFEINE 200 MG TABLET
|
Facility
|
OP
|
$33.47
|
|
|
Service Code
|
NDC 09629596325
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$30.12 |
| Rate for Payer: Aetna American Axle |
$21.76
|
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Aetna Medicare |
$16.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.76
|
| Rate for Payer: BCBS Complete |
$13.39
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Cofinity Advantage |
$23.43
|
| Rate for Payer: Cofinity Commercial |
$28.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$30.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.10
|
| Rate for Payer: PHP Commercial |
$28.45
|
| Rate for Payer: Priority Health SBD |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.76
|
| Rate for Payer: UHC Core |
$17.44
|
| Rate for Payer: UHC Exchange |
$13.15
|
| Rate for Payer: UMR Bronson Commercial |
$12.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.10
|
|
|
CAFFEINE 200 MG TABLET
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
NDC 09900000881
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna American Axle |
$1.06
|
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna Medicare |
$0.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.06
|
| Rate for Payer: BCBS Complete |
$0.65
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Cofinity Advantage |
$1.14
|
| Rate for Payer: Cofinity Commercial |
$1.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.30
|
| Rate for Payer: Healthscope Commercial |
$1.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.22
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health SBD |
$1.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.06
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UMR Bronson Commercial |
$0.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.22
|
|
|
CAFFEINE 200 MG TABLET
|
Facility
|
IP
|
$33.47
|
|
|
Service Code
|
NDC 09629596325
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$30.12 |
| Rate for Payer: Aetna American Axle |
$21.76
|
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.76
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Cofinity Advantage |
$23.43
|
| Rate for Payer: Cofinity Commercial |
$28.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$30.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.10
|
| Rate for Payer: PHP Commercial |
$28.45
|
| Rate for Payer: Priority Health SBD |
$21.09
|
| Rate for Payer: UMR Bronson Commercial |
$14.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.10
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) BOLUS/LOAD IV SOLUTION CUSTOM
|
Facility
|
OP
|
$44.78
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
163560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna Medicare |
$22.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: BCBS Complete |
$17.91
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cofinity Advantage |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$38.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.82
|
| Rate for Payer: Healthscope Commercial |
$40.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.59
|
| Rate for Payer: PHP Commercial |
$38.06
|
| Rate for Payer: Priority Health SBD |
$28.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.35
|
| Rate for Payer: UHC Core |
$3.35
|
| Rate for Payer: UHC Exchange |
$3.35
|
| Rate for Payer: UMR Bronson Commercial |
$16.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.59
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) BOLUS/LOAD IV SOLUTION CUSTOM
|
Facility
|
IP
|
$44.78
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
163560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$40.30 |
| Rate for Payer: Aetna American Axle |
$29.11
|
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.11
|
| Rate for Payer: Cash Price |
$35.82
|
| Rate for Payer: Cofinity Advantage |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$38.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.82
|
| Rate for Payer: Healthscope Commercial |
$40.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.59
|
| Rate for Payer: PHP Commercial |
$38.06
|
| Rate for Payer: Priority Health SBD |
$28.21
|
| Rate for Payer: UMR Bronson Commercial |
$19.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.59
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) BOLUS/LOAD ORAL SOLUTION CUSTOM
|
Facility
|
OP
|
$37.76
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
301512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna Medicare |
$18.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: BCBS Complete |
$15.10
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Advantage |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.32
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.35
|
| Rate for Payer: UHC Core |
$3.35
|
| Rate for Payer: UHC Exchange |
$3.35
|
| Rate for Payer: UMR Bronson Commercial |
$13.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
|
CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) BOLUS/LOAD ORAL SOLUTION CUSTOM
|
Facility
|
IP
|
$37.76
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
301512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$33.98 |
| Rate for Payer: Aetna American Axle |
$24.54
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.54
|
| Rate for Payer: Cash Price |
$30.21
|
| Rate for Payer: Cofinity Advantage |
$26.43
|
| Rate for Payer: Cofinity Commercial |
$32.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.32
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health SBD |
$23.79
|
| Rate for Payer: UMR Bronson Commercial |
$16.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.32
|
|
