|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$331.35
|
|
|
Service Code
|
NDC 69097082707
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$298.21 |
| Rate for Payer: Aetna American Axle |
$215.38
|
| Rate for Payer: Aetna Commercial |
$281.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.38
|
| Rate for Payer: Cash Price |
$265.08
|
| Rate for Payer: Cofinity Commercial |
$231.94
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.08
|
| Rate for Payer: Healthscope Commercial |
$298.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$281.65
|
| Rate for Payer: PHP Commercial |
$281.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.38
|
| Rate for Payer: Priority Health SBD |
$208.75
|
| Rate for Payer: UMR Bronson Commercial |
$145.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.51
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 00603243421
|
| Hospital Charge Code |
999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.17 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$157.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
BENZTROPINE 1 MG TABLET
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 69315013701
|
| Hospital Charge Code |
999
|
|
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: Cofinity Medicare Advantage |
$116.80
|
| 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 Commercial |
$141.82
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.45
|
| 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
|
|
|
BESIFLOXACIN 0.6 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$737.70
|
|
|
Service Code
|
NDC 24208044605
|
| Hospital Charge Code |
97934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.95 |
| Max. Negotiated Rate |
$663.93 |
| Rate for Payer: Aetna American Axle |
$479.50
|
| Rate for Payer: Aetna Commercial |
$627.04
|
| Rate for Payer: Aetna Medicare |
$368.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.50
|
| Rate for Payer: BCBS Complete |
$295.08
|
| Rate for Payer: Cash Price |
$590.16
|
| Rate for Payer: Cofinity Commercial |
$516.39
|
| Rate for Payer: Cofinity Commercial |
$634.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$516.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.16
|
| Rate for Payer: Healthscope Commercial |
$663.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$516.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.04
|
| Rate for Payer: PHP Commercial |
$627.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health SBD |
$464.75
|
| Rate for Payer: UMR Bronson Commercial |
$272.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.27
|
|
|
BESIFLOXACIN 0.6 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$737.70
|
|
|
Service Code
|
NDC 24208044605
|
| Hospital Charge Code |
97934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$324.59 |
| Max. Negotiated Rate |
$663.93 |
| Rate for Payer: Aetna American Axle |
$479.50
|
| Rate for Payer: Aetna Commercial |
$627.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.50
|
| Rate for Payer: Cash Price |
$590.16
|
| Rate for Payer: Cofinity Commercial |
$516.39
|
| Rate for Payer: Cofinity Commercial |
$634.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$516.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.16
|
| Rate for Payer: Healthscope Commercial |
$663.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$516.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.04
|
| Rate for Payer: PHP Commercial |
$627.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health SBD |
$464.75
|
| Rate for Payer: UMR Bronson Commercial |
$324.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.27
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$155.22
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.43 |
| Max. Negotiated Rate |
$139.70 |
| Rate for Payer: Aetna American Axle |
$100.89
|
| Rate for Payer: Aetna American Axle |
$122.99
|
| Rate for Payer: Aetna American Axle |
$99.79
|
| Rate for Payer: Aetna American Axle |
$101.09
|
| Rate for Payer: Aetna Commercial |
$160.84
|
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Medicare |
$77.77
|
| Rate for Payer: Aetna Medicare |
$76.77
|
| Rate for Payer: Aetna Medicare |
$94.61
|
| Rate for Payer: Aetna Medicare |
$77.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: BCBS Complete |
$61.41
|
| Rate for Payer: BCBS Complete |
$75.69
|
| Rate for Payer: BCBS Complete |
$62.21
|
| Rate for Payer: BCBS Complete |
$62.09
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$151.38
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$162.73
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$132.45
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Healthscope Commercial |
$170.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: PHP Commercial |
$160.84
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: Priority Health SBD |
$119.21
|
| Rate for Payer: Priority Health SBD |
$97.79
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: UMR Bronson Commercial |
$57.55
|
| Rate for Payer: UMR Bronson Commercial |
$57.43
|
| Rate for Payer: UMR Bronson Commercial |
$70.01
|
| Rate for Payer: UMR Bronson Commercial |
$56.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.42
|
|
|
BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$155.53
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
9266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$139.98 |
| Rate for Payer: Aetna American Axle |
$101.09
|
| Rate for Payer: Aetna American Axle |
$100.89
|
| Rate for Payer: Aetna American Axle |
$99.79
|
| Rate for Payer: Aetna American Axle |
$122.99
|
| Rate for Payer: Aetna Commercial |
$132.20
|
| Rate for Payer: Aetna Commercial |
$160.84
|
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.09
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$124.42
|
| Rate for Payer: Cash Price |
$122.82
|
| Rate for Payer: Cash Price |
$151.38
|
| Rate for Payer: Cofinity Commercial |
$107.47
|
| Rate for Payer: Cofinity Commercial |
$162.73
|
| Rate for Payer: Cofinity Commercial |
$132.45
|
| Rate for Payer: Cofinity Commercial |
$108.87
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$133.76
|
| Rate for Payer: Cofinity Commercial |
$132.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$139.98
|
| Rate for Payer: Healthscope Commercial |
$138.18
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Healthscope Commercial |
$170.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$132.20
|
| Rate for Payer: PHP Commercial |
$160.84
|
| Rate for Payer: PHP Commercial |
$130.50
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.79
|
| Rate for Payer: Priority Health SBD |
$119.21
|
| Rate for Payer: Priority Health SBD |
$96.72
|
| Rate for Payer: Priority Health SBD |
$97.79
|
| Rate for Payer: Priority Health SBD |
$97.98
|
| Rate for Payer: UMR Bronson Commercial |
$68.43
|
| Rate for Payer: UMR Bronson Commercial |
$83.26
|
| Rate for Payer: UMR Bronson Commercial |
$68.30
|
| Rate for Payer: UMR Bronson Commercial |
$67.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.65
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$1,067.36
|
|
|
Service Code
|
NDC 00065024610
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$469.64 |
| Max. Negotiated Rate |
$960.62 |
| Rate for Payer: Aetna American Axle |
$693.78
|
| Rate for Payer: Aetna Commercial |
$907.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.78
|
| Rate for Payer: Cash Price |
$853.89
|
| Rate for Payer: Cofinity Commercial |
$747.15
|
| Rate for Payer: Cofinity Commercial |
$917.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$747.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.89
|
| Rate for Payer: Healthscope Commercial |
$960.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$747.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.26
|
| Rate for Payer: PHP Commercial |
$907.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.78
|
| Rate for Payer: Priority Health SBD |
$672.44
|
| Rate for Payer: UMR Bronson Commercial |
$469.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.52
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$1,201.38
|
|
|
Service Code
|
NDC 00078072910
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$444.51 |
| Max. Negotiated Rate |
$1,081.24 |
| Rate for Payer: Aetna American Axle |
$780.90
|
| Rate for Payer: Aetna Commercial |
$1,021.17
|
| Rate for Payer: Aetna Medicare |
$600.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.90
|
| Rate for Payer: BCBS Complete |
$480.55
|
| Rate for Payer: Cash Price |
$961.10
|
| Rate for Payer: Cofinity Commercial |
$1,033.19
|
| Rate for Payer: Cofinity Commercial |
$840.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$840.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.10
|
| Rate for Payer: Healthscope Commercial |
$1,081.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$840.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$901.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.17
|
| Rate for Payer: PHP Commercial |
$1,021.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.90
|
| Rate for Payer: Priority Health SBD |
$756.87
|
| Rate for Payer: UMR Bronson Commercial |
$444.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.03
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$1,067.36
|
|
|
Service Code
|
NDC 00065024610
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$394.92 |
| Max. Negotiated Rate |
$960.62 |
| Rate for Payer: Aetna American Axle |
$693.78
|
| Rate for Payer: Aetna Commercial |
$907.26
|
| Rate for Payer: Aetna Medicare |
$533.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.78
|
| Rate for Payer: BCBS Complete |
$426.94
|
| Rate for Payer: Cash Price |
$853.89
|
| Rate for Payer: Cofinity Commercial |
$747.15
|
| Rate for Payer: Cofinity Commercial |
$917.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$747.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.89
|
| Rate for Payer: Healthscope Commercial |
$960.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$747.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.26
|
| Rate for Payer: PHP Commercial |
$907.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.78
|
| Rate for Payer: Priority Health SBD |
$672.44
|
| Rate for Payer: UMR Bronson Commercial |
$394.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.52
|
|
|
BETAXOLOL 0.25 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$1,201.38
|
|
|
Service Code
|
NDC 00078072910
|
| Hospital Charge Code |
19703
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$528.61 |
| Max. Negotiated Rate |
$1,081.24 |
| Rate for Payer: Aetna American Axle |
$780.90
|
| Rate for Payer: Aetna Commercial |
$1,021.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$780.90
|
| Rate for Payer: Cash Price |
$961.10
|
| Rate for Payer: Cofinity Commercial |
$1,033.19
|
| Rate for Payer: Cofinity Commercial |
$840.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$840.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$961.10
|
| Rate for Payer: Healthscope Commercial |
$1,081.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$840.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$901.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.17
|
| Rate for Payer: PHP Commercial |
$1,021.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.90
|
| Rate for Payer: Priority Health SBD |
$756.87
|
| Rate for Payer: UMR Bronson Commercial |
$528.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$901.03
|
|
|
BETAXOLOL 0.5 % EYE DROPS
|
Facility
|
OP
|
$165.90
|
|
|
Service Code
|
NDC 61314024501
|
| Hospital Charge Code |
9268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$149.31 |
| Rate for Payer: Aetna American Axle |
$107.83
|
| Rate for Payer: Aetna Commercial |
$141.01
|
| Rate for Payer: Aetna Medicare |
$82.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.83
|
| Rate for Payer: BCBS Complete |
$66.36
|
| Rate for Payer: Cash Price |
$132.72
|
| Rate for Payer: Cofinity Commercial |
$116.13
|
| Rate for Payer: Cofinity Commercial |
$142.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.72
|
| Rate for Payer: Healthscope Commercial |
$149.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.01
|
| Rate for Payer: PHP Commercial |
$141.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.83
|
| Rate for Payer: Priority Health SBD |
$104.52
|
| Rate for Payer: UMR Bronson Commercial |
$61.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.42
|
|
|
BETAXOLOL 0.5 % EYE DROPS
|
Facility
|
IP
|
$165.90
|
|
|
Service Code
|
NDC 61314024501
|
| Hospital Charge Code |
9268
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$149.31 |
| Rate for Payer: Aetna American Axle |
$107.83
|
| Rate for Payer: Aetna Commercial |
$141.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.83
|
| Rate for Payer: Cash Price |
$132.72
|
| Rate for Payer: Cofinity Commercial |
$116.13
|
| Rate for Payer: Cofinity Commercial |
$142.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.72
|
| Rate for Payer: Healthscope Commercial |
$149.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.01
|
| Rate for Payer: PHP Commercial |
$141.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.83
|
| Rate for Payer: Priority Health SBD |
$104.52
|
| Rate for Payer: UMR Bronson Commercial |
$73.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.42
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 00832051100
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.27 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$85.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 65162057210
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.89 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UMR Bronson Commercial |
$122.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$315.40
|
|
|
Service Code
|
NDC 00832051101
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna American Axle |
$205.01
|
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna Medicare |
$157.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.01
|
| Rate for Payer: BCBS Complete |
$126.16
|
| Rate for Payer: Cash Price |
$252.32
|
| Rate for Payer: Cofinity Commercial |
$220.78
|
| Rate for Payer: Cofinity Commercial |
$271.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.32
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.09
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.01
|
| Rate for Payer: Priority Health SBD |
$198.70
|
| Rate for Payer: UMR Bronson Commercial |
$116.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.55
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$315.40
|
|
|
Service Code
|
NDC 00832051101
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.78 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna American Axle |
$205.01
|
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.01
|
| Rate for Payer: Cash Price |
$252.32
|
| Rate for Payer: Cofinity Commercial |
$220.78
|
| Rate for Payer: Cofinity Commercial |
$271.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.32
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.09
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.01
|
| Rate for Payer: Priority Health SBD |
$198.70
|
| Rate for Payer: UMR Bronson Commercial |
$138.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.55
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$3.16
|
|
|
Service Code
|
NDC 00832051189
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna American Axle |
$2.05
|
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Aetna Medicare |
$1.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.05
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.53
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.69
|
| Rate for Payer: PHP Commercial |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
| Rate for Payer: Priority Health SBD |
$1.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.37
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
IP
|
$3.16
|
|
|
Service Code
|
NDC 00832051189
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna American Axle |
$2.05
|
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.05
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.53
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.69
|
| Rate for Payer: PHP Commercial |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
| Rate for Payer: Priority Health SBD |
$1.99
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.37
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$193.80
|
|
|
Service Code
|
NDC 00832051100
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.71 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Medicare |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: BCBS Complete |
$77.52
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$71.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
BETHANECHOL CHLORIDE 10 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 65162057210
|
| Hospital Charge Code |
1043
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.34 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna American Axle |
$181.54
|
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: Aetna Medicare |
$139.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UMR Bronson Commercial |
$103.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,313.05
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,297.74 |
| Max. Negotiated Rate |
$12,881.75 |
| Rate for Payer: Aetna American Axle |
$9,303.48
|
| Rate for Payer: Aetna American Axle |
$2,325.88
|
| Rate for Payer: Aetna Commercial |
$12,166.09
|
| Rate for Payer: Aetna Commercial |
$3,041.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,303.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.88
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cofinity Commercial |
$3,077.31
|
| Rate for Payer: Cofinity Commercial |
$2,504.79
|
| Rate for Payer: Cofinity Commercial |
$10,019.14
|
| Rate for Payer: Cofinity Commercial |
$12,309.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,019.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,504.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,450.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.62
|
| Rate for Payer: Healthscope Commercial |
$12,881.75
|
| Rate for Payer: Healthscope Commercial |
$3,220.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,019.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,504.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,734.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,683.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,166.09
|
| Rate for Payer: PHP Commercial |
$3,041.53
|
| Rate for Payer: PHP Commercial |
$12,166.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,303.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,325.88
|
| Rate for Payer: Priority Health SBD |
$9,017.22
|
| Rate for Payer: Priority Health SBD |
$2,254.31
|
| Rate for Payer: UMR Bronson Commercial |
$6,297.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,574.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,734.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,683.70
|
|
|
BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,578.27
|
|
|
Service Code
|
HCPCS J9035
|
| Hospital Charge Code |
38022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$3,220.44 |
| Rate for Payer: Aetna American Axle |
$2,325.88
|
| Rate for Payer: Aetna American Axle |
$9,303.48
|
| Rate for Payer: Aetna Commercial |
$12,166.09
|
| Rate for Payer: Aetna Commercial |
$3,041.53
|
| Rate for Payer: Aetna Medicare |
$76.13
|
| Rate for Payer: Aetna Medicare |
$76.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,303.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.50
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$73.20
|
| Rate for Payer: BCBS MAPPO |
$73.20
|
| Rate for Payer: BCN Medicare Advantage |
$73.20
|
| Rate for Payer: BCN Medicare Advantage |
$73.20
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cash Price |
$2,862.62
|
| Rate for Payer: Cash Price |
$11,450.44
|
| Rate for Payer: Cofinity Commercial |
$10,019.14
|
| Rate for Payer: Cofinity Commercial |
$12,309.22
|
| Rate for Payer: Cofinity Commercial |
$2,504.79
|
| Rate for Payer: Cofinity Commercial |
$3,077.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,019.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,504.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,862.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,450.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.20
|
| Rate for Payer: Healthscope Commercial |
$3,220.44
|
| Rate for Payer: Healthscope Commercial |
$12,881.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,504.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,019.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,734.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,683.70
|
| Rate for Payer: Mclaren Medicaid |
$39.24
|
| Rate for Payer: Mclaren Medicaid |
$39.24
|
| Rate for Payer: Mclaren Medicare |
$73.20
|
| Rate for Payer: Mclaren Medicare |
$73.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.86
|
| Rate for Payer: Meridian Medicaid |
$41.20
|
| Rate for Payer: Meridian Medicaid |
$41.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,041.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,166.09
|
| Rate for Payer: PACE Medicare |
$69.54
|
| Rate for Payer: PACE Medicare |
$69.54
|
| Rate for Payer: PACE SWMI |
$73.20
|
| Rate for Payer: PACE SWMI |
$73.20
|
| Rate for Payer: PHP Commercial |
$12,166.09
|
| Rate for Payer: PHP Commercial |
$3,041.53
|
| Rate for Payer: PHP Medicare Advantage |
$73.20
|
| Rate for Payer: PHP Medicare Advantage |
$73.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,303.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,325.88
|
| Rate for Payer: Priority Health Medicare |
$73.20
|
| Rate for Payer: Priority Health Medicare |
$73.20
|
| Rate for Payer: Priority Health SBD |
$9,017.22
|
| Rate for Payer: Priority Health SBD |
$2,254.31
|
| Rate for Payer: Railroad Medicare Medicare |
$73.20
|
| Rate for Payer: Railroad Medicare Medicare |
$73.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.20
|
| Rate for Payer: UHC Exchange |
$139.89
|
| Rate for Payer: UHC Exchange |
$139.89
|
| Rate for Payer: UHC Medicare Advantage |
$73.20
|
| Rate for Payer: UHC Medicare Advantage |
$73.20
|
| Rate for Payer: UHCCP Medicaid |
$39.24
|
| Rate for Payer: UHCCP Medicaid |
$39.24
|
| Rate for Payer: UMR Bronson Commercial |
$5,295.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,323.96
|
| Rate for Payer: VA VA |
$73.20
|
| Rate for Payer: VA VA |
$73.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,683.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,734.79
|
|
|
BEVACIZUMAB-AWWB 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,973.43
|
|
|
Service Code
|
HCPCS Q5107
|
| Hospital Charge Code |
190598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$10,776.09 |
| Rate for Payer: Aetna American Axle |
$7,782.73
|
| Rate for Payer: Aetna American Axle |
$1,945.74
|
| Rate for Payer: Aetna Commercial |
$10,177.42
|
| Rate for Payer: Aetna Commercial |
$2,544.43
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: Aetna Medicare |
$28.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,945.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,782.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.83
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS MAPPO |
$27.86
|
| Rate for Payer: BCBS MAPPO |
$27.86
|
| Rate for Payer: BCN Medicare Advantage |
$27.86
|
| Rate for Payer: BCN Medicare Advantage |
$27.86
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cash Price |
$9,578.74
|
| Rate for Payer: Cash Price |
$2,394.76
|
| Rate for Payer: Cofinity Commercial |
$2,095.41
|
| Rate for Payer: Cofinity Commercial |
$10,297.15
|
| Rate for Payer: Cofinity Commercial |
$8,381.40
|
| Rate for Payer: Cofinity Commercial |
$2,574.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,381.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,095.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,578.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,394.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.86
|
| Rate for Payer: Healthscope Commercial |
$10,776.09
|
| Rate for Payer: Healthscope Commercial |
$2,694.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,381.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,095.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,980.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,245.09
|
| Rate for Payer: Mclaren Medicaid |
$14.93
|
| Rate for Payer: Mclaren Medicaid |
$14.93
|
| Rate for Payer: Mclaren Medicare |
$27.86
|
| Rate for Payer: Mclaren Medicare |
$27.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.25
|
| Rate for Payer: Meridian Medicaid |
$15.68
|
| Rate for Payer: Meridian Medicaid |
$15.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,177.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,544.43
|
| Rate for Payer: PACE Medicare |
$26.47
|
| Rate for Payer: PACE Medicare |
$26.47
|
| Rate for Payer: PACE SWMI |
$27.86
|
| Rate for Payer: PACE SWMI |
$27.86
|
| Rate for Payer: PHP Commercial |
$10,177.42
|
| Rate for Payer: PHP Commercial |
$2,544.43
|
| Rate for Payer: PHP Medicare Advantage |
$27.86
|
| Rate for Payer: PHP Medicare Advantage |
$27.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,782.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,945.74
|
| Rate for Payer: Priority Health Medicare |
$27.86
|
| Rate for Payer: Priority Health Medicare |
$27.86
|
| Rate for Payer: Priority Health SBD |
$7,543.26
|
| Rate for Payer: Priority Health SBD |
$1,885.87
|
| Rate for Payer: Railroad Medicare Medicare |
$27.86
|
| Rate for Payer: Railroad Medicare Medicare |
$27.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.86
|
| Rate for Payer: UHC Exchange |
$53.24
|
| Rate for Payer: UHC Exchange |
$53.24
|
| Rate for Payer: UHC Medicare Advantage |
$27.86
|
| Rate for Payer: UHC Medicare Advantage |
$27.86
|
| Rate for Payer: UHCCP Medicaid |
$14.93
|
| Rate for Payer: UHCCP Medicaid |
$14.93
|
| Rate for Payer: UMR Bronson Commercial |
$4,430.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,107.58
|
| Rate for Payer: VA VA |
$27.86
|
| Rate for Payer: VA VA |
$27.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,980.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,245.09
|
|
|
BEVACIZUMAB-BVZR 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,427.53
|
|
|
Service Code
|
HCPCS Q5118
|
| Hospital Charge Code |
192559
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,068.11 |
| Max. Negotiated Rate |
$2,184.78 |
| Rate for Payer: Aetna American Axle |
$1,577.89
|
| Rate for Payer: Aetna American Axle |
$6,311.57
|
| Rate for Payer: Aetna Commercial |
$2,063.40
|
| Rate for Payer: Aetna Commercial |
$8,253.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,577.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,311.57
|
| Rate for Payer: Cash Price |
$1,942.02
|
| Rate for Payer: Cash Price |
$7,768.09
|
| Rate for Payer: Cofinity Commercial |
$8,350.69
|
| Rate for Payer: Cofinity Commercial |
$6,797.08
|
| Rate for Payer: Cofinity Commercial |
$1,699.27
|
| Rate for Payer: Cofinity Commercial |
$2,087.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,699.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,797.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,768.09
|
| Rate for Payer: Healthscope Commercial |
$2,184.78
|
| Rate for Payer: Healthscope Commercial |
$8,739.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,699.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,797.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,820.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,282.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,253.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,063.40
|
| Rate for Payer: PHP Commercial |
$8,253.59
|
| Rate for Payer: PHP Commercial |
$2,063.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,311.57
|
| Rate for Payer: Priority Health SBD |
$1,529.34
|
| Rate for Payer: Priority Health SBD |
$6,117.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,068.11
|
| Rate for Payer: UMR Bronson Commercial |
$4,272.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,820.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,282.58
|
|
