|
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
|
|
|
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 |
$1,302.42 |
| 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 |
$2,527.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70,897.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,037.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,037.36
|
| Rate for Payer: BCBS Complete |
$1,367.54
|
| Rate for Payer: BCBS MAPPO |
$2,429.89
|
| Rate for Payer: BCN Medicare Advantage |
$2,429.89
|
| 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 |
$2,429.89
|
| 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 |
$1,302.42
|
| Rate for Payer: Mclaren Medicare |
$2,429.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,551.38
|
| Rate for Payer: Meridian Medicaid |
$1,367.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,794.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92,712.33
|
| Rate for Payer: PACE Medicare |
$2,308.40
|
| Rate for Payer: PACE SWMI |
$2,429.89
|
| Rate for Payer: PHP Commercial |
$92,712.33
|
| Rate for Payer: PHP Medicare Advantage |
$2,429.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,302.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70,897.66
|
| Rate for Payer: Priority Health Medicare |
$2,429.89
|
| Rate for Payer: Priority Health SBD |
$68,716.20
|
| Rate for Payer: Railroad Medicare Medicare |
$2,429.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,839.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,429.89
|
| Rate for Payer: UHC Exchange |
$4,643.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,429.89
|
| Rate for Payer: UHCCP Medicaid |
$1,302.42
|
| Rate for Payer: UMR Bronson Commercial |
$40,357.13
|
| Rate for Payer: VA VA |
$2,429.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81,805.00
|
|
|
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 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 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
|
$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
|
$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
|
$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
|
$170.65
|
|
|
Service Code
|
NDC 69543013120
|
| Hospital Charge Code |
29048
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.09 |
| Max. Negotiated Rate |
$153.59 |
| 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 |
$119.45
|
| Rate for Payer: Cofinity Commercial |
$146.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.52
|
| Rate for Payer: Healthscope Commercial |
$153.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.45
|
| 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
|
|
|
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
|
$170.65
|
|
|
Service Code
|
NDC 69543013120
|
| Hospital Charge Code |
29048
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.14 |
| Max. Negotiated Rate |
$153.59 |
| Rate for Payer: Aetna American Axle |
$110.92
|
| Rate for Payer: Aetna Commercial |
$145.05
|
| Rate for Payer: Aetna Medicare |
$85.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.92
|
| Rate for Payer: BCBS Complete |
$68.26
|
| Rate for Payer: Cash Price |
$136.52
|
| Rate for Payer: Cofinity Commercial |
$119.45
|
| Rate for Payer: Cofinity Commercial |
$146.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.52
|
| Rate for Payer: Healthscope Commercial |
$153.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.45
|
| 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
|
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
|
|
|
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 |
$110.73 |
| 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 |
$214.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,006.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.24
|
| Rate for Payer: BCBS Complete |
$116.27
|
| Rate for Payer: BCBS MAPPO |
$206.59
|
| Rate for Payer: BCN Medicare Advantage |
$206.59
|
| 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 |
$206.59
|
| 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 |
$110.73
|
| Rate for Payer: Mclaren Medicare |
$206.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.92
|
| Rate for Payer: Meridian Medicaid |
$116.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,623.25
|
| Rate for Payer: PACE Medicare |
$196.26
|
| Rate for Payer: PACE SWMI |
$206.59
|
| Rate for Payer: PHP Commercial |
$2,623.25
|
| Rate for Payer: PHP Medicare Advantage |
$206.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,006.02
|
| Rate for Payer: Priority Health Medicare |
$206.59
|
| Rate for Payer: Priority Health SBD |
$1,944.29
|
| Rate for Payer: Railroad Medicare Medicare |
$206.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.59
|
| Rate for Payer: UHC Exchange |
$394.81
|
| Rate for Payer: UHC Medicare Advantage |
$206.59
|
| Rate for Payer: UHCCP Medicaid |
$110.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,141.89
|
| Rate for Payer: VA VA |
$206.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,314.64
|
|
|
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
|
|
|
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 |
$817.51
|
| 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 |
$817.51
|
|
|
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 |
$817.51
|
| 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 |
$817.51
|
|
|
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 |
$190.85
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.85
|
| 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 |
$190.85
|
| 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
|
OP
|
$277.40
|
|
|
Service Code
|
NDC 00603211521
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.64 |
| Max. Negotiated Rate |
$249.66 |
| Rate for Payer: Aetna American Axle |
$180.31
|
| Rate for Payer: Aetna Commercial |
$235.79
|
| Rate for Payer: Aetna Medicare |
$138.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.31
|
| Rate for Payer: BCBS Complete |
$110.96
|
| Rate for Payer: Cash Price |
$221.92
|
| Rate for Payer: Cofinity Commercial |
$194.18
|
| Rate for Payer: Cofinity Commercial |
$238.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.92
|
| Rate for Payer: Healthscope Commercial |
$249.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.79
|
| Rate for Payer: PHP Commercial |
$235.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.31
|
| Rate for Payer: Priority Health SBD |
$174.76
|
| Rate for Payer: UMR Bronson Commercial |
$102.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.05
|
|
|
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 |
$3.29 |
| 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 |
$3.29
|
| 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
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$2.73
|
|
|
Service Code
|
NDC 51079020501
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna American Axle |
$1.77
|
| Rate for Payer: Aetna Commercial |
$2.32
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: BCBS Complete |
$1.09
|
| 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 |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.05
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 00904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna American Axle |
$293.28
|
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna Medicare |
$225.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health SBD |
$284.26
|
| Rate for Payer: UMR Bronson Commercial |
$166.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
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
|
$451.20
|
|
|
Service Code
|
NDC 00904704161
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.53 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna American Axle |
$293.28
|
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Commercial |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.28
|
| Rate for Payer: Priority Health SBD |
$284.26
|
| Rate for Payer: UMR Bronson Commercial |
$198.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.40
|
|
|
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 |
$3.29 |
| 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 |
$3.29
|
| 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
|
OP
|
$272.65
|
|
|
Service Code
|
NDC 51079020520
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$136.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: BCBS Complete |
$109.06
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.85
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.85
|
| 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 |
$190.85
|
| 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 |
$100.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
