|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 65862-598-01
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.41 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna American Axle |
$108.45
|
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.82
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.80
|
| Rate for Payer: Priority Health SBD |
$105.12
|
| Rate for Payer: UMR Bronson Commercial |
$73.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$441.75
|
|
|
Service Code
|
NDC 0781-2076-01
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$397.58 |
| Rate for Payer: Aetna American Axle |
$287.14
|
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$375.49
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.22
|
| Rate for Payer: Priority Health SBD |
$278.30
|
| Rate for Payer: UMR Bronson Commercial |
$194.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 62756-160-88
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.89 |
| Max. Negotiated Rate |
$194.08 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.96
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UMR Bronson Commercial |
$94.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 68382-132-01
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.01 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna American Axle |
$158.08
|
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.08
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.72
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.24
|
| Rate for Payer: Priority Health SBD |
$153.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
NDC 50268-740-11
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna American Axle |
$1.43
|
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.43
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.87
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.54
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$288.80
|
|
|
Service Code
|
NDC 51079-294-20
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.07 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna American Axle |
$187.72
|
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Commercial |
$202.16
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$259.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$245.48
|
| Rate for Payer: PHP Commercial |
$245.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.16
|
| Rate for Payer: Priority Health SBD |
$181.94
|
| Rate for Payer: UMR Bronson Commercial |
$127.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.60
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 51079-294-01
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna American Axle |
$1.88
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.02
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 0904-6401-61
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.00
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UMR Bronson Commercial |
$84.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
TANGENTIAL BIOPSY OF SKIN (EG, SHAVE, SCOOP, SAUCERIZE, CURETTE); SINGLE LESION
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.67 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$185.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$90.51
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.20
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$448.16
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.34
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.95
|
| Rate for Payer: UHC Exchange |
$36.67
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
TAPENTADOL 50 MG TABLET
|
Facility
|
IP
|
$1,922.70
|
|
|
Service Code
|
NDC 50458-820-02
|
| Hospital Charge Code |
98253
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$845.99 |
| Max. Negotiated Rate |
$1,730.43 |
| Rate for Payer: Aetna American Axle |
$1,249.76
|
| Rate for Payer: Aetna Commercial |
$1,634.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.76
|
| Rate for Payer: Cash Price |
$1,538.16
|
| Rate for Payer: Cofinity Commercial |
$1,653.52
|
| Rate for Payer: Cofinity Commercial |
$1,345.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.16
|
| Rate for Payer: Healthscope Commercial |
$1,730.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,634.30
|
| Rate for Payer: PHP Commercial |
$1,634.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,345.89
|
| Rate for Payer: Priority Health SBD |
$1,211.30
|
| Rate for Payer: UMR Bronson Commercial |
$845.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.02
|
|
|
TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$572.34
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$515.11 |
| Rate for Payer: Aetna American Axle |
$372.02
|
| Rate for Payer: Aetna Commercial |
$486.49
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.25
|
| Rate for Payer: BCBS MAPPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Medicare Advantage |
$0.44
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cofinity Commercial |
$492.21
|
| Rate for Payer: Cofinity Commercial |
$400.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.44
|
| Rate for Payer: Healthscope Commercial |
$515.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$400.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.26
|
| Rate for Payer: Mclaren Medicaid |
$0.24
|
| Rate for Payer: Mclaren Medicare |
$0.44
|
| Rate for Payer: Meridian Medicaid |
$0.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.49
|
| Rate for Payer: PACE Medicare |
$0.42
|
| Rate for Payer: PACE SWMI |
$0.44
|
| Rate for Payer: PHP Commercial |
$486.49
|
| Rate for Payer: PHP Medicare Advantage |
$0.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Medicare |
$0.44
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health SBD |
$360.57
|
| Rate for Payer: Railroad Medicare Medicare |
$0.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.44
|
| Rate for Payer: UHC Medicare Advantage |
$0.45
|
| Rate for Payer: UMR Bronson Commercial |
$211.77
|
| Rate for Payer: VA VA |
$0.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.26
|
|
|
TBO-FILGRASTIM 300 MCG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$572.34
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168855
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$251.83 |
| Max. Negotiated Rate |
$515.11 |
| Rate for Payer: Aetna American Axle |
$372.02
|
| Rate for Payer: Aetna Commercial |
$486.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.02
|
| Rate for Payer: Cash Price |
$457.87
|
| Rate for Payer: Cofinity Commercial |
$400.64
|
| Rate for Payer: Cofinity Commercial |
$492.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.87
|
| Rate for Payer: Healthscope Commercial |
$515.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$400.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$486.49
|
| Rate for Payer: PHP Commercial |
$486.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.64
|
| Rate for Payer: Priority Health SBD |
$360.57
|
| Rate for Payer: UMR Bronson Commercial |
$251.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.26
|
|
|
TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$911.49
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$401.06 |
| Max. Negotiated Rate |
$820.34 |
| Rate for Payer: Aetna American Axle |
$592.47
|
| Rate for Payer: Aetna American Axle |
$592.48
|
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Commercial |
$774.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.47
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cofinity Commercial |
$783.89
|
| Rate for Payer: Cofinity Commercial |
$783.88
|
| Rate for Payer: Cofinity Commercial |
$638.04
|
| Rate for Payer: Cofinity Commercial |
$638.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.20
|
| Rate for Payer: Healthscope Commercial |
$820.35
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$774.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$774.78
|
| Rate for Payer: PHP Commercial |
$774.78
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.05
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: UMR Bronson Commercial |
$401.06
|
| Rate for Payer: UMR Bronson Commercial |
$401.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
|
|
TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$911.49
|
|
|
Service Code
|
HCPCS J1447
|
| Hospital Charge Code |
168856
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$820.34 |
| Rate for Payer: Aetna American Axle |
$592.47
|
| Rate for Payer: Aetna American Axle |
$592.48
|
| Rate for Payer: Aetna Commercial |
$774.77
|
| Rate for Payer: Aetna Commercial |
$774.78
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.25
|
| Rate for Payer: BCBS Complete |
$0.25
|
| Rate for Payer: BCBS MAPPO |
$0.44
|
| Rate for Payer: BCBS MAPPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Medicare Advantage |
$0.44
|
| Rate for Payer: BCN Medicare Advantage |
$0.44
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cash Price |
$729.20
|
| Rate for Payer: Cash Price |
$729.19
|
| Rate for Payer: Cofinity Commercial |
$783.88
|
| Rate for Payer: Cofinity Commercial |
$638.04
|
| Rate for Payer: Cofinity Commercial |
$638.05
|
| Rate for Payer: Cofinity Commercial |
$783.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.44
|
| Rate for Payer: Healthscope Commercial |
$820.34
|
| Rate for Payer: Healthscope Commercial |
$820.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.62
|
| Rate for Payer: Mclaren Medicaid |
$0.24
|
| Rate for Payer: Mclaren Medicaid |
$0.24
|
| Rate for Payer: Mclaren Medicare |
$0.44
|
| Rate for Payer: Mclaren Medicare |
$0.44
|
| Rate for Payer: Meridian Medicaid |
$0.25
|
| Rate for Payer: Meridian Medicaid |
$0.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$774.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$774.78
|
| Rate for Payer: PACE Medicare |
$0.42
|
| Rate for Payer: PACE Medicare |
$0.42
|
| Rate for Payer: PACE SWMI |
$0.44
|
| Rate for Payer: PACE SWMI |
$0.44
|
| Rate for Payer: PHP Commercial |
$774.77
|
| Rate for Payer: PHP Commercial |
$774.78
|
| Rate for Payer: PHP Medicare Advantage |
$0.44
|
| Rate for Payer: PHP Medicare Advantage |
$0.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Medicare |
$0.44
|
| Rate for Payer: Priority Health Medicare |
$0.44
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: Priority Health SBD |
$574.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.44
|
| Rate for Payer: Railroad Medicare Medicare |
$0.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.44
|
| Rate for Payer: UHC Medicare Advantage |
$0.45
|
| Rate for Payer: UHC Medicare Advantage |
$0.45
|
| Rate for Payer: UMR Bronson Commercial |
$337.26
|
| Rate for Payer: UMR Bronson Commercial |
$337.25
|
| Rate for Payer: VA VA |
$0.44
|
| Rate for Payer: VA VA |
$0.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.62
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$6,048.21
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$5,443.39 |
| Rate for Payer: Aetna American Axle |
$3,931.34
|
| Rate for Payer: Aetna Commercial |
$5,140.98
|
| Rate for Payer: Aetna Medicare |
$32.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,931.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.56
|
| Rate for Payer: BCBS Complete |
$17.72
|
| Rate for Payer: BCBS MAPPO |
$30.85
|
| Rate for Payer: BCBS Trust/PPO |
$99.65
|
| Rate for Payer: BCN Medicare Advantage |
$30.85
|
| Rate for Payer: Cash Price |
$4,838.57
|
| Rate for Payer: Cash Price |
$4,838.57
|
| Rate for Payer: Cofinity Commercial |
$4,233.75
|
| Rate for Payer: Cofinity Commercial |
$5,201.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,838.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.85
|
| Rate for Payer: Healthscope Commercial |
$5,443.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,233.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,536.16
|
| Rate for Payer: Mclaren Medicaid |
$16.87
|
| Rate for Payer: Mclaren Medicare |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$17.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,140.98
|
| Rate for Payer: PACE Medicare |
$29.30
|
| Rate for Payer: PACE SWMI |
$30.85
|
| Rate for Payer: PHP Commercial |
$5,140.98
|
| Rate for Payer: PHP Medicare Advantage |
$30.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,233.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.74
|
| Rate for Payer: Priority Health Medicare |
$30.85
|
| Rate for Payer: Priority Health Narrow Network |
$72.59
|
| Rate for Payer: Priority Health SBD |
$3,810.37
|
| Rate for Payer: Railroad Medicare Medicare |
$30.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.85
|
| Rate for Payer: UHC Medicare Advantage |
$31.77
|
| Rate for Payer: UMR Bronson Commercial |
$2,237.84
|
| Rate for Payer: VA VA |
$30.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,536.16
|
|
|
TECLISTAMAB-CQYV 10 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$6,048.21
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,661.21 |
| Max. Negotiated Rate |
$5,443.39 |
| Rate for Payer: Aetna American Axle |
$3,931.34
|
| Rate for Payer: Aetna Commercial |
$5,140.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,931.34
|
| Rate for Payer: Cash Price |
$4,838.57
|
| Rate for Payer: Cofinity Commercial |
$4,233.75
|
| Rate for Payer: Cofinity Commercial |
$5,201.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,838.57
|
| Rate for Payer: Healthscope Commercial |
$5,443.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,233.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,536.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,140.98
|
| Rate for Payer: PHP Commercial |
$5,140.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,233.75
|
| Rate for Payer: Priority Health SBD |
$3,810.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,661.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,536.16
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$30,819.36
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$27,737.42 |
| Rate for Payer: Aetna American Axle |
$20,032.58
|
| Rate for Payer: Aetna Commercial |
$26,196.46
|
| Rate for Payer: Aetna Medicare |
$32.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,032.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.56
|
| Rate for Payer: BCBS Complete |
$17.72
|
| Rate for Payer: BCBS MAPPO |
$30.85
|
| Rate for Payer: BCBS Trust/PPO |
$99.65
|
| Rate for Payer: BCN Medicare Advantage |
$30.85
|
| Rate for Payer: Cash Price |
$24,655.49
|
| Rate for Payer: Cash Price |
$24,655.49
|
| Rate for Payer: Cofinity Commercial |
$21,573.55
|
| Rate for Payer: Cofinity Commercial |
$26,504.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,655.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.85
|
| Rate for Payer: Healthscope Commercial |
$27,737.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,573.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,114.52
|
| Rate for Payer: Mclaren Medicaid |
$16.87
|
| Rate for Payer: Mclaren Medicare |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$17.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26,196.46
|
| Rate for Payer: PACE Medicare |
$29.30
|
| Rate for Payer: PACE SWMI |
$30.85
|
| Rate for Payer: PHP Commercial |
$26,196.46
|
| Rate for Payer: PHP Medicare Advantage |
$30.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,573.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.74
|
| Rate for Payer: Priority Health Medicare |
$30.85
|
| Rate for Payer: Priority Health Narrow Network |
$72.59
|
| Rate for Payer: Priority Health SBD |
$19,416.20
|
| Rate for Payer: Railroad Medicare Medicare |
$30.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.85
|
| Rate for Payer: UHC Medicare Advantage |
$31.77
|
| Rate for Payer: UMR Bronson Commercial |
$11,403.16
|
| Rate for Payer: VA VA |
$30.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,114.52
|
|
|
TECLISTAMAB-CQYV 90 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$30,819.36
|
|
|
Service Code
|
HCPCS J9380
|
| Hospital Charge Code |
201911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,560.52 |
| Max. Negotiated Rate |
$27,737.42 |
| Rate for Payer: Aetna American Axle |
$20,032.58
|
| Rate for Payer: Aetna Commercial |
$26,196.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,032.58
|
| Rate for Payer: Cash Price |
$24,655.49
|
| Rate for Payer: Cofinity Commercial |
$21,573.55
|
| Rate for Payer: Cofinity Commercial |
$26,504.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,655.49
|
| Rate for Payer: Healthscope Commercial |
$27,737.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,573.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,114.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26,196.46
|
| Rate for Payer: PHP Commercial |
$26,196.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,573.55
|
| Rate for Payer: Priority Health SBD |
$19,416.20
|
| Rate for Payer: UMR Bronson Commercial |
$13,560.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,114.52
|
|
|
TELAVANCIN 750 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,471.27
|
|
|
Service Code
|
HCPCS J3095
|
| Hospital Charge Code |
99997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$647.36 |
| Max. Negotiated Rate |
$1,324.14 |
| Rate for Payer: Aetna American Axle |
$956.33
|
| Rate for Payer: Aetna Commercial |
$1,250.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$956.33
|
| Rate for Payer: Cash Price |
$1,177.02
|
| Rate for Payer: Cofinity Commercial |
$1,029.89
|
| Rate for Payer: Cofinity Commercial |
$1,265.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,177.02
|
| Rate for Payer: Healthscope Commercial |
$1,324.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,029.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,103.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,250.58
|
| Rate for Payer: PHP Commercial |
$1,250.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.89
|
| Rate for Payer: Priority Health SBD |
$926.90
|
| Rate for Payer: UMR Bronson Commercial |
$647.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,103.45
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
NDC 51079-418-01
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna American Axle |
$0.97
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.97
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.04
|
| Rate for Payer: Priority Health SBD |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$148.75
|
|
|
Service Code
|
NDC 51079-418-20
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna American Axle |
$96.69
|
| Rate for Payer: Aetna Commercial |
$126.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.69
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cofinity Commercial |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.00
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.44
|
| Rate for Payer: PHP Commercial |
$126.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.12
|
| Rate for Payer: Priority Health SBD |
$93.71
|
| Rate for Payer: UMR Bronson Commercial |
$65.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.56
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$134.75
|
|
|
Service Code
|
NDC 0228-2076-10
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$121.28 |
| Rate for Payer: Aetna American Axle |
$87.59
|
| Rate for Payer: Aetna Commercial |
$114.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.59
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cofinity Commercial |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$94.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.80
|
| Rate for Payer: Healthscope Commercial |
$121.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.54
|
| Rate for Payer: PHP Commercial |
$114.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.32
|
| Rate for Payer: Priority Health SBD |
$84.89
|
| Rate for Payer: UMR Bronson Commercial |
$59.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.06
|
|
|
TEMAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$152.25
|
|
|
Service Code
|
NDC 0378-4010-01
|
| Hospital Charge Code |
7753
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.99 |
| Max. Negotiated Rate |
$137.02 |
| Rate for Payer: Aetna American Axle |
$98.96
|
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.96
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cofinity Commercial |
$106.58
|
| Rate for Payer: Cofinity Commercial |
$130.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.80
|
| Rate for Payer: Healthscope Commercial |
$137.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.41
|
| Rate for Payer: PHP Commercial |
$129.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.58
|
| Rate for Payer: Priority Health SBD |
$95.92
|
| Rate for Payer: UMR Bronson Commercial |
$66.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.19
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$964.86
|
|
|
Service Code
|
NDC 0406-9960-01
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$424.54 |
| Max. Negotiated Rate |
$868.37 |
| Rate for Payer: Aetna American Axle |
$627.16
|
| Rate for Payer: Aetna Commercial |
$820.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.16
|
| Rate for Payer: Cash Price |
$771.89
|
| Rate for Payer: Cofinity Commercial |
$675.40
|
| Rate for Payer: Cofinity Commercial |
$829.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.89
|
| Rate for Payer: Healthscope Commercial |
$868.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$820.13
|
| Rate for Payer: PHP Commercial |
$820.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.40
|
| Rate for Payer: Priority Health SBD |
$607.86
|
| Rate for Payer: UMR Bronson Commercial |
$424.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.64
|
|
|
TEMAZEPAM 7.5 MG CAPSULE
|
Facility
|
IP
|
$2,127.84
|
|
|
Service Code
|
NDC 0378-3110-01
|
| Hospital Charge Code |
11500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$936.25 |
| Max. Negotiated Rate |
$1,915.06 |
| Rate for Payer: Aetna American Axle |
$1,383.10
|
| Rate for Payer: Aetna Commercial |
$1,808.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,383.10
|
| Rate for Payer: Cash Price |
$1,702.27
|
| Rate for Payer: Cofinity Commercial |
$1,489.49
|
| Rate for Payer: Cofinity Commercial |
$1,829.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.27
|
| Rate for Payer: Healthscope Commercial |
$1,915.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,489.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,595.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,808.66
|
| Rate for Payer: PHP Commercial |
$1,808.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,489.49
|
| Rate for Payer: Priority Health SBD |
$1,340.54
|
| Rate for Payer: UMR Bronson Commercial |
$936.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,595.88
|
|
