|
ALDESLEUKIN 22 MILLION UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,926.11
|
|
|
Service Code
|
HCPCS J9015
|
| Hospital Charge Code |
8993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10,967.49 |
| Max. Negotiated Rate |
$22,433.50 |
| Rate for Payer: Aetna American Axle |
$16,201.97
|
| Rate for Payer: Aetna Commercial |
$21,187.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,201.97
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cofinity Commercial |
$17,448.28
|
| Rate for Payer: Cofinity Commercial |
$21,436.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,448.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,940.89
|
| Rate for Payer: Healthscope Commercial |
$22,433.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,448.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,694.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,187.19
|
| Rate for Payer: PHP Commercial |
$21,187.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,201.97
|
| Rate for Payer: Priority Health SBD |
$15,703.45
|
| Rate for Payer: UMR Bronson Commercial |
$10,967.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,694.58
|
|
|
ALDESLEUKIN 22 MILLION UNIT INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,926.11
|
|
|
Service Code
|
HCPCS J9015
|
| Hospital Charge Code |
8993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,841.48 |
| Max. Negotiated Rate |
$22,433.50 |
| Rate for Payer: Priority Health SBD |
$15,703.45
|
| Rate for Payer: Aetna American Axle |
$16,201.97
|
| Rate for Payer: Aetna Commercial |
$21,187.19
|
| Rate for Payer: Aetna Medicare |
$5,513.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,201.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,626.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,626.58
|
| Rate for Payer: BCBS Complete |
$2,983.55
|
| Rate for Payer: BCBS MAPPO |
$5,301.26
|
| Rate for Payer: BCBS Trust/PPO |
$14,553.29
|
| Rate for Payer: BCN Commercial |
$14,553.29
|
| Rate for Payer: BCN Medicare Advantage |
$5,301.26
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cash Price |
$19,940.89
|
| Rate for Payer: Cofinity Commercial |
$21,436.45
|
| Rate for Payer: Cofinity Commercial |
$17,448.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,448.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,940.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,301.26
|
| Rate for Payer: Healthscope Commercial |
$22,433.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,448.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,694.58
|
| Rate for Payer: Mclaren Medicaid |
$2,841.48
|
| Rate for Payer: Mclaren Medicare |
$5,301.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,566.32
|
| Rate for Payer: Meridian Medicaid |
$2,983.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,096.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,187.19
|
| Rate for Payer: Nomi Health Commercial |
$15,903.78
|
| Rate for Payer: PACE Medicare |
$5,036.20
|
| Rate for Payer: PACE SWMI |
$5,301.26
|
| Rate for Payer: PHP Commercial |
$21,187.19
|
| Rate for Payer: PHP Medicare Advantage |
$5,301.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,841.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,201.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,257.12
|
| Rate for Payer: Priority Health Medicare |
$5,301.26
|
| Rate for Payer: Priority Health Narrow Network |
$12,205.70
|
| Rate for Payer: Railroad Medicare Medicare |
$5,301.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,922.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,301.26
|
| Rate for Payer: UHC Exchange |
$10,131.24
|
| Rate for Payer: UHC Medicare Advantage |
$5,301.26
|
| Rate for Payer: UHCCP Medicaid |
$2,841.48
|
| Rate for Payer: UMR Bronson Commercial |
$9,222.66
|
| Rate for Payer: VA VA |
$5,301.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,694.58
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$109,073.33
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
173140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,293.56 |
| Max. Negotiated Rate |
$98,166.00 |
| Rate for Payer: Aetna American Axle |
$70,897.66
|
| Rate for Payer: Aetna Commercial |
$92,712.33
|
| Rate for Payer: Aetna Medicare |
$2,509.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70,897.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,016.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,016.70
|
| Rate for Payer: BCBS Complete |
$1,358.24
|
| Rate for Payer: BCBS MAPPO |
$2,413.36
|
| Rate for Payer: BCBS Trust/PPO |
$6,507.21
|
| Rate for Payer: BCN Commercial |
$6,507.21
|
| Rate for Payer: BCN Medicare Advantage |
$2,413.36
|
| Rate for Payer: Cash Price |
$87,258.66
|
| Rate for Payer: Cash Price |
$87,258.66
|
| Rate for Payer: Cofinity Commercial |
$93,803.06
|
| Rate for Payer: Cofinity Commercial |
$76,351.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$76,351.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87,258.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,413.36
|
| Rate for Payer: Healthscope Commercial |
$98,166.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76,351.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81,805.00
|
| Rate for Payer: Mclaren Medicaid |
$1,293.56
|
| Rate for Payer: Mclaren Medicare |
$2,413.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,534.03
|
| Rate for Payer: Meridian Medicaid |
$1,358.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,775.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92,712.33
|
| Rate for Payer: Nomi Health Commercial |
$7,240.08
|
| Rate for Payer: PACE Medicare |
$2,292.69
|
| Rate for Payer: PACE SWMI |
$2,413.36
|
| Rate for Payer: PHP Commercial |
$92,712.33
|
| Rate for Payer: PHP Medicare Advantage |
$2,413.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,293.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70,897.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,727.91
|
| Rate for Payer: Priority Health Medicare |
$2,413.36
|
| Rate for Payer: Priority Health Narrow Network |
$5,382.33
|
| Rate for Payer: Priority Health SBD |
$68,716.20
|
| Rate for Payer: Railroad Medicare Medicare |
$2,413.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,793.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,413.36
|
| Rate for Payer: UHC Exchange |
$4,612.17
|
| Rate for Payer: UHC Medicare Advantage |
$2,413.36
|
| Rate for Payer: UHCCP Medicaid |
$1,293.56
|
| Rate for Payer: UMR Bronson Commercial |
$40,357.13
|
| Rate for Payer: VA VA |
$2,413.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81,805.00
|
|
|
ALEMTUZUMAB 12 MG/1.2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$109,073.33
|
|
|
Service Code
|
HCPCS J0202
|
| Hospital Charge Code |
173140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47,992.27 |
| Max. Negotiated Rate |
$98,166.00 |
| Rate for Payer: Aetna American Axle |
$70,897.66
|
| Rate for Payer: Aetna Commercial |
$92,712.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70,897.66
|
| Rate for Payer: Cash Price |
$87,258.66
|
| Rate for Payer: Cofinity Commercial |
$76,351.33
|
| Rate for Payer: Cofinity Commercial |
$93,803.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$76,351.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87,258.66
|
| Rate for Payer: Healthscope Commercial |
$98,166.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76,351.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81,805.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92,712.33
|
| Rate for Payer: PHP Commercial |
$92,712.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70,897.66
|
| Rate for Payer: Priority Health SBD |
$68,716.20
|
| Rate for Payer: UMR Bronson Commercial |
$47,992.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81,805.00
|
|
|
ALENDRONATE 10 MG TABLET
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
NDC 64980034001
|
| Hospital Charge Code |
15661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.95 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna American Axle |
$152.75
|
| Rate for Payer: Aetna Commercial |
$199.75
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.75
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.00
|
| Rate for Payer: Healthscope Commercial |
$211.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.75
|
| Rate for Payer: PHP Commercial |
$199.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health SBD |
$148.05
|
| Rate for Payer: UMR Bronson Commercial |
$86.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.25
|
|
|
ALENDRONATE 10 MG TABLET
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
NDC 64980034001
|
| Hospital Charge Code |
15661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna American Axle |
$152.75
|
| Rate for Payer: Aetna Commercial |
$199.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.75
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$164.50
|
| Rate for Payer: Cofinity Commercial |
$202.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.00
|
| Rate for Payer: Healthscope Commercial |
$211.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.75
|
| Rate for Payer: PHP Commercial |
$199.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health SBD |
$148.05
|
| Rate for Payer: UMR Bronson Commercial |
$103.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.25
|
|
|
ALENDRONATE 35 MG TABLET
|
Facility
|
IP
|
$34.24
|
|
|
Service Code
|
NDC 65862032804
|
| Hospital Charge Code |
29072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$30.82 |
| Rate for Payer: Aetna American Axle |
$22.26
|
| Rate for Payer: Aetna Commercial |
$29.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.26
|
| Rate for Payer: Cash Price |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Cofinity Commercial |
$29.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$30.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.10
|
| Rate for Payer: PHP Commercial |
$29.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.26
|
| Rate for Payer: Priority Health SBD |
$21.57
|
| Rate for Payer: UMR Bronson Commercial |
$15.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.68
|
|
|
ALENDRONATE 35 MG TABLET
|
Facility
|
OP
|
$34.24
|
|
|
Service Code
|
NDC 65862032804
|
| Hospital Charge Code |
29072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$30.82 |
| Rate for Payer: Aetna American Axle |
$22.26
|
| Rate for Payer: Aetna Commercial |
$29.10
|
| Rate for Payer: Aetna Medicare |
$17.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.26
|
| Rate for Payer: BCBS Complete |
$13.70
|
| Rate for Payer: Cash Price |
$27.39
|
| Rate for Payer: Cofinity Commercial |
$23.97
|
| Rate for Payer: Cofinity Commercial |
$29.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$30.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.10
|
| Rate for Payer: PHP Commercial |
$29.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.26
|
| Rate for Payer: Priority Health SBD |
$21.57
|
| Rate for Payer: UMR Bronson Commercial |
$12.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.68
|
|
|
ALENDRONATE 35 MG TABLET
|
Facility
|
IP
|
$9.70
|
|
|
Service Code
|
NDC 69097022316
|
| Hospital Charge Code |
29072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna American Axle |
$6.30
|
| Rate for Payer: Aetna Commercial |
$8.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.30
|
| Rate for Payer: Cash Price |
$7.76
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Commercial |
$8.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.76
|
| Rate for Payer: Healthscope Commercial |
$8.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.24
|
| Rate for Payer: PHP Commercial |
$8.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.30
|
| Rate for Payer: Priority Health SBD |
$6.11
|
| Rate for Payer: UMR Bronson Commercial |
$4.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.28
|
|
|
ALENDRONATE 35 MG TABLET
|
Facility
|
OP
|
$9.70
|
|
|
Service Code
|
NDC 69097022316
|
| Hospital Charge Code |
29072
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Aetna American Axle |
$6.30
|
| Rate for Payer: Aetna Commercial |
$8.24
|
| Rate for Payer: Aetna Medicare |
$4.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.30
|
| Rate for Payer: BCBS Complete |
$3.88
|
| Rate for Payer: Cash Price |
$7.76
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Commercial |
$8.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.76
|
| Rate for Payer: Healthscope Commercial |
$8.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.24
|
| Rate for Payer: PHP Commercial |
$8.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.30
|
| Rate for Payer: Priority Health SBD |
$6.11
|
| Rate for Payer: UMR Bronson Commercial |
$3.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.28
|
|
|
ALENDRONATE 70 MG TABLET
|
Facility
|
IP
|
$13.83
|
|
|
Service Code
|
NDC 41616063860
|
| Hospital Charge Code |
29048
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Aetna American Axle |
$8.99
|
| Rate for Payer: Aetna Commercial |
$11.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.99
|
| Rate for Payer: Cash Price |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$9.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.06
|
| Rate for Payer: Healthscope Commercial |
$12.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.76
|
| Rate for Payer: PHP Commercial |
$11.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.99
|
| Rate for Payer: Priority Health SBD |
$8.71
|
| Rate for Payer: UMR Bronson Commercial |
$6.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.37
|
|
|
ALENDRONATE 70 MG TABLET
|
Facility
|
OP
|
$13.83
|
|
|
Service Code
|
NDC 41616063860
|
| Hospital Charge Code |
29048
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$12.45 |
| Rate for Payer: Aetna American Axle |
$8.99
|
| Rate for Payer: Aetna Commercial |
$11.76
|
| Rate for Payer: Aetna Medicare |
$6.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.99
|
| Rate for Payer: BCBS Complete |
$5.53
|
| Rate for Payer: Cash Price |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$9.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.06
|
| Rate for Payer: Healthscope Commercial |
$12.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.76
|
| Rate for Payer: PHP Commercial |
$11.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.99
|
| Rate for Payer: Priority Health SBD |
$8.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.37
|
|
|
ALENDRONATE 70 MG TABLET
|
Facility
|
OP
|
$170.65
|
|
|
Service Code
|
NDC 69543013120
|
| Hospital Charge Code |
29048
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.14 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: BCBS Complete |
$68.26
|
| Rate for Payer: Cash Price |
$136.52
|
| Rate for Payer: Cofinity Commercial |
$119.46
|
| Rate for Payer: Cofinity Commercial |
$146.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.46
|
| Rate for Payer: Aetna American Axle |
$110.92
|
| Rate for Payer: Aetna Commercial |
$145.05
|
| Rate for Payer: Aetna Medicare |
$85.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.52
|
| Rate for Payer: Healthscope Commercial |
$153.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.05
|
| Rate for Payer: PHP Commercial |
$145.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.92
|
| Rate for Payer: Priority Health SBD |
$107.51
|
| Rate for Payer: UMR Bronson Commercial |
$63.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.99
|
|
|
ALENDRONATE 70 MG TABLET
|
Facility
|
IP
|
$170.65
|
|
|
Service Code
|
NDC 69543013120
|
| Hospital Charge Code |
29048
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.09 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna American Axle |
$110.92
|
| Rate for Payer: Aetna Commercial |
$145.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.92
|
| Rate for Payer: Cash Price |
$136.52
|
| Rate for Payer: Cofinity Commercial |
$119.46
|
| Rate for Payer: Cofinity Commercial |
$146.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.52
|
| Rate for Payer: Healthscope Commercial |
$153.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.05
|
| Rate for Payer: PHP Commercial |
$145.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.92
|
| Rate for Payer: Priority Health SBD |
$107.51
|
| Rate for Payer: UMR Bronson Commercial |
$75.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.99
|
|
|
ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,086.18
|
|
|
Service Code
|
HCPCS J0221
|
| Hospital Charge Code |
76353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,357.92 |
| Max. Negotiated Rate |
$2,777.56 |
| Rate for Payer: Aetna American Axle |
$2,006.02
|
| Rate for Payer: Aetna Commercial |
$2,623.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,006.02
|
| Rate for Payer: Cash Price |
$2,468.94
|
| Rate for Payer: Cofinity Commercial |
$2,160.33
|
| Rate for Payer: Cofinity Commercial |
$2,654.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,160.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,468.94
|
| Rate for Payer: Healthscope Commercial |
$2,777.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,160.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,314.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,623.25
|
| Rate for Payer: PHP Commercial |
$2,623.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,006.02
|
| Rate for Payer: Priority Health SBD |
$1,944.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,357.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,314.64
|
|
|
ALGLUCOSIDASE ALFA 50 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,086.18
|
|
|
Service Code
|
HCPCS J0221
|
| Hospital Charge Code |
76353
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$2,777.56 |
| Rate for Payer: Aetna American Axle |
$2,006.02
|
| Rate for Payer: Aetna Commercial |
$2,623.25
|
| Rate for Payer: Aetna Medicare |
$209.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,006.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$252.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$252.05
|
| Rate for Payer: BCBS Complete |
$113.48
|
| Rate for Payer: BCBS MAPPO |
$201.64
|
| Rate for Payer: BCBS Trust/PPO |
$544.55
|
| Rate for Payer: BCN Commercial |
$544.55
|
| Rate for Payer: BCN Medicare Advantage |
$201.64
|
| Rate for Payer: Cash Price |
$2,468.94
|
| Rate for Payer: Cash Price |
$2,468.94
|
| Rate for Payer: Cofinity Commercial |
$2,654.11
|
| Rate for Payer: Cofinity Commercial |
$2,160.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,160.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,468.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.64
|
| Rate for Payer: Healthscope Commercial |
$2,777.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,160.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,314.64
|
| Rate for Payer: Mclaren Medicaid |
$108.08
|
| Rate for Payer: Mclaren Medicare |
$201.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.72
|
| Rate for Payer: Meridian Medicaid |
$113.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,623.25
|
| Rate for Payer: Nomi Health Commercial |
$604.92
|
| Rate for Payer: PACE Medicare |
$191.56
|
| Rate for Payer: PACE SWMI |
$201.64
|
| Rate for Payer: PHP Commercial |
$2,623.25
|
| Rate for Payer: PHP Medicare Advantage |
$201.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,006.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$581.27
|
| Rate for Payer: Priority Health Medicare |
$201.64
|
| Rate for Payer: Priority Health Narrow Network |
$465.02
|
| Rate for Payer: Priority Health SBD |
$1,944.29
|
| Rate for Payer: Railroad Medicare Medicare |
$201.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$567.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$201.64
|
| Rate for Payer: UHC Exchange |
$385.35
|
| Rate for Payer: UHC Medicare Advantage |
$201.64
|
| Rate for Payer: UHCCP Medicaid |
$108.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,141.89
|
| Rate for Payer: VA VA |
$201.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,314.64
|
|
|
ALISKIREN 150 MG TABLET
|
Facility
|
IP
|
$1,090.02
|
|
|
Service Code
|
NDC 70839015030
|
| Hospital Charge Code |
78653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$479.61 |
| Max. Negotiated Rate |
$981.02 |
| Rate for Payer: Aetna American Axle |
$708.51
|
| Rate for Payer: Aetna Commercial |
$926.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.51
|
| Rate for Payer: Cash Price |
$872.02
|
| Rate for Payer: Cofinity Commercial |
$763.01
|
| Rate for Payer: Cofinity Commercial |
$937.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$763.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.02
|
| Rate for Payer: Healthscope Commercial |
$981.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$763.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$817.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$926.52
|
| Rate for Payer: PHP Commercial |
$926.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$708.51
|
| Rate for Payer: Priority Health SBD |
$686.71
|
| Rate for Payer: UMR Bronson Commercial |
$479.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$817.52
|
|
|
ALISKIREN 150 MG TABLET
|
Facility
|
OP
|
$1,090.02
|
|
|
Service Code
|
NDC 70839015030
|
| Hospital Charge Code |
78653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$403.31 |
| Max. Negotiated Rate |
$981.02 |
| Rate for Payer: Aetna American Axle |
$708.51
|
| Rate for Payer: Aetna Commercial |
$926.52
|
| Rate for Payer: Aetna Medicare |
$545.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.51
|
| Rate for Payer: BCBS Complete |
$436.01
|
| Rate for Payer: Cash Price |
$872.02
|
| Rate for Payer: Cofinity Commercial |
$763.01
|
| Rate for Payer: Cofinity Commercial |
$937.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$763.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.02
|
| Rate for Payer: Healthscope Commercial |
$981.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$763.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$817.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$926.52
|
| Rate for Payer: PHP Commercial |
$926.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$708.51
|
| Rate for Payer: Priority Health SBD |
$686.71
|
| Rate for Payer: UMR Bronson Commercial |
$403.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$817.52
|
|
|
ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 20930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$317.44 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$317.44
|
| Rate for Payer: BCN Commercial |
$317.44
|
| Rate for Payer: UHC Core |
$700.00
|
|
|
ALLOGRAFT, STRUCTURAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$33,684.64
|
|
|
Service Code
|
CPT 20931
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$108.78 |
| Max. Negotiated Rate |
$33,684.64 |
| Rate for Payer: BCBS Trust/PPO |
$33,684.64
|
| Rate for Payer: BCN Commercial |
$33,684.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.66
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$108.78
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 62584098811
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna American Axle |
$2.37
|
| Rate for Payer: Aetna Commercial |
$3.10
|
| Rate for Payer: Aetna Medicare |
$1.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.37
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.10
|
| Rate for Payer: PHP Commercial |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health SBD |
$2.30
|
| Rate for Payer: UMR Bronson Commercial |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.74
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$2.73
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.91
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.32
|
| Rate for Payer: PHP Commercial |
$2.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 51079020520
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.86
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.22
|
| Rate for Payer: Priority Health SBD |
$171.77
|
| Rate for Payer: UMR Bronson Commercial |
$119.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 23155069301
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 62584098811
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna American Axle |
$2.37
|
| Rate for Payer: Aetna Commercial |
$3.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.37
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.10
|
| Rate for Payer: PHP Commercial |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health SBD |
$2.30
|
| Rate for Payer: UMR Bronson Commercial |
$1.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.74
|
|
