|
BALSALAZIDE 750 MG CAPSULE
|
Facility
|
IP
|
$962.31
|
|
|
Service Code
|
NDC 00054007928
|
| Hospital Charge Code |
29299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$423.42 |
| Max. Negotiated Rate |
$866.08 |
| Rate for Payer: Aetna American Axle |
$625.50
|
| Rate for Payer: Aetna Commercial |
$817.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.50
|
| Rate for Payer: Cash Price |
$769.85
|
| Rate for Payer: Cofinity Commercial |
$673.62
|
| Rate for Payer: Cofinity Commercial |
$827.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$673.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$769.85
|
| Rate for Payer: Healthscope Commercial |
$866.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$673.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$721.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$817.96
|
| Rate for Payer: PHP Commercial |
$817.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.50
|
| Rate for Payer: Priority Health SBD |
$606.26
|
| Rate for Payer: UMR Bronson Commercial |
$423.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$721.73
|
|
|
BARICITINIB 2 MG TABLET
|
Facility
|
OP
|
$9,736.26
|
|
|
Service Code
|
NDC 00002418230
|
| Hospital Charge Code |
186973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,602.42 |
| Max. Negotiated Rate |
$8,762.63 |
| Rate for Payer: Aetna American Axle |
$6,328.57
|
| Rate for Payer: Aetna Commercial |
$8,275.82
|
| Rate for Payer: Aetna Medicare |
$4,868.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,328.57
|
| Rate for Payer: BCBS Complete |
$3,894.50
|
| Rate for Payer: Cash Price |
$7,789.01
|
| Rate for Payer: Cofinity Commercial |
$6,815.38
|
| Rate for Payer: Cofinity Commercial |
$8,373.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,815.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,789.01
|
| Rate for Payer: Healthscope Commercial |
$8,762.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,815.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,302.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,275.82
|
| Rate for Payer: PHP Commercial |
$8,275.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,328.57
|
| Rate for Payer: Priority Health SBD |
$6,133.84
|
| Rate for Payer: UMR Bronson Commercial |
$3,602.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,302.20
|
|
|
BARICITINIB 2 MG TABLET
|
Facility
|
IP
|
$9,736.26
|
|
|
Service Code
|
NDC 00002418230
|
| Hospital Charge Code |
186973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,283.95 |
| Max. Negotiated Rate |
$8,762.63 |
| Rate for Payer: Aetna American Axle |
$6,328.57
|
| Rate for Payer: Aetna Commercial |
$8,275.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,328.57
|
| Rate for Payer: Cash Price |
$7,789.01
|
| Rate for Payer: Cofinity Commercial |
$6,815.38
|
| Rate for Payer: Cofinity Commercial |
$8,373.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,815.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,789.01
|
| Rate for Payer: Healthscope Commercial |
$8,762.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,815.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,302.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,275.82
|
| Rate for Payer: PHP Commercial |
$8,275.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,328.57
|
| Rate for Payer: Priority Health SBD |
$6,133.84
|
| Rate for Payer: UMR Bronson Commercial |
$4,283.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,302.20
|
|
|
BASILIXIMAB 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15,380.50
|
|
|
Service Code
|
HCPCS J0480
|
| Hospital Charge Code |
23082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,496.46 |
| Max. Negotiated Rate |
$13,972.74 |
| Rate for Payer: Aetna American Axle |
$9,997.32
|
| Rate for Payer: Aetna Commercial |
$13,073.42
|
| Rate for Payer: Aetna Medicare |
$4,843.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,997.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,821.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,821.98
|
| Rate for Payer: BCBS Complete |
$2,621.29
|
| Rate for Payer: BCBS MAPPO |
$4,657.58
|
| Rate for Payer: BCBS Trust/PPO |
$12,372.85
|
| Rate for Payer: BCN Commercial |
$12,372.85
|
| Rate for Payer: BCN Medicare Advantage |
$4,657.58
|
| Rate for Payer: Cash Price |
$12,304.40
|
| Rate for Payer: Cash Price |
$12,304.40
|
| Rate for Payer: Cofinity Commercial |
$13,227.23
|
| Rate for Payer: Cofinity Commercial |
$10,766.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,766.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,304.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,657.58
|
| Rate for Payer: Healthscope Commercial |
$13,842.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,766.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,535.38
|
| Rate for Payer: Mclaren Medicaid |
$2,496.46
|
| Rate for Payer: Mclaren Medicare |
$4,657.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,890.46
|
| Rate for Payer: Meridian Medicaid |
$2,621.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,356.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,073.42
|
| Rate for Payer: Nomi Health Commercial |
$13,972.74
|
| Rate for Payer: PACE Medicare |
$4,424.70
|
| Rate for Payer: PACE SWMI |
$4,657.58
|
| Rate for Payer: PHP Commercial |
$13,073.42
|
| Rate for Payer: PHP Medicare Advantage |
$4,657.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,496.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,997.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,206.56
|
| Rate for Payer: Priority Health Medicare |
$4,657.58
|
| Rate for Payer: Priority Health Narrow Network |
$10,565.25
|
| Rate for Payer: Priority Health SBD |
$9,689.72
|
| Rate for Payer: Railroad Medicare Medicare |
$4,657.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,110.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,657.58
|
| Rate for Payer: UHC Exchange |
$8,901.10
|
| Rate for Payer: UHC Medicare Advantage |
$4,657.58
|
| Rate for Payer: UHCCP Medicaid |
$2,496.46
|
| Rate for Payer: UMR Bronson Commercial |
$5,690.78
|
| Rate for Payer: VA VA |
$4,657.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,535.38
|
|
|
BASILIXIMAB 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15,380.50
|
|
|
Service Code
|
HCPCS J0480
|
| Hospital Charge Code |
23082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,767.42 |
| Max. Negotiated Rate |
$13,842.45 |
| Rate for Payer: Aetna American Axle |
$9,997.32
|
| Rate for Payer: Aetna Commercial |
$13,073.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,997.32
|
| Rate for Payer: Cash Price |
$12,304.40
|
| Rate for Payer: Cofinity Commercial |
$10,766.35
|
| Rate for Payer: Cofinity Commercial |
$13,227.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,766.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,304.40
|
| Rate for Payer: Healthscope Commercial |
$13,842.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,766.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,535.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,073.42
|
| Rate for Payer: PHP Commercial |
$13,073.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,997.32
|
| Rate for Payer: Priority Health SBD |
$9,689.72
|
| Rate for Payer: UMR Bronson Commercial |
$6,767.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,535.38
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION
|
Facility
|
IP
|
$488.06
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
116210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$214.75 |
| Max. Negotiated Rate |
$439.25 |
| Rate for Payer: Aetna American Axle |
$317.24
|
| Rate for Payer: Aetna Commercial |
$414.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.24
|
| Rate for Payer: Cash Price |
$390.45
|
| Rate for Payer: Cofinity Commercial |
$341.64
|
| Rate for Payer: Cofinity Commercial |
$419.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.45
|
| Rate for Payer: Healthscope Commercial |
$439.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.85
|
| Rate for Payer: PHP Commercial |
$414.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.24
|
| Rate for Payer: Priority Health SBD |
$307.48
|
| Rate for Payer: UMR Bronson Commercial |
$214.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.04
|
|
|
BCG LIVE 50 MG INTRAVESICAL SUSPENSION
|
Facility
|
OP
|
$488.06
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
116210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$439.25 |
| Rate for Payer: Aetna American Axle |
$317.24
|
| Rate for Payer: Aetna Commercial |
$414.85
|
| Rate for Payer: Aetna Medicare |
$244.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.24
|
| Rate for Payer: BCBS Complete |
$195.22
|
| Rate for Payer: BCBS Trust/PPO |
$8.07
|
| Rate for Payer: BCN Commercial |
$8.07
|
| Rate for Payer: Cash Price |
$390.45
|
| Rate for Payer: Cash Price |
$390.45
|
| Rate for Payer: Cofinity Commercial |
$341.64
|
| Rate for Payer: Cofinity Commercial |
$419.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.45
|
| Rate for Payer: Healthscope Commercial |
$439.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.85
|
| Rate for Payer: PHP Commercial |
$414.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.24
|
| Rate for Payer: Priority Health SBD |
$307.48
|
| Rate for Payer: UMR Bronson Commercial |
$180.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.04
|
|
|
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
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
NDC 40985022668
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.44 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna American Axle |
$137.80
|
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: BCBS Complete |
$84.80
|
| 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 |
$78.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
|
|
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
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 80681015400
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: BCBS Complete |
$59.20
|
| 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 |
$54.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
B-COMPLEX WITH VITAMIN C TABLET
|
Facility
|
OP
|
$188.37
|
|
|
Service Code
|
NDC 80681012600
|
| Hospital Charge Code |
807
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.70 |
| Max. Negotiated Rate |
$169.53 |
| Rate for Payer: Aetna American Axle |
$122.44
|
| Rate for Payer: Aetna Commercial |
$160.11
|
| Rate for Payer: Aetna Medicare |
$94.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.44
|
| Rate for Payer: BCBS Complete |
$75.35
|
| 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 |
$69.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.28
|
|
|
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
|
|
|
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 |
$22.37 |
| 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 |
$43.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,156.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.16
|
| Rate for Payer: BCBS Complete |
$23.49
|
| Rate for Payer: BCBS MAPPO |
$41.73
|
| Rate for Payer: BCBS Trust/PPO |
$121.73
|
| Rate for Payer: BCN Commercial |
$121.73
|
| Rate for Payer: BCN Medicare Advantage |
$41.73
|
| Rate for Payer: Cash Price |
$29,730.98
|
| Rate for Payer: Cash Price |
$29,730.98
|
| Rate for Payer: Cofinity Commercial |
$31,960.81
|
| Rate for Payer: Cofinity Commercial |
$26,014.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$26,014.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29,730.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.73
|
| 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: Mclaren Medicaid |
$22.37
|
| Rate for Payer: Mclaren Medicare |
$41.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.82
|
| Rate for Payer: Meridian Medicaid |
$23.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,589.17
|
| Rate for Payer: Nomi Health Commercial |
$125.19
|
| Rate for Payer: PACE Medicare |
$39.64
|
| Rate for Payer: PACE SWMI |
$41.73
|
| Rate for Payer: PHP Commercial |
$31,589.17
|
| Rate for Payer: PHP Medicare Advantage |
$41.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,156.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.63
|
| Rate for Payer: Priority Health Medicare |
$41.73
|
| Rate for Payer: Priority Health Narrow Network |
$107.70
|
| Rate for Payer: Priority Health SBD |
$23,413.15
|
| Rate for Payer: Railroad Medicare Medicare |
$41.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.73
|
| Rate for Payer: UHC Exchange |
$79.75
|
| Rate for Payer: UHC Medicare Advantage |
$41.73
|
| Rate for Payer: UHCCP Medicaid |
$22.37
|
| Rate for Payer: UMR Bronson Commercial |
$13,750.58
|
| Rate for Payer: VA VA |
$41.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27,872.80
|
|
|
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
|
|
|
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 |
$2.11 |
| Max. Negotiated Rate |
$2,653.60 |
| Rate for Payer: Aetna American Axle |
$1,916.49
|
| Rate for Payer: Aetna Commercial |
$2,506.18
|
| Rate for Payer: Aetna Medicare |
$4.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,916.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.91
|
| Rate for Payer: BCBS Complete |
$2.21
|
| Rate for Payer: BCBS MAPPO |
$3.93
|
| Rate for Payer: BCBS Trust/PPO |
$10.59
|
| Rate for Payer: BCN Commercial |
$10.59
|
| Rate for Payer: BCN Medicare Advantage |
$3.93
|
| 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 |
$2,063.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,063.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,358.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$2,653.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,063.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,211.34
|
| Rate for Payer: Mclaren Medicaid |
$2.11
|
| Rate for Payer: Mclaren Medicare |
$3.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: Meridian Medicaid |
$2.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,506.18
|
| Rate for Payer: Nomi Health Commercial |
$11.79
|
| Rate for Payer: PACE Medicare |
$3.73
|
| Rate for Payer: PACE SWMI |
$3.93
|
| Rate for Payer: PHP Commercial |
$2,506.18
|
| Rate for Payer: PHP Medicare Advantage |
$3.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,916.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Medicare |
$3.93
|
| Rate for Payer: Priority Health Narrow Network |
$8.78
|
| Rate for Payer: Priority Health SBD |
$1,857.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.93
|
| Rate for Payer: UHC Exchange |
$7.51
|
| Rate for Payer: UHC Medicare Advantage |
$3.93
|
| Rate for Payer: UHCCP Medicaid |
$2.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,090.93
|
| Rate for Payer: VA VA |
$3.93
|
| 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 |
$2,653.60 |
| 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 |
$2,063.92
|
| Rate for Payer: Cofinity Commercial |
$2,535.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,063.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,358.76
|
| Rate for Payer: Healthscope Commercial |
$2,653.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,063.92
|
| 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 |
$29.43 |
| 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 |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.64
|
| Rate for Payer: BCBS Complete |
$30.90
|
| Rate for Payer: BCBS MAPPO |
$54.91
|
| Rate for Payer: BCBS Trust/PPO |
$148.04
|
| Rate for Payer: BCN Commercial |
$148.04
|
| Rate for Payer: BCN Medicare Advantage |
$54.91
|
| Rate for Payer: Cash Price |
$1,624.96
|
| Rate for Payer: Cash Price |
$1,624.96
|
| Rate for Payer: Cofinity Commercial |
$1,746.83
|
| Rate for Payer: Cofinity Commercial |
$1,421.84
|
| 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 |
$54.91
|
| 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 |
$29.43
|
| Rate for Payer: Mclaren Medicare |
$54.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.66
|
| Rate for Payer: Meridian Medicaid |
$30.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.52
|
| Rate for Payer: Nomi Health Commercial |
$164.73
|
| Rate for Payer: PACE Medicare |
$52.16
|
| Rate for Payer: PACE SWMI |
$54.91
|
| Rate for Payer: PHP Commercial |
$1,726.52
|
| Rate for Payer: PHP Medicare Advantage |
$54.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.85
|
| Rate for Payer: Priority Health Medicare |
$54.91
|
| Rate for Payer: Priority Health Narrow Network |
$124.68
|
| Rate for Payer: Priority Health SBD |
$1,279.66
|
| Rate for Payer: Railroad Medicare Medicare |
$54.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.91
|
| Rate for Payer: UHC Exchange |
$104.94
|
| Rate for Payer: UHC Medicare Advantage |
$54.91
|
| Rate for Payer: UHCCP Medicaid |
$29.43
|
| Rate for Payer: UMR Bronson Commercial |
$751.54
|
| Rate for Payer: VA VA |
$54.91
|
| 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 |
$29.43 |
| 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 |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,575.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.64
|
| Rate for Payer: BCBS Complete |
$30.90
|
| Rate for Payer: BCBS MAPPO |
$54.91
|
| Rate for Payer: BCBS Trust/PPO |
$148.04
|
| Rate for Payer: BCN Commercial |
$148.04
|
| Rate for Payer: BCN Medicare Advantage |
$54.91
|
| 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 |
$54.91
|
| 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 |
$4,125.62
|
| Rate for Payer: Mclaren Medicaid |
$29.43
|
| Rate for Payer: Mclaren Medicare |
$54.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.66
|
| Rate for Payer: Meridian Medicaid |
$30.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,675.70
|
| Rate for Payer: Nomi Health Commercial |
$164.73
|
| Rate for Payer: PACE Medicare |
$52.16
|
| Rate for Payer: PACE SWMI |
$54.91
|
| Rate for Payer: PHP Commercial |
$4,675.70
|
| Rate for Payer: PHP Medicare Advantage |
$54.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,575.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.85
|
| Rate for Payer: Priority Health Medicare |
$54.91
|
| Rate for Payer: Priority Health Narrow Network |
$124.68
|
| Rate for Payer: Priority Health SBD |
$3,465.52
|
| Rate for Payer: Railroad Medicare Medicare |
$54.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.91
|
| Rate for Payer: UHC Exchange |
$104.94
|
| Rate for Payer: UHC Medicare Advantage |
$54.91
|
| Rate for Payer: UHCCP Medicaid |
$29.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,035.30
|
| Rate for Payer: VA VA |
$54.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,125.62
|
|
|
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 |
$4,125.62
|
| 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 |
$4,125.62
|
|
|
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 |
$9.18 |
| Max. Negotiated Rate |
$8,698.95 |
| Rate for Payer: Aetna American Axle |
$6,282.58
|
| Rate for Payer: Aetna Commercial |
$8,215.68
|
| Rate for Payer: Aetna Medicare |
$17.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,282.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.41
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS MAPPO |
$17.13
|
| Rate for Payer: BCBS Trust/PPO |
$38.82
|
| Rate for Payer: BCN Commercial |
$38.82
|
| Rate for Payer: BCN Medicare Advantage |
$17.13
|
| 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 |
$17.13
|
| 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 |
$9.18
|
| Rate for Payer: Mclaren Medicare |
$17.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.99
|
| Rate for Payer: Meridian Medicaid |
$9.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,215.68
|
| Rate for Payer: Nomi Health Commercial |
$51.39
|
| Rate for Payer: PACE Medicare |
$16.27
|
| Rate for Payer: PACE SWMI |
$17.13
|
| Rate for Payer: PHP Commercial |
$8,215.68
|
| Rate for Payer: PHP Medicare Advantage |
$17.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,282.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.25
|
| Rate for Payer: Priority Health Medicare |
$17.13
|
| Rate for Payer: Priority Health Narrow Network |
$63.40
|
| Rate for Payer: Priority Health SBD |
$6,089.26
|
| Rate for Payer: Railroad Medicare Medicare |
$17.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.13
|
| Rate for Payer: UHC Exchange |
$32.74
|
| Rate for Payer: UHC Medicare Advantage |
$17.13
|
| Rate for Payer: UHCCP Medicaid |
$9.18
|
| Rate for Payer: UMR Bronson Commercial |
$3,576.24
|
| Rate for Payer: VA VA |
$17.13
|
| 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 |
$6,282.58
|
| Rate for Payer: Aetna Commercial |
$8,215.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,282.58
|
| 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 |
$8,215.68
|
| Rate for Payer: PHP Commercial |
$8,215.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,282.58
|
| Rate for Payer: Priority Health SBD |
$6,089.26
|
| 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
|
OP
|
$6,460.63
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
176654
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.21 |
| 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 |
$8,100.60
|
| Rate for Payer: Aetna Commercial |
$5,491.54
|
| Rate for Payer: Aetna Medicare |
$13.99
|
| Rate for Payer: Aetna Medicare |
$13.99
|
| 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: Allen County Amish Medical Aid Commercial |
$16.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.81
|
| Rate for Payer: BCBS Complete |
$7.57
|
| Rate for Payer: BCBS Complete |
$7.57
|
| Rate for Payer: BCBS MAPPO |
$13.45
|
| Rate for Payer: BCBS MAPPO |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$35.59
|
| Rate for Payer: BCBS Trust/PPO |
$35.59
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: BCN Medicare Advantage |
$13.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.45
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cash Price |
$5,168.50
|
| Rate for Payer: Cash Price |
$7,624.10
|
| Rate for Payer: Cash Price |
$5,168.50
|
| 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 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 |
$5,168.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,624.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.45
|
| 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 |
$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 |
$7.21
|
| Rate for Payer: Mclaren Medicaid |
$7.21
|
| Rate for Payer: Mclaren Medicare |
$13.45
|
| Rate for Payer: Mclaren Medicare |
$13.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.12
|
| Rate for Payer: Meridian Medicaid |
$7.57
|
| Rate for Payer: Meridian Medicaid |
$7.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,491.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,100.60
|
| Rate for Payer: Nomi Health Commercial |
$40.35
|
| Rate for Payer: Nomi Health Commercial |
$40.35
|
| Rate for Payer: PACE Medicare |
$12.78
|
| Rate for Payer: PACE Medicare |
$12.78
|
| Rate for Payer: PACE SWMI |
$13.45
|
| Rate for Payer: PACE SWMI |
$13.45
|
| Rate for Payer: PHP Commercial |
$5,491.54
|
| Rate for Payer: PHP Commercial |
$8,100.60
|
| Rate for Payer: PHP Medicare Advantage |
$13.45
|
| Rate for Payer: PHP Medicare Advantage |
$13.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.21
|
| 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 HMO/PPO/Tiered Network |
$37.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.26
|
| Rate for Payer: Priority Health Medicare |
$13.45
|
| Rate for Payer: Priority Health Medicare |
$13.45
|
| Rate for Payer: Priority Health Narrow Network |
$29.81
|
| Rate for Payer: Priority Health Narrow Network |
$29.81
|
| Rate for Payer: Priority Health SBD |
$4,070.20
|
| Rate for Payer: Priority Health SBD |
$6,003.98
|
| Rate for Payer: Railroad Medicare Medicare |
$13.45
|
| Rate for Payer: Railroad Medicare Medicare |
$13.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.45
|
| Rate for Payer: UHC Exchange |
$25.70
|
| Rate for Payer: UHC Exchange |
$25.70
|
| Rate for Payer: UHC Medicare Advantage |
$13.45
|
| Rate for Payer: UHC Medicare Advantage |
$13.45
|
| Rate for Payer: UHCCP Medicaid |
$7.21
|
| Rate for Payer: UHCCP Medicaid |
$7.21
|
| Rate for Payer: UMR Bronson Commercial |
$2,390.43
|
| Rate for Payer: UMR Bronson Commercial |
$3,526.14
|
| Rate for Payer: VA VA |
$13.45
|
| Rate for Payer: VA VA |
$13.45
|
| 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
|
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 (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 |
$0.96 |
| 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 |
$1.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,807.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.25
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: BCBS MAPPO |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$14.37
|
| Rate for Payer: BCN Commercial |
$14.37
|
| Rate for Payer: BCN Medicare Advantage |
$1.80
|
| Rate for Payer: Cash Price |
$8,378.31
|
| Rate for Payer: Cash Price |
$8,378.31
|
| Rate for Payer: Cofinity Commercial |
$9,006.69
|
| Rate for Payer: Cofinity Commercial |
$7,331.02
|
| 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 |
$1.80
|
| 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 |
$0.96
|
| Rate for Payer: Mclaren Medicare |
$1.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.89
|
| Rate for Payer: Meridian Medicaid |
$1.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,901.96
|
| Rate for Payer: Nomi Health Commercial |
$5.40
|
| Rate for Payer: PACE Medicare |
$1.71
|
| Rate for Payer: PACE SWMI |
$1.80
|
| Rate for Payer: PHP Commercial |
$8,901.96
|
| Rate for Payer: PHP Medicare Advantage |
$1.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,807.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.63
|
| Rate for Payer: Priority Health Medicare |
$1.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.50
|
| Rate for Payer: Priority Health SBD |
$6,597.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.80
|
| Rate for Payer: UHC Exchange |
$3.44
|
| Rate for Payer: UHC Medicare Advantage |
$1.80
|
| Rate for Payer: UHCCP Medicaid |
$0.96
|
| Rate for Payer: UMR Bronson Commercial |
$3,874.97
|
| Rate for Payer: VA VA |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,854.67
|
|
