|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 80681015400
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$188.37
|
|
|
Service Code
|
NDC 80681012600
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$169.53 |
| Rate for Payer: Aetna American Axle |
$122.44
|
| Rate for Payer: Aetna Commercial |
$160.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.44
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Cofinity Commercial |
$131.86
|
| Rate for Payer: Cofinity Commercial |
$162.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.70
|
| Rate for Payer: Healthscope Commercial |
$169.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.11
|
| Rate for Payer: PHP Commercial |
$160.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.44
|
| Rate for Payer: Priority Health SBD |
$118.67
|
| Rate for Payer: UMR Bronson Commercial |
$82.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.28
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
NDC 40985022668
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.28 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna American Axle |
$137.80
|
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health SBD |
$133.56
|
| Rate for Payer: UMR Bronson Commercial |
$93.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
|
|
BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$37,163.73
|
|
|
Service Code
|
HCPCS J9037
|
| Hospital Charge Code |
194707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16,352.04 |
| Max. Negotiated Rate |
$33,447.36 |
| Rate for Payer: Aetna American Axle |
$24,156.42
|
| Rate for Payer: Aetna Commercial |
$31,589.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,156.42
|
| Rate for Payer: Cash Price |
$29,730.98
|
| Rate for Payer: Cofinity Commercial |
$26,014.61
|
| Rate for Payer: Cofinity Commercial |
$31,960.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$26,014.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29,730.98
|
| Rate for Payer: Healthscope Commercial |
$33,447.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26,014.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27,872.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,589.17
|
| Rate for Payer: PHP Commercial |
$31,589.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,156.42
|
| Rate for Payer: Priority Health SBD |
$23,413.15
|
| Rate for Payer: UMR Bronson Commercial |
$16,352.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27,872.80
|
|
|
BELANTAMAB MAFODOTIN-BLMF 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$37,163.73
|
|
|
Service Code
|
HCPCS J9037
|
| Hospital Charge Code |
194707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,750.58 |
| Max. Negotiated Rate |
$33,447.36 |
| Rate for Payer: Aetna American Axle |
$24,156.42
|
| Rate for Payer: Aetna Commercial |
$31,589.17
|
| Rate for Payer: Aetna Medicare |
$18,581.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,156.42
|
| Rate for Payer: BCBS Complete |
$14,865.49
|
| Rate for Payer: Cash Price |
$29,730.98
|
| Rate for Payer: Cofinity Commercial |
$26,014.61
|
| Rate for Payer: Cofinity Commercial |
$31,960.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$26,014.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29,730.98
|
| Rate for Payer: Healthscope Commercial |
$33,447.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26,014.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27,872.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,589.17
|
| Rate for Payer: PHP Commercial |
$31,589.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,156.42
|
| Rate for Payer: Priority Health SBD |
$23,413.15
|
| Rate for Payer: UMR Bronson Commercial |
$13,750.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27,872.80
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,948.45
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
152968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$2,653.61 |
| Rate for Payer: Aetna American Axle |
$1,916.49
|
| Rate for Payer: Aetna Commercial |
$2,506.18
|
| Rate for Payer: Aetna Medicare |
$4.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,916.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.86
|
| Rate for Payer: BCBS Complete |
$2.19
|
| Rate for Payer: BCBS MAPPO |
$3.89
|
| Rate for Payer: BCN Medicare Advantage |
$3.89
|
| Rate for Payer: Cash Price |
$2,358.76
|
| Rate for Payer: Cash Price |
$2,358.76
|
| Rate for Payer: Cofinity Commercial |
$2,535.67
|
| Rate for Payer: Cofinity Commercial |
$2,063.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,063.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,358.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.89
|
| Rate for Payer: Healthscope Commercial |
$2,653.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,063.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,211.34
|
| Rate for Payer: Mclaren Medicaid |
$2.09
|
| Rate for Payer: Mclaren Medicare |
$3.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.08
|
| Rate for Payer: Meridian Medicaid |
$2.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,506.18
|
| Rate for Payer: PACE Medicare |
$3.70
|
| Rate for Payer: PACE SWMI |
$3.89
|
| Rate for Payer: PHP Commercial |
$2,506.18
|
| Rate for Payer: PHP Medicare Advantage |
$3.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,916.49
|
| Rate for Payer: Priority Health Medicare |
$3.89
|
| Rate for Payer: Priority Health SBD |
$1,857.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.89
|
| Rate for Payer: UHC Exchange |
$7.43
|
| Rate for Payer: UHC Medicare Advantage |
$3.89
|
| Rate for Payer: UHCCP Medicaid |
$2.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,090.93
|
| Rate for Payer: VA VA |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,211.34
|
|
|
BELATACEPT 250 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,948.45
|
|
|
Service Code
|
HCPCS J0485
|
| Hospital Charge Code |
152968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,297.32 |
| Max. Negotiated Rate |
$2,653.61 |
| Rate for Payer: Aetna American Axle |
$1,916.49
|
| Rate for Payer: Aetna Commercial |
$2,506.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,916.49
|
| Rate for Payer: Cash Price |
$2,358.76
|
| Rate for Payer: Cofinity Commercial |
$2,063.91
|
| Rate for Payer: Cofinity Commercial |
$2,535.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,063.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,358.76
|
| Rate for Payer: Healthscope Commercial |
$2,653.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,063.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,211.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,506.18
|
| Rate for Payer: PHP Commercial |
$2,506.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,916.49
|
| Rate for Payer: Priority Health SBD |
$1,857.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,297.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,211.34
|
|
|
BELIMUMAB 120 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,031.20
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$1,828.08 |
| Rate for Payer: Aetna American Axle |
$1,320.28
|
| Rate for Payer: Aetna Commercial |
$1,726.52
|
| Rate for Payer: Aetna Medicare |
$58.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.09
|
| Rate for Payer: BCBS Complete |
$31.56
|
| Rate for Payer: BCBS MAPPO |
$56.07
|
| Rate for Payer: BCN Medicare Advantage |
$56.07
|
| Rate for Payer: Cash Price |
$1,624.96
|
| Rate for Payer: Cash Price |
$1,624.96
|
| Rate for Payer: Cofinity Commercial |
$1,421.84
|
| Rate for Payer: Cofinity Commercial |
$1,746.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,421.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,624.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.07
|
| Rate for Payer: Healthscope Commercial |
$1,828.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,421.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.40
|
| Rate for Payer: Mclaren Medicaid |
$30.05
|
| Rate for Payer: Mclaren Medicare |
$56.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.87
|
| Rate for Payer: Meridian Medicaid |
$31.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.52
|
| Rate for Payer: PACE Medicare |
$53.27
|
| Rate for Payer: PACE SWMI |
$56.07
|
| Rate for Payer: PHP Commercial |
$1,726.52
|
| Rate for Payer: PHP Medicare Advantage |
$56.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.28
|
| Rate for Payer: Priority Health Medicare |
$56.07
|
| Rate for Payer: Priority Health SBD |
$1,279.66
|
| Rate for Payer: Railroad Medicare Medicare |
$56.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.07
|
| Rate for Payer: UHC Exchange |
$107.16
|
| Rate for Payer: UHC Medicare Advantage |
$56.07
|
| Rate for Payer: UHCCP Medicaid |
$30.05
|
| Rate for Payer: UMR Bronson Commercial |
$751.54
|
| Rate for Payer: VA VA |
$56.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.40
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,500.82
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$4,950.74 |
| Rate for Payer: Aetna American Axle |
$3,575.53
|
| Rate for Payer: Aetna Commercial |
$4,675.70
|
| Rate for Payer: Aetna Medicare |
$58.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,575.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.09
|
| Rate for Payer: BCBS Complete |
$31.56
|
| Rate for Payer: BCBS MAPPO |
$56.07
|
| Rate for Payer: BCN Medicare Advantage |
$56.07
|
| Rate for Payer: Cash Price |
$4,400.66
|
| Rate for Payer: Cash Price |
$4,400.66
|
| Rate for Payer: Cofinity Commercial |
$4,730.71
|
| Rate for Payer: Cofinity Commercial |
$3,850.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,850.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,400.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.07
|
| Rate for Payer: Healthscope Commercial |
$4,950.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,850.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,125.61
|
| Rate for Payer: Mclaren Medicaid |
$30.05
|
| Rate for Payer: Mclaren Medicare |
$56.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.87
|
| Rate for Payer: Meridian Medicaid |
$31.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,675.70
|
| Rate for Payer: PACE Medicare |
$53.27
|
| Rate for Payer: PACE SWMI |
$56.07
|
| Rate for Payer: PHP Commercial |
$4,675.70
|
| Rate for Payer: PHP Medicare Advantage |
$56.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,575.53
|
| Rate for Payer: Priority Health Medicare |
$56.07
|
| Rate for Payer: Priority Health SBD |
$3,465.52
|
| Rate for Payer: Railroad Medicare Medicare |
$56.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.07
|
| Rate for Payer: UHC Exchange |
$107.16
|
| Rate for Payer: UHC Medicare Advantage |
$56.07
|
| Rate for Payer: UHCCP Medicaid |
$30.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,035.30
|
| Rate for Payer: VA VA |
$56.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,125.61
|
|
|
BELIMUMAB 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,500.82
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
152251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,420.36 |
| Max. Negotiated Rate |
$4,950.74 |
| Rate for Payer: Aetna American Axle |
$3,575.53
|
| Rate for Payer: Aetna Commercial |
$4,675.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,575.53
|
| Rate for Payer: Cash Price |
$4,400.66
|
| Rate for Payer: Cofinity Commercial |
$3,850.57
|
| Rate for Payer: Cofinity Commercial |
$4,730.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,850.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,400.66
|
| Rate for Payer: Healthscope Commercial |
$4,950.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,850.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,125.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,675.70
|
| Rate for Payer: PHP Commercial |
$4,675.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,575.53
|
| Rate for Payer: Priority Health SBD |
$3,465.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,420.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,125.61
|
|
|
BENDAMUSTINE (BELRAPZO) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,665.50
|
|
|
Service Code
|
HCPCS J9036
|
| Hospital Charge Code |
300602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$8,698.95 |
| Rate for Payer: Aetna American Axle |
$6,282.57
|
| Rate for Payer: Aetna Commercial |
$8,215.67
|
| Rate for Payer: Aetna Medicare |
$12.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,282.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.35
|
| Rate for Payer: BCBS Complete |
$6.91
|
| Rate for Payer: BCBS MAPPO |
$12.28
|
| Rate for Payer: BCN Medicare Advantage |
$12.28
|
| Rate for Payer: Cash Price |
$7,732.40
|
| Rate for Payer: Cash Price |
$7,732.40
|
| Rate for Payer: Cofinity Commercial |
$8,312.33
|
| Rate for Payer: Cofinity Commercial |
$6,765.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,765.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,732.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.28
|
| Rate for Payer: Healthscope Commercial |
$8,698.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,765.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,249.12
|
| Rate for Payer: Mclaren Medicaid |
$6.58
|
| Rate for Payer: Mclaren Medicare |
$12.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.89
|
| Rate for Payer: Meridian Medicaid |
$6.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,215.67
|
| Rate for Payer: PACE Medicare |
$11.67
|
| Rate for Payer: PACE SWMI |
$12.28
|
| Rate for Payer: PHP Commercial |
$8,215.67
|
| Rate for Payer: PHP Medicare Advantage |
$12.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,282.57
|
| Rate for Payer: Priority Health Medicare |
$12.28
|
| Rate for Payer: Priority Health SBD |
$6,089.27
|
| Rate for Payer: Railroad Medicare Medicare |
$12.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.28
|
| Rate for Payer: UHC Exchange |
$23.47
|
| Rate for Payer: UHC Medicare Advantage |
$12.28
|
| Rate for Payer: UHCCP Medicaid |
$6.58
|
| Rate for Payer: UMR Bronson Commercial |
$3,576.24
|
| Rate for Payer: VA VA |
$12.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,249.12
|
|
|
BENDAMUSTINE (BELRAPZO) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$9,665.50
|
|
|
Service Code
|
HCPCS J9036
|
| Hospital Charge Code |
300602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,252.82 |
| Max. Negotiated Rate |
$8,698.95 |
| Rate for Payer: Aetna American Axle |
$6,282.57
|
| Rate for Payer: Aetna Commercial |
$8,215.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,282.57
|
| Rate for Payer: Cash Price |
$7,732.40
|
| Rate for Payer: Cofinity Commercial |
$6,765.85
|
| Rate for Payer: Cofinity Commercial |
$8,312.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,765.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,732.40
|
| Rate for Payer: Healthscope Commercial |
$8,698.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,765.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,249.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,215.67
|
| Rate for Payer: PHP Commercial |
$8,215.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,282.57
|
| Rate for Payer: Priority Health SBD |
$6,089.27
|
| Rate for Payer: UMR Bronson Commercial |
$4,252.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,249.12
|
|
|
BENDAMUSTINE (BENDEKA) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,460.63
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
176654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,842.68 |
| Max. Negotiated Rate |
$5,814.57 |
| Rate for Payer: Aetna American Axle |
$4,199.41
|
| Rate for Payer: Aetna American Axle |
$6,194.58
|
| Rate for Payer: Aetna Commercial |
$5,491.54
|
| Rate for Payer: Aetna Commercial |
$8,100.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,199.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,194.58
|
| Rate for Payer: Cash Price |
$5,168.50
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cofinity Commercial |
$8,195.90
|
| Rate for Payer: Cofinity Commercial |
$6,671.08
|
| Rate for Payer: Cofinity Commercial |
$4,522.44
|
| Rate for Payer: Cofinity Commercial |
$5,556.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,522.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,671.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,168.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,624.10
|
| Rate for Payer: Healthscope Commercial |
$5,814.57
|
| Rate for Payer: Healthscope Commercial |
$8,577.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,522.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,671.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,845.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,147.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,100.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,491.54
|
| Rate for Payer: PHP Commercial |
$8,100.60
|
| Rate for Payer: PHP Commercial |
$5,491.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,199.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,194.58
|
| Rate for Payer: Priority Health SBD |
$4,070.20
|
| Rate for Payer: Priority Health SBD |
$6,003.98
|
| Rate for Payer: UMR Bronson Commercial |
$2,842.68
|
| Rate for Payer: UMR Bronson Commercial |
$4,193.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,845.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,147.59
|
|
|
BENDAMUSTINE (BENDEKA) 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,530.12
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
176654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$8,577.11 |
| Rate for Payer: Aetna American Axle |
$6,194.58
|
| Rate for Payer: Aetna American Axle |
$4,199.41
|
| Rate for Payer: Aetna Commercial |
$5,491.54
|
| Rate for Payer: Aetna Commercial |
$8,100.60
|
| Rate for Payer: Aetna Medicare |
$14.03
|
| Rate for Payer: Aetna Medicare |
$14.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,194.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,199.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.86
|
| Rate for Payer: BCBS Complete |
$7.59
|
| Rate for Payer: BCBS Complete |
$7.59
|
| Rate for Payer: BCBS MAPPO |
$13.49
|
| Rate for Payer: BCBS MAPPO |
$13.49
|
| Rate for Payer: BCN Medicare Advantage |
$13.49
|
| Rate for Payer: BCN Medicare Advantage |
$13.49
|
| Rate for Payer: Cash Price |
$5,168.50
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cash Price |
$5,168.50
|
| Rate for Payer: Cofinity Commercial |
$4,522.44
|
| Rate for Payer: Cofinity Commercial |
$5,556.14
|
| Rate for Payer: Cofinity Commercial |
$6,671.08
|
| Rate for Payer: Cofinity Commercial |
$8,195.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,522.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,671.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,624.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,168.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.49
|
| Rate for Payer: Healthscope Commercial |
$8,577.11
|
| Rate for Payer: Healthscope Commercial |
$5,814.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,671.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,522.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,845.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,147.59
|
| Rate for Payer: Mclaren Medicaid |
$7.23
|
| Rate for Payer: Mclaren Medicaid |
$7.23
|
| Rate for Payer: Mclaren Medicare |
$13.49
|
| Rate for Payer: Mclaren Medicare |
$13.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.16
|
| Rate for Payer: Meridian Medicaid |
$7.59
|
| Rate for Payer: Meridian Medicaid |
$7.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,100.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,491.54
|
| Rate for Payer: PACE Medicare |
$12.82
|
| Rate for Payer: PACE Medicare |
$12.82
|
| Rate for Payer: PACE SWMI |
$13.49
|
| Rate for Payer: PACE SWMI |
$13.49
|
| Rate for Payer: PHP Commercial |
$5,491.54
|
| Rate for Payer: PHP Commercial |
$8,100.60
|
| Rate for Payer: PHP Medicare Advantage |
$13.49
|
| Rate for Payer: PHP Medicare Advantage |
$13.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,199.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,194.58
|
| Rate for Payer: Priority Health Medicare |
$13.49
|
| Rate for Payer: Priority Health Medicare |
$13.49
|
| Rate for Payer: Priority Health SBD |
$4,070.20
|
| Rate for Payer: Priority Health SBD |
$6,003.98
|
| Rate for Payer: Railroad Medicare Medicare |
$13.49
|
| Rate for Payer: Railroad Medicare Medicare |
$13.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.49
|
| Rate for Payer: UHC Exchange |
$25.78
|
| Rate for Payer: UHC Exchange |
$25.78
|
| Rate for Payer: UHC Medicare Advantage |
$13.49
|
| Rate for Payer: UHC Medicare Advantage |
$13.49
|
| Rate for Payer: UHCCP Medicaid |
$7.23
|
| Rate for Payer: UHCCP Medicaid |
$7.23
|
| Rate for Payer: UMR Bronson Commercial |
$2,390.43
|
| Rate for Payer: UMR Bronson Commercial |
$3,526.14
|
| Rate for Payer: VA VA |
$13.49
|
| Rate for Payer: VA VA |
$13.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,147.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,845.47
|
|
|
BENDAMUSTINE (TREANDA) 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$10,472.89
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
91300
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$9,425.60 |
| Rate for Payer: Aetna American Axle |
$6,807.38
|
| Rate for Payer: Aetna Commercial |
$8,901.96
|
| Rate for Payer: Aetna Medicare |
$1.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,807.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.35
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS MAPPO |
$1.88
|
| Rate for Payer: BCN Medicare Advantage |
$1.88
|
| Rate for Payer: Cash Price |
$8,378.31
|
| Rate for Payer: Cash Price |
$8,378.31
|
| Rate for Payer: Cofinity Commercial |
$7,331.02
|
| Rate for Payer: Cofinity Commercial |
$9,006.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,331.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,378.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$9,425.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,331.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,854.67
|
| Rate for Payer: Mclaren Medicaid |
$1.01
|
| Rate for Payer: Mclaren Medicare |
$1.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.97
|
| Rate for Payer: Meridian Medicaid |
$1.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,901.96
|
| Rate for Payer: PACE Medicare |
$1.79
|
| Rate for Payer: PACE SWMI |
$1.88
|
| Rate for Payer: PHP Commercial |
$8,901.96
|
| Rate for Payer: PHP Medicare Advantage |
$1.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,807.38
|
| Rate for Payer: Priority Health Medicare |
$1.88
|
| Rate for Payer: Priority Health SBD |
$6,597.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.88
|
| Rate for Payer: UHC Exchange |
$3.59
|
| Rate for Payer: UHC Medicare Advantage |
$1.88
|
| Rate for Payer: UHCCP Medicaid |
$1.01
|
| Rate for Payer: UMR Bronson Commercial |
$3,874.97
|
| Rate for Payer: VA VA |
$1.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,854.67
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$19,146.17
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
185161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,424.31 |
| Max. Negotiated Rate |
$17,231.55 |
| Rate for Payer: Aetna American Axle |
$12,445.01
|
| Rate for Payer: Aetna Commercial |
$16,274.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,445.01
|
| Rate for Payer: Cash Price |
$15,316.94
|
| Rate for Payer: Cofinity Commercial |
$13,402.32
|
| Rate for Payer: Cofinity Commercial |
$16,465.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,402.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,316.94
|
| Rate for Payer: Healthscope Commercial |
$17,231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,402.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,359.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,274.24
|
| Rate for Payer: PHP Commercial |
$16,274.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,445.01
|
| Rate for Payer: Priority Health SBD |
$12,062.09
|
| Rate for Payer: UMR Bronson Commercial |
$8,424.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,359.63
|
|
|
BENRALIZUMAB 30 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$19,146.17
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
185161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.22 |
| Max. Negotiated Rate |
$17,231.55 |
| Rate for Payer: Aetna American Axle |
$12,445.01
|
| Rate for Payer: Aetna Commercial |
$16,274.24
|
| Rate for Payer: Aetna Medicare |
$171.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,445.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.74
|
| Rate for Payer: BCBS Complete |
$92.63
|
| Rate for Payer: BCBS MAPPO |
$164.59
|
| Rate for Payer: BCN Medicare Advantage |
$164.59
|
| Rate for Payer: Cash Price |
$15,316.94
|
| Rate for Payer: Cash Price |
$15,316.94
|
| Rate for Payer: Cofinity Commercial |
$16,465.71
|
| Rate for Payer: Cofinity Commercial |
$13,402.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,402.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,316.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.59
|
| Rate for Payer: Healthscope Commercial |
$17,231.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,402.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,359.63
|
| Rate for Payer: Mclaren Medicaid |
$88.22
|
| Rate for Payer: Mclaren Medicare |
$164.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.82
|
| Rate for Payer: Meridian Medicaid |
$92.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,274.24
|
| Rate for Payer: PACE Medicare |
$156.36
|
| Rate for Payer: PACE SWMI |
$164.59
|
| Rate for Payer: PHP Commercial |
$16,274.24
|
| Rate for Payer: PHP Medicare Advantage |
$164.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,445.01
|
| Rate for Payer: Priority Health Medicare |
$164.59
|
| Rate for Payer: Priority Health SBD |
$12,062.09
|
| Rate for Payer: Railroad Medicare Medicare |
$164.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.59
|
| Rate for Payer: UHC Exchange |
$314.55
|
| Rate for Payer: UHC Medicare Advantage |
$164.59
|
| Rate for Payer: UHCCP Medicaid |
$88.22
|
| Rate for Payer: UMR Bronson Commercial |
$7,084.08
|
| Rate for Payer: VA VA |
$164.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,359.63
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$129.14
|
|
|
Service Code
|
NDC 00283067960
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$116.23 |
| Rate for Payer: Aetna American Axle |
$83.94
|
| Rate for Payer: Aetna Commercial |
$109.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.94
|
| Rate for Payer: Cash Price |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Cofinity Commercial |
$90.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.31
|
| Rate for Payer: Healthscope Commercial |
$116.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.77
|
| Rate for Payer: PHP Commercial |
$109.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.94
|
| Rate for Payer: Priority Health SBD |
$81.36
|
| Rate for Payer: UMR Bronson Commercial |
$56.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.86
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$100.09
|
|
|
Service Code
|
NDC 00283067902
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.04 |
| Max. Negotiated Rate |
$90.08 |
| Rate for Payer: Aetna American Axle |
$65.06
|
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.06
|
| Rate for Payer: Cash Price |
$80.07
|
| Rate for Payer: Cofinity Commercial |
$70.06
|
| Rate for Payer: Cofinity Commercial |
$86.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.07
|
| Rate for Payer: Healthscope Commercial |
$90.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.08
|
| Rate for Payer: PHP Commercial |
$85.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.06
|
| Rate for Payer: Priority Health SBD |
$63.06
|
| Rate for Payer: UMR Bronson Commercial |
$44.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.07
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$100.09
|
|
|
Service Code
|
NDC 00283067902
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.03 |
| Max. Negotiated Rate |
$90.08 |
| Rate for Payer: Aetna American Axle |
$65.06
|
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Aetna Medicare |
$50.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.06
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: Cash Price |
$80.07
|
| Rate for Payer: Cofinity Commercial |
$70.06
|
| Rate for Payer: Cofinity Commercial |
$86.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.07
|
| Rate for Payer: Healthscope Commercial |
$90.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.08
|
| Rate for Payer: PHP Commercial |
$85.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.06
|
| Rate for Payer: Priority Health SBD |
$63.06
|
| Rate for Payer: UMR Bronson Commercial |
$37.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.07
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$95.57
|
|
|
Service Code
|
NDC 00283091402
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$86.01 |
| Rate for Payer: Aetna American Axle |
$62.12
|
| Rate for Payer: Aetna Commercial |
$81.23
|
| Rate for Payer: Aetna Medicare |
$47.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.12
|
| Rate for Payer: BCBS Complete |
$38.23
|
| Rate for Payer: Cash Price |
$76.46
|
| Rate for Payer: Cofinity Commercial |
$66.90
|
| Rate for Payer: Cofinity Commercial |
$82.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.46
|
| Rate for Payer: Healthscope Commercial |
$86.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.23
|
| Rate for Payer: PHP Commercial |
$81.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.12
|
| Rate for Payer: Priority Health SBD |
$60.21
|
| Rate for Payer: UMR Bronson Commercial |
$35.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.68
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$129.14
|
|
|
Service Code
|
NDC 00283067960
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.78 |
| Max. Negotiated Rate |
$116.23 |
| Rate for Payer: Aetna American Axle |
$83.94
|
| Rate for Payer: Aetna Commercial |
$109.77
|
| Rate for Payer: Aetna Medicare |
$64.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.94
|
| Rate for Payer: BCBS Complete |
$51.66
|
| Rate for Payer: Cash Price |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Cofinity Commercial |
$90.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.31
|
| Rate for Payer: Healthscope Commercial |
$116.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.77
|
| Rate for Payer: PHP Commercial |
$109.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.94
|
| Rate for Payer: Priority Health SBD |
$81.36
|
| Rate for Payer: UMR Bronson Commercial |
$47.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.86
|
|
|
BENZOCAINE 20 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$95.57
|
|
|
Service Code
|
NDC 00283091402
|
| Hospital Charge Code |
19696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$86.01 |
| Rate for Payer: Aetna American Axle |
$62.12
|
| Rate for Payer: Aetna Commercial |
$81.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.12
|
| Rate for Payer: Cash Price |
$76.46
|
| Rate for Payer: Cofinity Commercial |
$66.90
|
| Rate for Payer: Cofinity Commercial |
$82.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.46
|
| Rate for Payer: Healthscope Commercial |
$86.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.23
|
| Rate for Payer: PHP Commercial |
$81.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.12
|
| Rate for Payer: Priority Health SBD |
$60.21
|
| Rate for Payer: UMR Bronson Commercial |
$42.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.68
|
|
|
BENZOCAINE 20 % MUCOSAL GEL
|
Facility
|
OP
|
$26.98
|
|
|
Service Code
|
NDC 00573022567
|
| Hospital Charge Code |
19691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$24.28 |
| Rate for Payer: Aetna American Axle |
$17.54
|
| Rate for Payer: Aetna Commercial |
$22.93
|
| Rate for Payer: Aetna Medicare |
$13.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.54
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$24.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.93
|
| Rate for Payer: PHP Commercial |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.54
|
| Rate for Payer: Priority Health SBD |
$17.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.23
|
|
|
BENZOCAINE 20 % MUCOSAL GEL
|
Facility
|
IP
|
$10.38
|
|
|
Service Code
|
NDC 10310028340
|
| Hospital Charge Code |
19691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna American Axle |
$6.75
|
| Rate for Payer: Aetna Commercial |
$8.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.82
|
| Rate for Payer: PHP Commercial |
$8.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.75
|
| Rate for Payer: Priority Health SBD |
$6.54
|
| Rate for Payer: UMR Bronson Commercial |
$4.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.79
|
|
